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Effects of Placement and Pressure

David C. Pearson, MD; David A. Sherris, MD

Arch Facial Plast Surg. 1999;1:261-264.

Objective  To evaluate the extent to which silicone rubber mandibular implant (Silastic; Dow Corning, Midland, Mich) pressure and placement (supraperiosteal or subperiosteal) affect underlying mandibular resorption.

Design  A randomized, controlled animal trial.

Subjects  Ten mixed-breed adult hounds.

Interventions  Each animal's mandible was implanted with 6 Silastic blocks, 3 inserted supraperiosteally and 3 subperiosteally. Within each grouping of 3 implants, pressure was varied from "minimum" to "moderate" to "maximum" by compressing the implant with titanium miniplates. After 4 months, the animals were killed and their mandibles sectioned for microscopic examination.

Results  Mandibular resorption occurred in varying degrees beneath all implants by the end of the study period. The extent of resorption was consistent with retrospective studies in humans. No statistically significant difference was found between supraperiosteal or subperiosteal placement of the implants. However, higher-pressure implants tended to produce less resorption than lower-pressure implants.

Conclusions  While some bone resorption seems inevitable with Silastic mandibular implants, these results would seem to suggest that the placement of implants above or below the periosteum need not be a concern for the surgeon attempting to minimize this consequence. On the other hand, increased pressure may actually decrease resorption, contrary to current assumptions.

From the Mayo Medical School, Division of Facial Plastic Surgery, Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minn.

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