A randomized controlled trial of resorbable versus titanium fixation for orthognathic surgery.
To determine any differences in the intra- and postoperative morbidities and complications between resorbable and titanium plating systems for fixation in orthognathic surgery.
                This prospective randomized clinical trial was conducted in the Oral and Maxillofacial Surgery unit of the University of Hong Kong. Patients with dentofacial deformities were randomly assigned into the titanium and resorbable fixation groups. Intraoperative data such as the surgical procedures, time for fixing each plate, and number of broken plates and screws were recorded. Subjective and objective parameters related to clinical morbidities were assessed postoperatively.
                A total of 60 patients with 177 osteotomies were included in this study. Eighty-seven osteotomies fixated with 196 titanium plates and 784 titanium screws were performed in 30 patients, whereas 90 osteotomies fixated with 165 resorbable plates and 658 resorbable screws were done in another 30. The postoperative infection rate was 1.53% (3/196) and 1.82% (3/165) in the titanium and resorbable fixation groups, respectively. These infections were mainly due to loose screws and wound dehiscence. The plate exposure rate was 1.02% (2/196) for the titanium group and 1.21% (2/165) for the resorbable group. The plate removal rate in the titanium and resorbable groups was 1.53% (3/196) and 3.63% (6/165), respectively. Statistically significant difference was shown in the plating time of step (mandibular body) and Hofer (mandibular subapical) osteotomies. There was no significant difference in the subjective clinical parameters such as wound discomfort, clinical stability of the osteotomy segments, palpability of plate, and overall satisfaction of the results between the 2 fixation groups. Similarly, objective parameters including wound dehiscence, rate of infection, plate exposure, occurrence of sinus tract, and palpability assessed by surgeons in both groups also showed no significant difference.
                Bioresorbable fixation devices offer similar function as titanium in fixation for orthognathic surgery and do not impose an increase in the clinical morbidities.
This review provides some evidence to show that there is no statistically significant difference in postoperative discomfort, level of patient satisfaction, plate exposure or infection for plate and screw fixation using either titanium or resorbable materials in orthognathic surgery.