title: Segmental stability in orthognathic surgery: hydroxyapatite/Poly-l-lactide osteoconductive composite versus titanium miniplate osteosyntheses.
abstract: Hydroxyapatite was included into F-u-HA/PLLA (unsintered hydroxyapatite - Poly l-lactide) composite osteosynthesis material for its documented osteoconductive capacity. This study investigates segmental retention capacities and outcome stability using F-u-HA/PLLA composite osteosyntheses in orthognathic surgery. Of fifty patients in total, 25 patients were osteofixated with F-u-HA/PLLA osteoconductive bioabsorbable osteosyntheses and compared to a group of 25 patients treated with titanium miniplates. The F-u-HA/PLLA group included 14 maxillary advancements, 4 setbacks, 13 impactions, 5 elongations at A-point; the titanium group included 20 maxillary advancements, 2 setbacks, 11 impactions and 11 elongations. In the mandible the F-u-HA/PLLA group included 13 advancements at B-point, 11 setbacks, 16 clockwise rotations and 8 counterclockwise rotations at the Gonial angle (Ar-Go-Gn); the titanium group included 9 mandibular advancements, 5 setbacks, 8 clockwise rotations and 6 counterclockwise rotations at Ar-Go-Gn. Segmental stability and relapse were assessed comparing preoperative, postoperative and follow-up roentgen cephalometrics at 22 ± 11 months on average in F-u-HA/PLLA cases, 24 ± 22 months on average in the titanium group. All absolute operative movements were nonsignificant in the F-u-HA/PLLA cases compared to the titanium osteosynthesis cases. Relapses were nonsignificant but there was greater vertical relapse in maxillary impactions with titanium osteosyntheses. Throughout this study, F-u-HA/PLLA composite osteosyntheses appeared as stable as titanium miniplates. It can therefore be concluded, although from a limited number of patients, that the investigated osteoconductive osteosynthesis can be used in a similar way to titanium miniplates in orthognathic surgery. Compared to earlier studies using other bioabsorbable polymers in the literature, F-u-HA/PLLA proved to be more stable in segmental retention.
authors.affiliation: Department of Oral Maxillofacial and Plastic Facial Surgery, (Chair: Prof. Dr. Dr. Robert Sader), University Medical Centre Frankfurt/Main, Theodor-Stern-Kai 7, 60596 Frankfurt/Main, Germany. Electronic address: constantinlandes@googlemail.com.
authors.forename: Constantin A
authors.initials: CA
authors.lastname: Landes
authors.affiliation: Department of Oral Maxillofacial and Plastic Facial Surgery, (Chair: Prof. Dr. Dr. Robert Sader), University Medical Centre Frankfurt/Main, Theodor-Stern-Kai 7, 60596 Frankfurt/Main, Germany. Electronic address: a.ballon@web.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Ballon
authors.affiliation: Department of Oral Maxillofacial and Plastic Facial Surgery, (Chair: Prof. Dr. Dr. Robert Sader), University Medical Centre Frankfurt/Main, Theodor-Stern-Kai 7, 60596 Frankfurt/Main, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Tran
authors.affiliation: Department of Oral Maxillofacial and Plastic Facial Surgery, (Chair: Prof. Dr. Dr. Robert Sader), University Medical Centre Frankfurt/Main, Theodor-Stern-Kai 7, 60596 Frankfurt/Main, Germany.
authors.forename: Shahram
authors.initials: S
authors.lastname: Ghanaati
authors.affiliation: Department of Oral Maxillofacial and Plastic Facial Surgery, (Chair: Prof. Dr. Dr. Robert Sader), University Medical Centre Frankfurt/Main, Theodor-Stern-Kai 7, 60596 Frankfurt/Main, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Sader
mesh_terms: D020341:Absorbable Implants; D000293:Adolescent; D000328:Adult; D001672:Biocompatible Materials / Q000737:chemistry*; D001860:Bone Plates; D002508:Cephalometry / Q000379:methods; D017886:Durapatite / Q000737:chemistry*; D005260:Female; D005500:Follow-Up Studies; D063172:Genioplasty / Q000295:instrumentation; D006801:Humans; D008297:Male; D008312:Malocclusion, Angle Class II / Q000601:surgery; D008313:Malocclusion, Angle Class III / Q000601:surgery; D008334:Mandible / Q000473:pathology; D019186:Mandibular Advancement / Q000295:instrumentation; D008437:Maxilla / Q000473:pathology; D008875:Middle Aged; D024343:Open Bite / Q000601:surgery; D056948:Orthognathic Surgical Procedures / Q000295:instrumentation*; D019340:Osteotomy, Le Fort / Q000295:instrumentation; D059229:Osteotomy, Sagittal Split Ramus / Q000295:instrumentation; D011091:Polyesters / Q000737:chemistry*; D012008:Recurrence; D012189:Retrospective Studies; D014025:Titanium / Q000737:chemistry*; D055815:Young Adult
chemical_list: D001672:Biocompatible Materials; D011091:Polyesters; C499699:hydroxyapatite-polylactide; D017886:Durapatite; D014025:Titanium
keywords: Bioabsorbable osteosyntheses; Hydroxyapatite; Orthognathic surgery; Osteoconductive osteosynthesis