Long-Term Stability of the Use of Patient Specific Implants in Orthognathic Surgery: A Systematic Review

ABSTRACT: Introduction and aim: This systematic review aimed to evaluate the long-term stability of patient-specific implants (PSIs) in orthognathic surgery. Methods: The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic search including an electronic search of numerous databases with keywords, manual and reference searches was performed. The search results were evaluated and underwent 2 rounds of elimination, first by title and abstract and second by fulfilling the 6 predetermined criteria. The included studies underwent the final systematic review. Results: Six studies with a total of 171 subjects were included in the final review. The long-term stability of the use of PSIs in orthognathic surgery ranged from 0.27 mm to 0.5 mm for the x-axis and 0.3 mm to 1.07 mm for the y-axis. The mean change was 0.1°, 0.5° and 0.2° for the pitch, roll and yaw, respectively. The absolute mean difference of the SNA angle was 0.57°. The mean duration of operation for using PSIs was shorter than the use of conventional miniplates in orthognathic surgery by 15.7%. Complications and reoperation rates when using PSIs in orthognathic surgery were reported to be 0 in 3 studies and not reported in the other 3 studies. Conclusion: The results of this systematic review indicate that PSIs demonstrate clinically acceptable stability over the medium-to-long term and represent a reliable method of fixation in orthognathic surgery. Additional high-quality studies with standardised methodology and longer follow-up period of more than 24 months are recommended. Clinical relevance: This systematic review highlights the high level of long-term stability when using PSIs in orthognathic surgery in terms of bodily movements, complications and reoperation rates. Oral and maxillofacial surgeons and biomechanical engineers may now have a more comprehensive and deeper understanding of the use of PSIs in the long term, which can assist them in choosing the method of fixation in orthognathic surgery.