Application of Resorbable Plates: Japanese Experience
Plates or screws are used in osteosynthesis for jaw deformities. They are constructed of either titanium or absorbable materials. Various types of titanium plates have been developed and are widely used. They are removed approximately one year following osteosynthesis. Use of absorbable plates began around 1995 in Japan. When introduced, absorbable plates were expected to be widely-accepted because they do not require removal. However, due to their complicated manipulation and high cost, they are used less than their titanium counterparts. This report presents an overview of plate application in osteosynthesis for jaw deformities, actual status and issues regarding absorbable plates in Japan.
2. Materials and methods
The following materials and methods were used to evaluate the status of absorbable plates Japan; relevant issues are discussed:
(1) Published documents on absorbable plates used in Japan.
(2) Number of published articles and presentations on absorbable plates in Japanese academic meetings that were archived in the Japana Centra Revuo medicina (Ichishi) database.
(3) Materials used in osteosynthesis for jaw deformity used in Japan, as documented by past publications.
(4) Efforts for improving operability
4. Results
(1) Absorbable plates used in Japan.
Absorbable plates began to be used about 1995 in Japan; improvements have been made since then. At present, three types of plates from three companies are available: PLLAPGA, u-HA/PLLA and PLLA.
(2) Number of published articles and presentations on absorbable plate from Japanese academic meetings.
The search results comprising the past five years for the retrieval key “absorbable plate” from the Ichushi-Web database located 34 publications and 59 academic presentations. When the search period was undefined, 60 publications and 100 academic presentations were located. Thus, research on this topic is somewhat limited.
(3) Materials used for osteosynthesis in Japan.
According to a study by Kobayashi T, Saito T, et al., miniplates were used in 70.3% of osteosynthesis cases, screws in 13.5%, miniplates or screws in 11.2%, miniplates or intraosseous wiring in 2.2%, miniplates, screws, or intraosseous wiring in 1.1%, and intraosseous wiring in 1.1% for jaw deformity treatment in Japan from April 2006 to March 2007. Miniplates were primarily used; however, the ratio between titanium plates and absorbable plates used was not described. A study by Yamada S et al. reported that 56 cases of sagittal split osteotomy SSRO) from 1991 through 2006 used the Obwegeser-Dal Pont method for osteosynthesis; metal screws were used in 42.2% of cases; metal plates alone were used in 27.7%; a PLLA alone was used in 12.0%; bone suture with wire was used in 4.8%; and PLLA screws alone were used in 1.2%. Titanium plates surpassed absorbable plates in number of applications. The reason may include the following disadvantages of absorbable plates: poor operability, difficult confirmation of indications and contraindications, and the possibility of complications including infection and breakage.
5. Conclusions
Absorbable plates require improvement in quality and operability. Improved absorbable plates will be more clinically applicable and have a wider range of indications. In addition, these improved plates will provide quality of life improvements to patients with deformities.
6. References
T Kobayashi, T Saito, K Omura,et al. Treatment of Jaw Deformity: A Nationwide Survey of the Situation in Japan. Jpn J Jaw Deform, 18(2008), p237
S Yamada, G Kawasaki, M Baba, et al. A clinicostatistical ivestigation of orhognathic srgery.Jpn J Oral Diag 19(2006), p 213
P.S.
This abstract is related to a symposium “Update on Resorbable Fixation in Oral and Maxillofacial Surgery (Baur) 90 minutes ”