Any suggestions with Biodegradable screws in sliding genioplasty?

Question

Have you used these or know of successful cases done with these? Do they cause more inflammation or problems in comparison with titanium screws/plates? I'm looking at the ones made of polylactic acid and hydroxyapatite. Are they expensive compared to titanium? Are they harder for a surgeon to use?

Alejandro Nogueira, MD · Answer

I am a surgeon practicing 99% of my chin augmentations by means of sliding genioplasty during the last 15 years, and I never used any kind of plates and screws, neither steel made nor resorbable.Plates and screws are necessary for mandibular fractures and for ortognatic surgery of the jaw involvin major osteotomies; however the sliding genioplasty consists in an apical or marginal osteotomy affecting exslusively the chin and not any structural or support pillars of the jaw, neither its integrity, therefore no strong fixation is required; the piece of bone slided forward is tiny compared with the rest of the jaw and stands for no supporting forces or tractions, in addition the healing is amazingly quick and satisfactory in all cases. All this makes plates and screws unnecessary.I use very thin steel wires to fix the piece, 2 or 3 anchors suffice, and they remain buried unther the osseous callus formed around the area. In my vast experience I never had a case of migration, intolerance or revomal was required. However a majority of plates and screws produce pain, irritation, disturbance, may migrate or need removal with years. I am talking about follow up times beyond 10 years, an additionally I never had one case of consolidation problems, pseudartrosis or infection.Sliding genioplasty is neatly superior to chin implants for multiple reasons, and also is safer, confiable and more natural, dont hesitate to go for it and find a surgeon with experience; avoid plates and screws and you'll forget of your chin all your lifetime.

Barry L. Eppley, MD, DMD · Answer

Having developed one of the major bioresorbable systems for use in craniomaxillofacial surgery, I have used these devices many times in sliding genioplasties. While they can be used in the chin, they offer less stability and versatility than much smaller metal plate and screw systems. I would not recommend their use in the chin unless your surgeon is very skilled at using them, you are prepared to pay more for their use and you can accept a risk of bone instability or non-union. (a risk that metal fixation virtually does not have)

Any suggestions with Biodegradable screws in sliding genioplasty?

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