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This systematic review aimed to assess the efficacy and morbidity of biodegradable vs. titanium osteosyntheses in orthognathic surgery (PROSPERO CRD42018086477). Patients with syndromic disorder(s) and\/or cleft lip\/palate were excluded. Randomised, prospective and retrospective controlled studies were searched for in nine databases (February 2021). The time periods perioperative, short\u2010term, intermediate, long\u2010term,\u00a0and overall follow\u2010up were studied. Meta\u2010analyses were performed using random\u2010effects models. A total of 9073 records was assessed, of which 33 were included, comprising 2551 patients. Seven RCTs had \u2018some concerns\u2019 while another seven RCTs had \u2018high\u2019 risk of bias (Cochrane\u2010RoB2). No differences in malunion (qualitative analyses), mobility of bone segments [RR 1.37 (0.47; 3.99)], and malocclusion [RR 0.93 (0.39; 2.26)] were found. The operative time was longer in the biodegradable group [SMD 0.50 (0.09; 0.91)]. Symptomatic plate\/screw removal was comparable among both groups [RR 1.29 (0.68; 2.44)]. Skeletal stability was similar in most types of surgery. Biodegradable osteosyntheses is a valid alternative to titanium osteosyntheses for orthognathic surgery, but with longer operation times. Since the quality of evidence varied from very low to moderate, high\u2010quality research is necessary to elucidate the potential of biodegradable osteosyntheses.<\/jats:p>","DOI":"10.1111\/eos.12800","type":"journal-article","created":{"date-parts":[[2021,6,16]],"date-time":"2021-06-16T06:02:12Z","timestamp":1623823332000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Efficacy and morbidity of biodegradable versus titanium osteosyntheses in orthognathic surgery: A systematic review with meta\u2010analysis and trial sequential analysis"],"prefix":"10.1111","volume":"129","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3534-9176","authenticated-orcid":false,"given":"Barzi","family":"Gareb","sequence":"first","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery University Medical Center Groningen University of Groningen Groningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0094-8873","authenticated-orcid":false,"given":"Nico B.","family":"van Bakelen","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery University Medical Center Groningen University of Groningen Groningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5487-1907","authenticated-orcid":false,"given":"Pieter U.","family":"Dijkstra","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery University Medical Center Groningen University of Groningen Groningen the Netherlands"},{"name":"Department of Rehabilitation Medicine University Medical Center Groningen University of Groningen Groningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2581-4361","authenticated-orcid":false,"given":"Arjan","family":"Vissink","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery University Medical Center Groningen University of Groningen Groningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7377-466X","authenticated-orcid":false,"given":"Ruud R. 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