{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T12:56:53Z","timestamp":1791982613980,"version":"4.4.0"},"reference-count":253,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2022,7,7]],"date-time":"2022-07-07T00:00:00Z","timestamp":1657152000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Polymers"],"abstract":"<jats:p>Osteosynthesis systems are used to fixate bone segments in maxillofacial surgery. Titanium osteosynthesis systems are currently the gold standard. However, the disadvantages result in symptomatic removal in up to 40% of cases. Biodegradable osteosynthesis systems, composed of degradable polymers, could reduce the need for removal of osteosynthesis systems while avoiding the aforementioned disadvantages of titanium osteosyntheses. However, disadvantages of biodegradable systems include decreased mechanical properties and possible foreign body reactions. In this review, the literature that focused on the in vitro and in vivo performances of biodegradable and titanium osteosyntheses is discussed. The focus was on factors underlying the favorable clinical outcome of osteosyntheses, including the degradation characteristics of biodegradable osteosyntheses and the host response they elicit. Furthermore, recommendations for clinical usage and future research are given. Based on the available (clinical) evidence, biodegradable copolymeric osteosyntheses are a viable alternative to titanium osteosyntheses when applied to treat maxillofacial trauma, with similar efficacy and significantly lower symptomatic osteosynthesis removal. For orthognathic surgery, biodegradable copolymeric osteosyntheses are a valid alternative to titanium osteosyntheses, but a longer operation time is needed. An osteosynthesis system composed of an amorphous copolymer, preferably using ultrasound welding with well-contoured shapes and sufficient mechanical properties, has the greatest potential as a biocompatible biodegradable copolymeric osteosynthesis system. Future research should focus on surface modifications (e.g., nanogel coatings) and novel biodegradable materials (e.g., magnesium alloys and silk) to address the disadvantages of current osteosynthesis systems.<\/jats:p>","DOI":"10.3390\/polym14142782","type":"journal-article","created":{"date-parts":[[2022,7,7]],"date-time":"2022-07-07T07:51:56Z","timestamp":1657180316000},"page":"2782","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":42,"title":["Titanium or Biodegradable Osteosynthesis in Maxillofacial Surgery? In Vitro and In Vivo Performances"],"prefix":"10.3390","volume":"14","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 Centre Groningen, Hanzeplein 1, 9713 GZ, P.O. Box 30001, 9700 RB Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nico B.","family":"Van Bakelen","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, P.O. Box 30001, 9700 RB 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 Centre Groningen, Hanzeplein 1, 9713 GZ, P.O. Box 30001, 9700 RB Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruud R. M.","family":"Bos","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, P.O. Box 30001, 9700 RB Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5642-8194","authenticated-orcid":false,"given":"Baucke","family":"Van Minnen","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, P.O. Box 30001, 9700 RB Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Haerle, F., Champy, M., and Terry, B.C. (2009). Atlas of Craniomaxillofacial Osteosynthesis, Thieme.","DOI":"10.1055\/b-002-72255"},{"key":"ref_2","first-page":"483","article-title":"A propos des ost\u00e8osynth\u00e9ses fronto-malaires par plaques viss\u00e9es","volume":"76","author":"Champy","year":"1975","journal-title":"Rev. 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