Custom-Made Titanium Plates Versus Custom-Made Polyether Ether Ketone (PEEK) Plates

Maxillofacial trauma is the most common cause of facial injuries resulting from various causes such as road traffic accidents, accidental falls, assaults, industrial mishaps, sports injuries and firearm injuries. The severity and pattern of maxillofacial trauma depend on the anatomic site, magnitude, and the direction of the force delivered to the face.

Reconstruction of facial bones following traumatic events represents one of the greatest challenges to maxillofacial surgeons. The role of the mandible is crucial in maintaining facial esthetics and functional occlusion. Due to its prominence and mobility, mandibular fractures represent the most common facial fractures, accounting for approximately 59% of all maxillofacial fractures.

Treatment modalities for mandibular fractures include closed reduction with intermaxillary fixation, open reduction with wire osteosynthesis and open reduction with rigid fixation. With modern surgical advances, modalities for the treatment of mandibular fracture depending on scientific facilities have been directed to facilitate the need of early, preferably and immediate mobilization in order to reduce the need of maxillomandibular fixation (MMF).

Whereas MMF is to blame for impairing the oral hygiene, masticatory efficiency and mouth opening besides it causes pain, phonetic disturbance and weight loss. Mandibular fractures are ideally treated with open reduction and internal fixation by an intraoral or extraoral approach. Direct bone contact between the fracture segments supports primary bone healing, that results in earlier bone regrowth and stability across the fracture site.

Nowadays, computers are being extensively used not only for diagnosis but also for designing surgical procedures in the craniomaxillofacial field. Advances in virtual surgery, 3D printing and milling techniques have significantly increased surgical precision and efficiency. These advances can be utilized alongside digital imaging techniques like computerized tomography (CT) to generate custom-made plates specifically tailored for each fracture. This can serve to shorten the operation time, eliminate the need to remove the plates and improve fixation system stability. The possibility of generating a three-dimensional model from CT scans was first mentioned in 19870.

Many materials can be employed in the process of manufacturing these custom-made plates like titanium, which is the most common conventional used type and Polyether ether ketone (PEEK) being a recent alternative.

PEEK is a linear semi-crystalline poly-aromatic polymer which has dimensional properties close to that of living bone in terms of strength and stiffness. The major beneficial property of PEEK is its lower Young's modulus of elasticity which is close to that of the cortical bone and therefore, it is likely to eliminate the major problem encountered with titanium plating system which is the stress shielding phenomenon. It is highly durable, resists a high degree of temperature greater than 300 degrees Celsius and can be used without adverse tissue effects. This study aims to evaluate the use of custom-made titanium plates versus PEEK plates in the treatment of mandibular fractures.

The null hypothesis states that there is no significant difference in clinical and radiographic outcomes between custom-made titanium plates and custom-made PEEK plates for fixation of mandibular fractures.