Skeletal Fixation in Craniomaxillofacial Surgery: A Systematic Review and Meta-Analysis of Patient-Specific Implants Versus Stock Plates

Patient-specific implants (PSIs) are increasingly used in craniomaxillofacial (CMF) surgery, but their advantages over stock plates in long-term outcomes remain unclear. This systematic review and meta-analysis compared PSIs and stock plates in 4 surgical categories: mandibular reconstruction, non-cleft orthognathic surgery, cleft orthognathic surgery, and mandibular fractures. A systematic search of PubMed, Embase, and Scopus identified comparative studies reporting quantitative outcomes. Meta-analyses were conducted for surgical accuracy, skeletal stability, relapse rates, complication rates, and functional outcomes. Twenty studies with 1,066 participants were included. In mandibular reconstruction, PSIs significantly reduced complication rates (RR=0.50, 95% CI: 0.31 to 0.82, P =0.006) but had higher incomplete osseous union rates, especially in patients receiving adjuvant radiotherapy (OR=3.518, P =0.02). In non-cleft orthognathic surgery, PSIs improved surgical accuracy (SMD=-1.11, 95% CI: -1.57 to -0.65, P <0.0001) but did not significantly reduce relapse rates. In cleft orthognathic surgery, PSIs lowered relapse in large advancements (>10 mm) ( P =0.003), but overall stability was similar to stock plates. In mandibular fractures, PSIs improved occlusal function at 3 months (SMD=1.88, 95% CI: 1.11 to 2.65, P <0.0001) but did not enhance fracture healing (RR=1.11, P =0.30) or reduce complications (RR=0.67, P =0.64). Virtual surgical planning was more common with PSIs, potentially biasing accuracy improvements. PSIs may improve surgical accuracy and reduce complications but do not consistently enhance long-term stability or healing. Future studies should control for virtual planning and assess long-term outcomes more comprehensively.