Reasons for removal of bone plates after orthognathic surgery

ABSTRACT

The aim of this prospective clinical trial was to evaluate the reasons for removal of miniplates from patients who had orthognathic surgery over a 7-year period. Fifty consecutive patients with fixed miniplates following orthognathic surgery [11 males and 39 females] aged 20 to 43 years [mean=28 +/- 6 years] were recruited into this study. Personal information, dental and medical history, type of orthognathic operation, indications for plate removal, placement site of plates and time between insertion and removal were recorded. The site of plate insertion was classified into right, left and anterior maxilla; right, left and anterior mandible; and chin. All plates were inserted and removed intra-orally under local or general anesthesia. The association between the variables was analyzed using the Pearson correlation and Chi-Square test. For all statistical analysis, the significance level was set at P<0.05. 312 titanium miniplates were inserted in 50 patients. A total of 108 plates [34.6%] were removed. The retention period for the removed plates ranged from 4 months to 4.5 years. The most common sites for plate removal were maxilla [22 patients, 44%] followed by mandible [19 patients, 38%]. The most common cause for plate removal was palpable plates [27 patients] followed by infection [13 patients], patient discomfort and preference [7 patients] and plate exposure and wound dehiscence [3 patients]. No significant relationships were found between plate removal [including number and location of removed plates and reason for plate removal] and age and gender [p<0.05]. Reason of plate removal was significantly related to the number of plates [p=0.001, r=0.441] and the location of removed plate [p<0.001, r= 0.62]. Type of removed plate had no significant relation with reason for plate removal [p=0.576, r=-0.081] number of plates [p= 0.62, r= 0.072] and location of removed plates [p= 0.467, r= -0.105]. Reason for performing the orthognathic surgery and type of the orthognathic surgery had no significant relations with the number and location of removed plates and reason for plate removal [p<0.05]. Plate removal was attributed to palpable plates, infection, subjective discomfort and patient preference, and plate exposure and wound dehiscence. Plate-related complications caused plate removal which was more likely to occur within the first year of insertion. This should be accounted for during the process of obtaining informed consent