Is Patient-Specific Hardware for Orthognathic Surgery More Frequently Removed Than Stock Plates?

Area of Science:

• Orthognathic Surgery
• Biomaterials in Medicine
• Surgical Outcomes

Background:

• Patient-specific implants (PSIs) offer advantages in orthognathic surgery but their hardware removal rates are not well-defined.
• Hardware removal incurs healthcare costs and negatively impacts patients.

Purpose of the Study:

• To compare hardware removal rates between patient-specific implants (PSIs) and stock plates in orthognathic surgery.
• To identify risk factors associated with hardware removal after orthognathic procedures.

Main Methods:

• Retrospective cohort study of 675 patients undergoing orthognathic surgery with plate fixation (2008-2024).
• Primary predictor: hardware type (PSI vs. stock). Primary outcome: time to plate removal.
• Statistical analyses included t tests, chi-squared tests, Kaplan-Meier, and Cox proportional hazards models.

Main Results:

• Overall, 8.6% of patients required plate removal.
• Patient-specific implants (PSIs) had a significantly higher removal rate (12.8%) compared to stock plates (6.0%).
• Adjusted analysis revealed PSIs were associated with an 8.82 times higher risk of removal; procedure type, length, ancillary procedures, and postoperative malocclusion were also risk factors.

Conclusions:

• Patient-specific implants (PSIs) are linked to an increased risk of hardware removal in orthognathic surgery compared to stock plates.
• The decision to use PSIs should involve a thorough assessment of their benefits against the elevated risk of removal.