Clinical studies that assessed use of any type of resorbable implant for treatment of mandibular fractures of the angle ramus, symphysis or subcondylar regions or mandibular osteotomy were eligible for inclusion in the review. Patients with risk factors such as alcohol or tobacco use were included. Participants were not restricted by age, but syndromic patients or those with combination fixation, bimaxillary osteotomies or cancer were excluded from the review. Computer simulation studies were excluded. Studies had to report sufficient data to assess outcomes that included morbidity or resorbable device success. Studies that focused on finite element analysis, distraction osteogenesis or laboratory biomechanical testing were excluded.
Most included studies used plates and screws for mandibular fixation; the rest used screws only. The most commonly used implant was made from 70% poly-L-lactic acid and 30% poly-D, L-lactic acid (PLLA 70/PDLLA 30). Other implants included those made from 100% PLLA (half of which used strength reinforced PLLA; SR-PLLA) and thoise made from 82% PLLA and 18% polyglycolic acid (PLLA82/PGA18). Studies involved 10 different implant manufacturers, which included LactoSorb, Walter Lorenz Surgical, Biofix and BioSorbFX. In most studies mean age of participants was not reported; where reported, mean age ranged from 23.1 to 32.1 years (range six months to 83 years). Most patients underwent open reduction and internal fixation (ORIF) for treatment of a mandibular fracture (type of fracture varied between studies) or bilateral split sagittal osteotomy (BSSO) for advancement. Forty-two percent of studies included patients other than those who underwent mandibular surgery. Mean follow-up ranged from three to 348 weeks. Reported outcomes included incidence of infections, foreign-body reactions, malocclusions, malunions and premature plate removals.
Studies were assessed for inclusion by two independent authors. Discrepancies were resolved through consensus.