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Is Patient-Specific Hardware for Orthognathic Surgery More Frequently Removed Than Stock Plates?
Si Kun Wang1, Michael C Britt2, Lisa Nussbaum3
1DMD Candidate, Harvard School of Dental Medicine, Boston, MA.
Background:
Patient-specific implants (PSIs) offer predictability, accuracy, and ease of use, but their removal requirements after orthognathic surgery are unclear. Removing hardware has both a health care cost and negative impact on patients.
Purpose:
The purpose of this study was to compare hardware removal between orthognathic fixation with either PSIs or stock plates and identify risk factors associated with removal.
Study Design, Setting, Sample:
This retrospective cohort study included patients with skeletal malocclusion who underwent orthognathic surgery with plate fixation between 2008 and 2024 at Boston Children's Hospital. Patients with less than 3 months of follow-up or incomplete records were excluded.
Predictor Variable:
The primary predictor variable was the type of hardware used (PSI vs stock).
Outcome Variable:
The primary outcome was time from plate fixation to plate removal.
Covariates:
Covariates included age, sex, presence of cleft lip/palate, procedure type and length, ancillary procedures during the same anesthetic, presence of postoperative malocclusion, hardware lifespan, reason for removal, and plate location.
Analyses:
Independent samples t tests, tests of medians, χ2 tests, and Fisher exact tests were used to evaluate sample characteristics. Kaplan-Meier analyses and Cox proportional hazards were used to generate hazard ratios. P values of less than .05 were significant.
Results:
The sample included 675 subjects with a mean age of 19.40 years (standard deviation (SD) = 3.29) and 47.9% (n = 323) males. Overall, 8.6% (n = 58) required plate removal, and PSIs were removed more frequently than stock plates (12.8% (n = 33) vs 6.0% (n = 25), respectively, P = .002; unadjusted HR = 3.99, 95% confidence interval (CI): (2.30, 6.93), P < .001). After adjusting for procedure type, ancillary procedures, and postoperative malocclusion, PSIs were associated with a risk of plate removal 8.82 (95% confidence interval (CI): (4.27, 18.20), P < .001) times that of the stock group. Procedure type, procedure length, ancillary procedures during the same anesthetic, and postoperative malocclusion were also associated with removal. The most common reasons for removal included a future procedure and infection, with no difference between cohorts.
Conclusions And Relevance:
PSIs were associated with an increased risk for hardware removal compared to stock plates for subjects who underwent orthognathic surgery. The benefits and risks of PSIs should be weighed and clinical judgment exercised accordingly.
