Resorbable Implants for Mandibular Fracture Fixation: A Systematic Review and Meta-Analysis

The mandible represents one of the most common sites of involvement for adult craniofacial trauma.1,2 Mandibular fractures most commonly occur in young adults following blunt trauma such as motor vehicle accidents, assault, and falls.3 Given that this population engages in at risk behaviors, there is an increased susceptibility to postoperative complications, making prompt diagnosis and management a necessity.4 In the majority of cases, rigid fixation is required to ensure maintenance of proper occlusion and fracture stabilization while minimizing the risk of infection.1,4 In select cases, namely nondisplaced fractures without evidence of malocclusion or fracture mobility, conservative management with a soft diet may be sufficient.1,5 Historically, open reduction and internal fixation (ORIF) for traumatic mandibular fractures has been achieved through the use of metallic plates, namely titanium. Metallic implants carry the benefit of providing the necessary tensile strength to withstand forces of mastication while limiting fracture mobility. However, metallic plates can be palpable, which necessitates secondary surgery for removal and have been associated with interference of radiologic examinations, possible hardware migration, thermal sensitivity, osteolysis, corrosion, and peri-implant soft tissue reactions.6–10 Concerns regarding the use of metallic fixation devices led to the advent of resorbable materials, which were initially developed to avoid secondary surgery for implant removal.11 Early monomeric forms of biodegradable implants, namely poly-L-lactide, were associated with delayed degradation (>5 years), which led to reports of foreign-body reactions, local fistulas, osteolytic lesions, and peri-implant fluctuant swelling.7,12,13 However, with the development of advanced copolymers, self-reinforcing materials, and increased control over degradation rates, recent studies have shown promising results.14,15 In light of this recent evidence, and the increasing use of biodegradable implants for mandibular fracture fixation, it is of great value to shed light on overall complication rates and long-term functional outcomes. Given that the literature is devoid of any recent comprehensive reviews comparing outcomes of resorbable and metallic implants for fixation of mandibular fractures, we sought to synthesize the available data in an effort to offer an evidence-based view to guide clinical management.