scholarly journals Customized Polymethyl Methacrylate Implants for the Reconstruction of Craniofacial Osseous Defects

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
André Luis Fernandes da Silva ◽  
Alexandre Meireles Borba ◽  
Niverso Rodrigues Simão ◽  
Fábio Luis Miranda Pedro ◽  
Alvaro Henrique Borges ◽  
...  
Keyword(s):  
Polymethyl Methacrylate ◽  
Well Being ◽  
Bone Defects ◽  
Uneventful Recovery ◽  
Facial Skeleton ◽  
Aesthetic Result ◽  
Craniofacial Bone ◽  
Small Series ◽  
Custom Made ◽  
Craniofacial Defects

Craniofacial defects represent alterations in the anatomy and morphology of the cranial vault and the facial bones that potentially affect an individual’s psychological and social well-being. Although a variety of techniques and restorative procedures have been described for the reconstruction of the affected area, polymethyl methacrylate (PMMA), a biocompatible and nondegradable acrylic resin-based implant, is the most widely used alloplastic material for such craniomaxillofacial reconstruction. The aim of this study was to describe a technique for aesthetic and functional preoperative customized reconstruction of craniofacial bone defects from a small series of patients offered by the Brazilian public health system. Three adult male patients attended consultation with chief complaints directly related to their individual craniofacial bone defects. With the aid of multislice computed tomography scans and subsequent fabrication of the three-dimensional craniofacial prototype, custom-made PMMA implants were fabricated preoperatively. Under general anesthesia, with access to the craniofacial defects with a coronal approach, the PMMA implants were adapted and fixated to the facial skeleton with titanium plates and screws. Postoperative evaluation demonstrated uneventful recovery and an excellent aesthetic result. Customized prefabricated PMMA implants manufactured over the rapid prototyping models proved to be effective and feasible.

A new custom made bioceramic implant for the repair of large and complex craniofacial bone defects

2013 ◽  
Vol 41 (5) ◽  
pp. 403-407 ◽  
Author(s):  
Joël Brie ◽  
Thierry Chartier ◽  
Christophe Chaput ◽  
Cyrille Delage ◽  
Benjamin Pradeau ◽  
...  
Keyword(s):  
Bone Defects ◽  
Craniofacial Bone ◽  
Custom Made

Reconstruction of craniofacial bone defects with three-dimensional custom-made implants. A five year experience

2009 ◽  
Vol 38 (5) ◽  
pp. 500 ◽  
Author(s):  
H. Rotaru ◽  
G. Bǎciuţ ◽  
H. Stan ◽  
R. Schumacher ◽  
H.F. Zeilhofer ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Bone Defects ◽  
Craniofacial Bone ◽  
Custom Made

scholarly journals Custom-Made Zirconium Dioxide Implants for Craniofacial Bone Reconstruction

Materials ◽  
2021 ◽  
Vol 14 (4) ◽  
pp. 840
Author(s):  
Marcin Kozakiewicz ◽  
Tomasz Gmyrek ◽  
Radosław Zajdel ◽  
Bartłomiej Konieczny
Keyword(s):  
Alumina Particle ◽  
Air Abrasion ◽  
Facial Skeleton ◽  
Orbital Surgery ◽  
Modern Material ◽  
Standard Material ◽  
Genotoxic Agent ◽  
Craniofacial Bone ◽  
Custom Made

Reconstruction of the facial skeleton is challenging for surgeons because of difficulties in proper shape restoration and maintenance of the proper long-term effect. ZrO2 implant application can be a solution with many advantages (e.g., osseointegration, stability, and radio-opaqueness) and lacks the disadvantages of other biomaterials (e.g., metalosis, radiotransparency, and no osseointegration) or autologous bone (e.g., morbidity, resorption, and low accuracy). We aimed to evaluate the possibility of using ZrO2 implants as a new application of this material for craniofacial bone defect reconstruction. First, osteoblast (skeleton-related cell) cytotoxicity and genotoxicity were determined in vitro by comparing ZrO2 implants and alumina particle air-abraded ZrO2 implants to the following: 1. a titanium alloy (standard material); 2. ultrahigh-molecular-weight polyethylene (a modern material used in orbital surgery); 3. a negative control (minimally cytotoxic or genotoxic agent action); 4. a positive control (maximally cytotoxic or genotoxic agent action). Next, 14 custom in vivo clinical ZrO2 implants were manufactured for post-traumatologic periorbital region reconstruction. The soft tissue position improvement in photogrammetry was recorded, and clinical follow-up was conducted at least 6 years postoperatively. All the investigated materials revealed no cytotoxicity. Alumina particle air-abraded ZrO2 implants showed genotoxicity compared to those without subjection to air abrasion ZrO2, which were not genotoxic. The 6-month and 6- to 8-year clinical results were aesthetic and stable. Skeleton reconstructions using osseointegrated, radio-opaque, personalized implants comprising ZrO2 material are the next option for craniofacial surgery.

Workflow and Principles for Precisely Designing a Custom-Made Polyetheretherketone Implant Applied in Irregular Craniofacial Bone Defects

2021 ◽  
Vol 26 (3) ◽  
pp. 404-410
Author(s):  
Taoran Jiang ◽  
Zheyuan Yu ◽  
Jie Yuan ◽  
Liang Xu ◽  
Huichuang Duan ◽  
...  
Keyword(s):  
Bone Defects ◽  
Craniofacial Bone ◽  
Custom Made

scholarly journals Early Outcomes of Patient-Specific Modular Cones for Substitution of Methaphysial and Diaphysial Bone Defects in Revision Knee Arthroplasty

2019 ◽  
Vol 25 (2) ◽  
pp. 9-18 ◽  
Author(s):  
A. A. Cherny ◽  
A. N. Kovalenko ◽  
S. S. Bilyk ◽  
A. O. Denisov ◽  
A. V. Kazemirskiy ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Scoring Systems ◽  
Bone Defects ◽  
Patient Specific ◽  
Implant Fixation ◽  
Diaphyseal Bone ◽  
Custom Made ◽  
The Stability ◽  
Valid Solution

The aim of this study was the assessment of early outcomes of patient-specific three-dimensional titanium cones with specified porosity parameters to compensate for extensive metaphysical-diaphyseal bone defects in RTKA.Materials and Methods. Since 2017 till 2019 30 patient-specific titanium cones (12 femoral and 18 tibial) implanted during 26 RTKAS. Clinical outcomes evaluated using KSS, WOMAC and fjS-12 scoring systems on average 10 (2–18) months after surgery. At the same time the stability of implant fixation analyzed using frontal, lateral and axial knee roentgenograms.Results. During all procedures there were no technical difficulties in positioning and implantation of custom-made titanium cones. At the time of preparation of the publication, none of the patients had indications for further surgical intervention, as well as intra- and postoperative complications. Six months after surgery all scores improved significantly: KSS from 23 (2–42, SD 19.96) to 66.5 (62–78, SD 7.68), WOMAC from 59 (56–96, SD 28.31) to 32.25 (19–46, SD 11.76), the index FJS-12 was 29.16 points (0–68.75, SD 30.19). The average scores continued to improve up to 18 months: KSS — 97.5 (88–108, SD 9.14), WOMAC — 16.5 (9–24, SD 6.45), FJS-12 — 45.85 (25–75, SD 22.03). No radiolucent lines were noticed during this period of observation.Conclusion. The original additive technology of designing and producing patient-specific titanium cones for compensation of extensive metaphyseal-diaphyseal bone defects in RTKA is a valid solution at least in the short term. A longer follow-up period is required to assess its medium-and long-term reliability compared to existing alternative surgical solutions.

scholarly journals Reconstruction of anterior frontal wall and contours defects using bone substitute

2021 ◽  
pp. 34
Author(s):  
Keyword(s):  
Bone Substitute ◽  
Calcium Sulfate ◽  
Donor Site ◽  
Bone Defects ◽  
Autogenous Bone ◽  
Bone Void Filler ◽  
Custom Made ◽  
Cranial Implant ◽  
Bone Void ◽  
Orbital Area

Aim: The aim of this article is to report on the safety and long-term efficacy of Cerament® BoneVoid Filler bone substitute for repairing craniofacial bone defects. Post-traumatic cranioplasty is a complex and challenging procedure for all maxillo-craniofacial surgeons and neurosurgeons, especially when repairing large areas. The standard criterion for repairing small cranial defects is the use autogenous bone from the iliac crest or split calvarial grafts. Autogenous grafts may result in donor-site morbidity, increased surgical time, reabsorption, blood loss, and longer recovery time . Alloplastic materials used for bone repair, such as methyl methacrylate, hydroxyapatite, titanium, or porous polyethylene, are expected to have optimal properties, including easy adaptation, biocompatibility, ingrowth of new tissue, stability of shape, and low rate of reabsorption. A cranial implant should be easily shaped and positioned, allowing easy tissue growth. In very wide cranium defects the new technology is a custom made cranial implant constructed three-dimensionally with different types of materials. However, this procedure is very expensive with various infection rates depending on the kind of material used and on the chemicophysical composition of the implant. Methods: The authors report the case of a 50-year-old man with a severe deformity of the forehead-supra orbital area as a result of a previous complex fronto-facial trauma treated in an emergency Unit. Secondary correction and reconstruction of the residual deformities were performed by using Cerament® Bone Void Filler, an alloplastic biphasic material, composed of 40% hydroxyapatite, 60% calcium sulfate and the radio-contrast agent iohexol. The unique ratio of hydroxyapatite and calcium sulfate is designed to enable Cerament to resorb at the same rate that bone forms. Calcium sulfate acts as a resorbable carrier for hydroxyapatite which is highly osteoconductive, promoting bone ingrowth.It seems to be a promising bone graft substitute in the management of bony irregularities in the fronto-orbital area. Conclusion: The patient was first hospitalized as the result of a serious craniofacial trauma. One year after the first emergency cranio-orbital reconstructive operation, a marked deformity of the frontal region appeared with a “grid effect” due to the inadequate plate-bony fixation of the fractures applied during the first bony recomposition and because it was not as rigid as it should have been . A secondary surgery for deformity correction was performed. The hardware was totally removed and the bony deformity smoothed, reshaped, covered and filled using Cerament® Bone Void Filler, a biomaterial. The patient recovered with a satisfactory cranium-forehead shape, no complications, and complete disappearance of a frowning look of the fronto-orbital region. Recently, increased use of bone substitutes in the reconstruction of bone defects has been fuelled by donor site complications associated with autologous bone harvesting. Cerament® BoneVoid Filler is a biphasic and injectable bone substitute that has a highly compressive strength and the ability to promote cancellous bone healing

scholarly journals A Simplified Approach for Ocular Rehabilitation - A Case Report

2020 ◽  
Vol 3 (2) ◽  
pp. 120-124
Author(s):  
P Manandhar ◽  
S R.B. Mathema
Keyword(s):  
Case Report ◽  
Cost Effective ◽  
Well Being ◽  
Body Part ◽  
Ocular Prosthesis ◽  
Simplified Approach ◽  
Comprehensive Method ◽  
Satisfactory Outcome ◽  
Custom Made ◽  
Ocular Defect

Loss of an eye or any body part has an intimidating and crippling effect on the psychosocial well-being of the patient. Although the artificial prosthesis cannot restore the function, it can highly improve the patient’s esthetics and help them regain their psychological confidence. Literature has advocated various rehabilitation modalities including empirical use of stock shells, modifying stock eyes, custom-made ocular prostheses, ocular implants, etc. A custom-made ocular prosthesis, among all the techniques, shows improved adaptation to tissue bed, distributes uniform pressure, provides a more esthetic and precise result, and is relatively cost-effective. This case report explores a relatively comprehensive method of custom ocular prosthesis fabrication for an ocular defect with a satisfactory outcome. 

scholarly journals 3D Biomimetic Porous Titanium (Ti6Al4V ELI) Scaffolds for Large Bone Critical Defect Reconstruction: An Experimental Study in Sheep

Animals ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. 1389 ◽  
Author(s):  
Alberto Maria Crovace ◽  
Luca Lacitignola ◽  
Donato Monopoli Forleo ◽  
Francesco Staffieri ◽  
Edda Francioso ◽  
...  
Keyword(s):  
Bone Defects ◽  
Porous Titanium ◽  
Control Group ◽  
Large Animal ◽  
Sintered Titanium ◽  
Porous Hydroxyapatite ◽  
X Ray ◽  
Custom Made ◽  
Critical Defect ◽  
Large Bone

The main goal in the treatment of large bone defects is to guarantee a rapid loading of the affected limb. In this paper, the authors proposed a new reconstructive technique that proved to be suitable to reach this purpose through the use of a custom-made biomimetic porous titanium scaffold. An in vivo study was undertaken where a complete critical defect was experimentally created in the diaphysis of the right tibia of twelve sheep and replaced with a five-centimeter porous scaffold of electron beam melting (EBM)-sintered titanium alloy (EBM group n = 6) or a porous hydroxyapatite scaffold (CONTROL group, n = 6). After surgery, the sheep were allowed to move freely in the barns. The outcome was monitored for up to 12 months by periodical X-ray and clinical examination. All animals in the CONTROL group were euthanized for humane reasons within the first month after surgery due to the onset of plate bending due to mechanical overload. Nine months after surgery, X-ray imaging showed the complete integration of the titanium implant in the tibia diaphysis and remodeling of the periosteal callus, with a well-defined cortical bone. At 12 months, sheep were euthanized, and the tibia were harvested and subjected to histological analysis. This showed bone tissue formations with bone trabeculae bridging titanium trabeculae, evidencing an optimal tissue-metal interaction. Our results show that EBM-sintered titanium devices, if used to repair critical bone defects in a large animal model, can guarantee immediate body weight-bearing, a rapid functional recovery, and a good osseointegration. The porous hydroxyapatite scaffolds proved to be not suitable in this model of large bone defect due to their known poor mechanical properties.

scholarly journals Pediatric Mandibular Resection and Reconstruction: Long-Term Results with Autogenous Rib Grafts

2010 ◽  
Vol 3 (1) ◽  
pp. 25-32 ◽  
Author(s):  
André M. Eckardt ◽  
Enno-Ludwig Barth ◽  
Johannes Berten ◽  
Nils-Claudius Gellrich
Keyword(s):  
Tumor Resection ◽  
Three Dimensional ◽  
Bone Defects ◽  
Long Term Results ◽  
Benign Tumors ◽  
Tumor Surgery ◽  
Bone Augmentation ◽  
Facial Skeleton ◽  
Computed Tomographic

Reconstruction of mandibular defects following tumor resection in infants is a particular challenge. Although autogenous rib grafts have no relevance in the restoration of mandibular bone defects occurring after ablative tumor surgery due to limited bone stock and the availability of other donor areas, they are a useful surgical alternative following tumor surgery in infants. We here report on a 2, 5, 8, and 15-year follow-up of four children who were diagnosed with benign tumors of the mandible with osseous destruction at the age of 4, 6, 15, and 18 months, respectively. Histologic diagnoses were melanotic neuroectodermal tumor ( n=2), hemangioendothelioma of the mandible ( n=1), and ameloblastoma ( n=1). Following continuity resection of the mandible, lateromandibular bone defects were restored using autogenous rib grafts. Both clinical and radiologic follow-up visits were performed for all children to assess growth of the facial skeleton and the mandible. One child was already further reconstructed using bone augmentation at the age of 15 years. Cephalometric measurements on panorex films and three-dimensional computed tomographic scans revealed a slight vertical growth excess and transversal growth inhibition of the reconstructed mandible compared with the nonoperated side. Although further growth of rib grafts is difficult to predict and occlusal disharmony may occur due to physiologic maxillary growth and growth of the unaffected mandible, we believe that autogenous rib grafts can be ideally used for the restoration of mandibular continuity defects in newborns and young children. Clinical follow-up visits on a yearly basis and orthodontic controls are useful for early orthodontic treatment of growth deficits. Further corrective surgery with bone augmentation or osseous distraction is required following completion of growth of the facial skeleton.

Polyetheretherketone Implants for the Repair of Large Cranial Defects

Neurosurgery ◽  
2014 ◽  
Vol 75 (5) ◽  
pp. 523-529 ◽  
Author(s):  
Guy Rosenthal ◽  
Ivan Ng ◽  
Samuel Moscovici ◽  
Kah K. Lee ◽  
Twyila Lay ◽  
...  
Keyword(s):  
San Francisco ◽  
Family Satisfaction ◽  
University Hospital ◽  
Surgical Removal ◽  
Aesthetic Result ◽  
Postoperative Hematoma ◽  
Wound Breakdown ◽  
Titanium Screws ◽  
Custom Made ◽  
Autologous Bone

Abstract BACKGROUND: Calvarial reconstruction of large cranial defects following decompressive surgery is challenging. Autologous bone cannot always be used due to infection, fragmentation, bone resorption, and other causes. Polyetheretherketone (PEEK) is a synthetic material that has many advantages in cranial-repair surgery, including strength, stiffness, durability, and inertness. OBJECTIVE: To describe our experience with custom-made PEEK implants for the repair of large cranial defects in 3 institutions: San Francisco General Hospital, Hadassah-Hebrew University Hospital, and the National Neuroscience Institute, Singapore. METHODS: A preoperative high-resolution computed tomography scan was obtained for each patient for design of the PEEK implant. Cranioplasty was performed via standard technique with the use of self-tapping titanium screws and miniplates. RESULTS: Between 2006 and 2012, 66 cranioplasties with PEEK implants were performed in 65 patients (46 men, 19 women, mean age 35 ± 14 years) for repair of large cranial defects. There were 5 infections of implants and 1 wound breakdown requiring removal of the implant (infection and surgical removal rates of 7.6% and 9.1%, respectively). Two patients required drainage of postoperative hematoma (overall surgical complication rate, 12.7%). Nonsurgical complications in 5 patients included seizures, nonoperative collection, and cerebrospinal fluid rhinorrhea that resolved spontaneously. Overall median patient or family satisfaction with the cranioplasty and aesthetic result was good, 4 on a scale of 5. Temporal wasting was the main aesthetic concern. CONCLUSION: Custom-designed PEEK implants are a good option for patients with large cranial defects. The rate of complications is comparable to other implants or autologous bone. Given the large size of these defects, the aesthetic results are good.

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