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Verbist M, Vandevelde AL, Geusens J, Sun Y, Shaheen E, Willaert R. Reconstruction of Craniomaxillofacial Bone Defects with 3D-Printed Bioceramic Implants: Scoping Review and Clinical Case Series. J Clin Med 2024; 13:2805. [PMID: 38792347 PMCID: PMC11122134 DOI: 10.3390/jcm13102805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/27/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Reconstruction of craniomaxillofacial bone defects using 3D-printed hydroxyapatite (HA) bioceramic patient-specific implants (PSIs) is a new technique with great potential. This study aimed to investigate the advantages, disadvantages, and clinical outcomes of these implants in craniomaxillofacial surgeries. The PubMed and Embase databases were searched for patients with craniomaxillofacial bone defects treated with bioceramic PSIs. Clinical outcomes such as biocompatibility, biomechanical properties, and aesthetics were evaluated and compared to those of commonly used titanium or poly-ether-ether-ketone (PEEK) implants and autologous bone grafts. Two clinical cases are presented to illustrate the surgical procedure and clinical outcomes of HA bioceramic PSIs. Literature review showed better a biocompatibility of HA PSIs than titanium and PEEK. The initial biomechanical properties were inferior to those of autologous bone grafts, PEEK, and titanium but improved when integrated. Satisfactory aesthetic results were found in our two clinical cases with good stability and absence of bone resorption or infection. Radiological signs of osteogenesis were observed in the two clinical cases six months postoperatively. HA bioceramic PSIs have excellent biocompatible properties and imitate natural bone biomechanically and radiologically. They are a well-suited alternative for conventional biomaterials in the reconstruction of load-sharing bone defects in the craniomaxillofacial region.
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Affiliation(s)
- Maarten Verbist
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
- OMFS IMPATH Research Group: Department of Oral and Maxillofacial Surgery, Imaging and Pathology, Leuven University Hospitals, 3000 Leuven, Belgium
| | - Anne-Laure Vandevelde
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
- OMFS IMPATH Research Group: Department of Oral and Maxillofacial Surgery, Imaging and Pathology, Leuven University Hospitals, 3000 Leuven, Belgium
| | - Joris Geusens
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
- OMFS IMPATH Research Group: Department of Oral and Maxillofacial Surgery, Imaging and Pathology, Leuven University Hospitals, 3000 Leuven, Belgium
| | - Yi Sun
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
- OMFS IMPATH Research Group: Department of Oral and Maxillofacial Surgery, Imaging and Pathology, Leuven University Hospitals, 3000 Leuven, Belgium
| | - Eman Shaheen
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
- OMFS IMPATH Research Group: Department of Oral and Maxillofacial Surgery, Imaging and Pathology, Leuven University Hospitals, 3000 Leuven, Belgium
| | - Robin Willaert
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
- OMFS IMPATH Research Group: Department of Oral and Maxillofacial Surgery, Imaging and Pathology, Leuven University Hospitals, 3000 Leuven, Belgium
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Prajapati HP, Singh DK. A Single Standard Polyvinyl Chloride 3D Skull Model to Create the Polymethyl Methacrylate Cranioplasty Flap: A Novel and Low-Cost Technique. J Neurol Surg A Cent Eur Neurosurg 2024. [PMID: 38621709 DOI: 10.1055/s-0044-1785648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND Although, cranioplasty is a commonly performed neurosurgical procedure worldwide, the cost of available cranioplasty implants is a major issue in a low-income country like India. The aims of this study were to introduce a novel and low-cost technique using a single standard three-dimensional (3D) skull model to guide the polymethyl methacrylate (PMMA) cranioplasty flap production and to evaluate the functional and cosmetic outcomes. METHODS We retrospectively evaluated 47 cases of PMMA cranioplasty in the period from February 2019 to June 2022. A single standard 3D skull model was used to make the PMMA cranioplasty flaps. The overall cost of this PMMA implant was compared with that of other available cranioplasty implants. The functional and cosmetic outcomes were evaluated postoperatively. RESULTS The mean age of our patients was 37.17 ± 13.83 years and the age range was 17 to 63 years. The primary cause of surgery was trauma in the majority of cases (n = 31, 65.96%). The mean operative time was 78.55 ± 19.82 minutes. The cosmetic results were very satisfying in 46 of 47 (97.87%) patients and moderately satisfying in 1 (2.12%) patient. Overall, there were three (6.38%) complications. CONCLUSION Our technique provides excellent functional and cosmetic outcomes. The overall surgical cost of these PMMA implants was lower than that of the other available cranioplasty implants. This technique is currently the most cost-effective option for cranioplasty.
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Affiliation(s)
- Hanuman Prasad Prajapati
- Department of Neurosurgery, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India
| | - Deepak Kumar Singh
- Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Systermans S, Cobraiville E, Camby S, Meyer C, Louvrier A, Lie SA, Schouman T, Siciliano S, Beckers O, Poulet V, Ullmann N, Nolens G, Biscaccianti V, Nizet JL, Hascoët JY, Gilon Y, Vidal L. An innovative 3D hydroxyapatite patient-specific implant for maxillofacial bone reconstruction: A case series of 13 patients. J Craniomaxillofac Surg 2024; 52:420-431. [PMID: 38461138 DOI: 10.1016/j.jcms.2024.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/28/2023] [Accepted: 02/17/2024] [Indexed: 03/11/2024] Open
Abstract
The study aimed to evaluate and discuss the use of an innovative PSI made of porous hydroxyapatite, with interconnected porosity promoting osteointegration, called MyBone Custom® implant (MBCI), for maxillofacial bone reconstruction. A multicentric cohort of 13 patients underwent maxillofacial bone reconstruction surgery using MBCIs for various applications, from genioplasty to orbital floor reconstruction, including zygomatic and mandibular bone reconstruction, both for segmental defects and bone augmentation. The mean follow-up period was 9 months (1-22 months). No infections, displacements, or postoperative fractures were reported. Perioperative modifications of the MBCIs were possible when necessary. Additionally, surgeons reported significant time saved during surgery. For patients with postoperative CT scans, osteointegration signs were visible at the 6-month postoperative follow-up control, and continuous osteointegration was observed after 1 year. The advantages and disadvantages compared with current techniques used are discussed. MBCIs offer new bone reconstruction possibilities with long-term perspectives, while precluding the drawbacks of titanium and PEEK. The low level of postoperative complications associated with the high osteointegration potential of MBCIs paves the way to more extensive use of this new hydroxyapatite PSI in maxillofacial bone reconstruction.
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Affiliation(s)
- Simon Systermans
- Department of Plastic and Maxillofacial Surgery, CHU, University of Liège, Liège, Belgium; Department of Oral and Maxillofacial Surgery, ZOL Genk, Genk, Belgium
| | | | - Séverine Camby
- Department of Plastic and Maxillofacial Surgery, CHU, University of Liège, Liège, Belgium
| | - Christophe Meyer
- Chirurgie Maxillo-Faciale, Stomatologie et Odontologie Hospitalière, CHU, Université de Franche-Comté, Besançon, France
| | - Aurélien Louvrier
- Chirurgie Maxillo-Faciale, Stomatologie et Odontologie Hospitalière, CHU, Université de Franche-Comté, Besançon, France
| | - Suen An Lie
- Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Thomas Schouman
- Department of Maxillofacial Surgery, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Assistance Publique des Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Sergio Siciliano
- Department of Stomatology and Maxillofacial Surgery, Clinique Sainte Elisabeth, Brussels, Belgium
| | - Olivier Beckers
- Department of Oral and Maxillofacial Surgery, ZOL Genk, Genk, Belgium
| | - Vinciane Poulet
- Department of Maxillofacial Surgery, Toulouse Purpan University Hospital, Toulouse, France
| | - Nicolas Ullmann
- Service de Chirurgie Maxillo-faciale et Stomatologie, Hôpital de Villeneuve Saint Georges, France
| | | | - Vincent Biscaccianti
- Research Institute of Civil Engineering and Mechanics (GeM), CNRS, Nantes, France
| | - Jean-Luc Nizet
- Department of Plastic and Maxillofacial Surgery, CHU, University of Liège, Liège, Belgium
| | - Jean-Yves Hascoët
- Research Institute of Civil Engineering and Mechanics (GeM), CNRS, Nantes, France
| | - Yves Gilon
- Department of Plastic and Maxillofacial Surgery, CHU, University of Liège, Liège, Belgium
| | - Luciano Vidal
- Research Institute of Civil Engineering and Mechanics (GeM), CNRS, Nantes, France; Department of Plastic and Reconstructive Surgery, Clinique Bretéché - ELSAN, Nantes, France.
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Negrescu AM, Mocanu AC, Miculescu F, Mitran V, Constantinescu AE, Cimpean A. In Vitro Studies on 3D-Printed PLA/HA/GNP Structures for Bone Tissue Regeneration. Biomimetics (Basel) 2024; 9:55. [PMID: 38275452 PMCID: PMC10813057 DOI: 10.3390/biomimetics9010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/29/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
The successful regeneration of large-size bone defects remains one of the most critical challenges faced in orthopaedics. Recently, 3D printing technology has been widely used to fabricate reliable, reproducible and economically affordable scaffolds with specifically designed shapes and porosity, capable of providing sufficient biomimetic cues for a desired cellular behaviour. Natural or synthetic polymers reinforced with active bioceramics and/or graphene derivatives have demonstrated adequate mechanical properties and a proper cellular response, attracting the attention of researchers in the bone regeneration field. In the present work, 3D-printed graphene nanoplatelet (GNP)-reinforced polylactic acid (PLA)/hydroxyapatite (HA) composite scaffolds were fabricated using the fused deposition modelling (FDM) technique. The in vitro response of the MC3T3-E1 pre-osteoblasts and RAW 264.7 macrophages revealed that these newly designed scaffolds exhibited various survival rates and a sustained proliferation. Moreover, as expected, the addition of HA into the PLA matrix contributed to mimicking a bone extracellular matrix, leading to positive effects on the pre-osteoblast osteogenic differentiation. In addition, a limited inflammatory response was also observed. Overall, the results suggest the great potential of the newly developed 3D-printed composite materials as suitable candidates for bone tissue engineering applications.
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Affiliation(s)
- Andreea-Mariana Negrescu
- Department of Biochemistry and Molecular Biology, Faculty of Biology, University of Bucharest, 91-95 Splaiul Independentei, 050095 Bucharest, Romania; (A.-M.N.); (V.M.)
| | - Aura-Cătălina Mocanu
- Department of Metallic Materials Science, Physical Metallurgy, National University of Science and Technology Politehnica Bucharest, 313 Splaiul Independentei, J Building, District 6, 060042 Bucharest, Romania; (A.-C.M.); (F.M.); (A.-E.C.)
| | - Florin Miculescu
- Department of Metallic Materials Science, Physical Metallurgy, National University of Science and Technology Politehnica Bucharest, 313 Splaiul Independentei, J Building, District 6, 060042 Bucharest, Romania; (A.-C.M.); (F.M.); (A.-E.C.)
| | - Valentina Mitran
- Department of Biochemistry and Molecular Biology, Faculty of Biology, University of Bucharest, 91-95 Splaiul Independentei, 050095 Bucharest, Romania; (A.-M.N.); (V.M.)
| | - Andreea-Elena Constantinescu
- Department of Metallic Materials Science, Physical Metallurgy, National University of Science and Technology Politehnica Bucharest, 313 Splaiul Independentei, J Building, District 6, 060042 Bucharest, Romania; (A.-C.M.); (F.M.); (A.-E.C.)
| | - Anisoara Cimpean
- Department of Biochemistry and Molecular Biology, Faculty of Biology, University of Bucharest, 91-95 Splaiul Independentei, 050095 Bucharest, Romania; (A.-M.N.); (V.M.)
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Rafikova G, Piatnitskaia S, Shapovalova E, Chugunov S, Kireev V, Ialiukhova D, Bilyalov A, Pavlov V, Kzhyshkowska J. Interaction of Ceramic Implant Materials with Immune System. Int J Mol Sci 2023; 24:4200. [PMID: 36835610 PMCID: PMC9959507 DOI: 10.3390/ijms24044200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/30/2023] [Accepted: 02/07/2023] [Indexed: 02/22/2023] Open
Abstract
The immuno-compatibility of implant materials is a key issue for both initial and long-term implant integration. Ceramic implants have several advantages that make them highly promising for long-term medical solutions. These beneficial characteristics include such things as the material availability, possibility to manufacture various shapes and surface structures, osteo-inductivity and osteo-conductivity, low level of corrosion and general biocompatibility. The immuno-compatibility of an implant essentially depends on the interaction with local resident immune cells and, first of all, macrophages. However, in the case of ceramics, these interactions are insufficiently understood and require intensive experimental examinations. Our review summarizes the state of the art in variants of ceramic implants: mechanical properties, different chemical modifications of the basic material, surface structures and modifications, implant shapes and porosity. We collected the available information about the interaction of ceramics with the immune system and highlighted the studies that reported ceramic-specific local or systemic effects on the immune system. We disclosed the gaps in knowledge and outlined the perspectives for the identification to ceramic-specific interactions with the immune system using advanced quantitative technologies. We discussed the approaches for ceramic implant modification and pointed out the need for data integration using mathematic modelling of the multiple ceramic implant characteristics and their contribution for long-term implant bio- and immuno-compatibility.
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Affiliation(s)
- Guzel Rafikova
- Laboratory of Immunology, Institute of Urology and Clinical Oncology, Bashkir State Medical University, 450008 Ufa, Russia
| | - Svetlana Piatnitskaia
- Institute of Fundamental Medicine, Bashkir State Medical University, 450008 Ufa, Russia
| | - Elena Shapovalova
- Department of Chemistry, Tomsk State University, 634050 Tomsk, Russia
| | | | - Victor Kireev
- Institute of Fundamental Medicine, Bashkir State Medical University, 450008 Ufa, Russia
- Department of Applied Physics, Ufa University of Science and Technology, 450076 Ufa, Russia
| | - Daria Ialiukhova
- Institute of Fundamental Medicine, Bashkir State Medical University, 450008 Ufa, Russia
| | - Azat Bilyalov
- Institute of Fundamental Medicine, Bashkir State Medical University, 450008 Ufa, Russia
| | | | - Julia Kzhyshkowska
- Institute of Fundamental Medicine, Bashkir State Medical University, 450008 Ufa, Russia
- Department of Chemistry, Tomsk State University, 634050 Tomsk, Russia
- Institute of Transfusion Medicine and Immunology, Mannheim Institute of Innate Immunosciecnes (MI3), Medical Faculty Mannheim, Heidelberg University, 69117 Mannheim, Germany
- German Red Cross Blood Service Baden-Württemberg, 68167 Mannheim, Germany
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A Review of 3D Polymeric Scaffolds for Bone Tissue Engineering: Principles, Fabrication Techniques, Immunomodulatory Roles, and Challenges. Bioengineering (Basel) 2023; 10:bioengineering10020204. [PMID: 36829698 PMCID: PMC9952306 DOI: 10.3390/bioengineering10020204] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 02/09/2023] Open
Abstract
Over the last few years, biopolymers have attracted great interest in tissue engineering and regenerative medicine due to the great diversity of their chemical, mechanical, and physical properties for the fabrication of 3D scaffolds. This review is devoted to recent advances in synthetic and natural polymeric 3D scaffolds for bone tissue engineering (BTE) and regenerative therapies. The review comprehensively discusses the implications of biological macromolecules, structure, and composition of polymeric scaffolds used in BTE. Various approaches to fabricating 3D BTE scaffolds are discussed, including solvent casting and particle leaching, freeze-drying, thermally induced phase separation, gas foaming, electrospinning, and sol-gel techniques. Rapid prototyping technologies such as stereolithography, fused deposition modeling, selective laser sintering, and 3D bioprinting are also covered. The immunomodulatory roles of polymeric scaffolds utilized for BTE applications are discussed. In addition, the features and challenges of 3D polymer scaffolds fabricated using advanced additive manufacturing technologies (rapid prototyping) are addressed and compared to conventional subtractive manufacturing techniques. Finally, the challenges of applying scaffold-based BTE treatments in practice are discussed in-depth.
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Preliminary results of customized bone graft made by robocasting hydroxyapatite and tricalcium phosphates for oral surgery. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 135:192-203. [PMID: 36089487 DOI: 10.1016/j.oooo.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/24/2022] [Accepted: 06/05/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study was to assess the mechanical characteristics and the clinical usefulness of beta-tricalcium phosphate (β-TCP) and hydroxyapatite (HA) bioblocks grafted in edentulous jaws of 12 patients. METHODS The scaffolds were produced by robocasting ceramic inks containing 80%/20% β-TCP and HA, respectively, with an overall porosity of 60%, with a macropore size between 300 and 500 μm. The mechanical performance of cylindrical vs conical specimens was compared using a universal testing machine. The clinical study was performed on 12 edentulous patients who received 4 cylindrical bone bioblocks. After 10 to 16 weeks of osseointegration, the bioblocks were explanted with trephine for histologic analysis by Goldner and Von Kossa staining. RESULTS Conical shapes were significantly stronger (96.4 ± 8.7 MPa) than cylindrical shapes (87.8 ± 12.2 MPa). The overall degree of porosity ranged from 53.4% to 58.1% in the coronal region to 62.5% to 66.9% at the apex. After the maturation period, 41 valid bioblocks (85.4%) were obtained for histologic study. Bone showing some cellularity was found in 68.4% of the samples, indicating biologically active bone, and adequate calcification was found in 31.7% of the samples. In terms of biomaterial degradation, 73.2% of the samples were completely resorbed or showed significant resorption. CONCLUSIONS The 80%/20% β-TCP and HA grafts customized by robocasting appear adequate for regenerating self-contained defects.
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Zhang X, Chen JL, Xing F, Duan X. Three-dimensional printed polylactic acid and hydroxyapatite composite scaffold with urine-derived stem cells as a treatment for bone defects. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2022; 33:71. [PMID: 36190568 PMCID: PMC9529701 DOI: 10.1007/s10856-022-06686-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 08/22/2022] [Indexed: 06/16/2023]
Abstract
Bone defects still pose various challenges in osteology. As one treatment method for bone defects, tissue engineering requires biomaterials with good biocompatibility and stem cells with good differentiation. This study aimed to fabricate a 3D-printed polylactic acid and hydroxyapatite (PLA/HA) composite scaffold with urine-derived stem cells (USCs) to study its therapeutic effect in a rat model of skull defects. USCs were isolated and extracted from the urine of healthy adult males and inoculated onto PLA/HA and PLA scaffolds fabricated by 3D printing technology. A total of 36 skull defect models in eighteen Sprague-Dawley rats were randomly divided into a control group (no treatment of the defects), PLA group (treated with PLA scaffolds with USCs), and PLA/HA group (treated with PLA/HA scaffolds with USCs). The therapeutic efficacy was evaluated by real-time PCR, microcomputed tomography (micro-CT), and immunohistochemistry at 4, 8, and 12 weeks. We found that the PLA/HA scaffold loaded with USCs effectively promoted new bone regeneration in the defect area. CT images showed that in the PLA/HA group, the defect area was almost entirely covered by newly formed bone (coverage of 96.7 ± 1.6%), and the coverage was greater than that in the PLA group (coverage of 74.6 ± 1.9%) at 12 weeks. Histology and immunohistochemical staining showed the highest new bone formation on the PLA/HA scaffolds containing USCs in the defect site at 12 weeks. These findings demonstrate the broad application prospects of PLA/HA scaffolds with USCs in bone tissue engineering. Graphical abstract.
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Affiliation(s)
- Xiang Zhang
- Department of Orthopaedics, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Jia-Lei Chen
- Department of Orthopaedics, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Fei Xing
- Department of Orthopaedics, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Xin Duan
- Department of Orthopaedics, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, China.
- Department of Orthopedics, Ganzi Tibetan Autonomous Prefecture People's Hospital, Ganzi Prefecture, 626700, Sichuan, China.
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From Reparative Surgery to Regenerative Surgery: State of the Art of Porous Hydroxyapatite in Cranioplasty. Int J Mol Sci 2022; 23:ijms23105434. [PMID: 35628245 PMCID: PMC9140937 DOI: 10.3390/ijms23105434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/06/2022] [Accepted: 05/12/2022] [Indexed: 02/05/2023] Open
Abstract
Decompressive craniectomy is one of the most common neurosurgical procedures, usually performed after neuropathological disorders, such as traumatic brain injury (TBI), but also vascular accidents (strokes), erosive tumours, infections and other congenital abnormalities. This procedure is usually followed by the reconstruction of the cranial vault, which is also known as cranioplasty (CP). The gold-standard material for the reconstruction process is the autologous bone of the patient. However, this is not always a feasible option for all patients. Several heterologous materials have been created in the last decades to overcome such limitation. One of the most prominent materials that started to be used in CP is porous hydroxyapatite. PHA is a bioceramic material from the calcium phosphate family. It is already widely used in other medical specialties and only recently in neurosurgery. In this narrative review of the literature, we summarize the evidence on the use of PHA for cranial reconstruction, highlighting the clinical properties and limitations. We also explain how this material contributed to changing the concept of cranial reconstruction from reparative to regenerative surgery.
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Splavski B, Lakicevic G, Kovacevic M, Godec D. Customized alloplastic cranioplasty of large bone defects by 3D-printed prefabricated mold template after posttraumatic decompressive craniectomy: A technical note. Surg Neurol Int 2022; 13:169. [PMID: 35509538 PMCID: PMC9062916 DOI: 10.25259/sni_1239_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/16/2022] [Indexed: 11/09/2022] Open
Abstract
Background Manufacturing of customized three-dimensional (3D)-printed cranioplastic implant after decompressive craniectomy has been introduced to overcome the difficulties of intraoperative implant molding. The authors present and discuss the technique, which consists of the prefabrication of silicone implant mold using additive manufacturing, also known as 3D printing, and polymethyl methacrylate (PMMA) implant casting. Methods To reconstruct a large bone defect sustained after decompressive craniectomy due to traumatic brain injury (TBI), a 3D-printed prefabricated mold template was used to create a customized PMMA implant for cranial vault repair in five consecutive patients. Results A superb restoration of the symmetrical contours and curvature of the cranium was achieved in all patients. The outcome was clinically and cosmetically favorable in all of them. Conclusion Customized alloplastic cranioplasty using 3D-printed prefabricated mold for casting PMMA implant is easy to perform technique for the restoration of cranial vault after a decompressive craniectomy following moderate-to-severe TBI. It is a valuable and modern technique to advance manufacturing of personalized prefabricated cranioplastic implants used for the reconstruction of large skull defects having complex geometry. It is a safe and cost-effective procedure having an excellent cosmetic outcome, which may considerably decrease expenses and time needed for cranial reconstructive surgery.
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Affiliation(s)
- Bruno Splavski
- Department of Neurosurgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Goran Lakicevic
- Department of Neurosurgery, Mostar University Hospital, Mostar, Bosnia and Herzegovina, Osijek, Croatia
| | - Marko Kovacevic
- Department of Neurosurgery, Osijek University Hospital Center, Osijek, Croatia
| | - Damir Godec
- Department of Technology, Chair of Polymer Processing, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia
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Park H, Choi JW, Jeong WS. Clinical Application of Three-Dimensional Printing of Polycaprolactone/Beta-Tricalcium Phosphate Implants for Cranial Reconstruction. J Craniofac Surg 2022; 33:1394-1399. [PMID: 35261367 PMCID: PMC9275841 DOI: 10.1097/scs.0000000000008595] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/12/2022] [Indexed: 11/25/2022] Open
Abstract
Polycaprolactone (PCL) implants are a biodegradable polymeric material with appropriate mechanical strength and durability for use in cranioplasty. They can be manufactured as patient- customized implants using a three-dimensional (3D) printer. Herein, the authors aimed to share our experience in cranioplasty of patients with deformed and asymmetric skulls using PCL/beta- tricalcium phosphate (ß-TCP) implants. Seven patients underwent cranioplasty using patient-specific PCL/ß-TCP implants. Cranial computed tomography images were converted to a 3D model and mirrored to design a patient-specific implant. Based on the 3D simulation, an implant was 3D printed using PCL/ß-TCP. A 6-month follow-up was conducted with periodic visits and computed tomography scans. Symmetry after surgery and complications were evaluated. Postoperatively, the soft tissue volumes increased to 15.8 ± 17.2 cm3 and 14.9 ± 15.7 cm3 at 2 weeks and 6 months of follow-up, respectively. The volume change from 2 weeks to 6 months was —4.4 ± 2.5%. Six patients achieved complete symmetry after cranioplasty, whereas 1 patient noticed partial symmetry. The symmetry remained unchanged at 6 months of follow-up. Upon palpation to assess smoothness, 6 patients exhibited a smooth edge interface, whereas 1 patient had a slightly irregular edge. Based on these findings, 3D-printed PCL/ß-TCP implants are an excellent material for cranioplasty, and a favorable cosmetic outcome can be achieved. Specifically, these novel PCL/ß-TCP implants have good biocompatibility and mechanical strength without any postoperative foreign body reaction.
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Affiliation(s)
- Hojin Park
- Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
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Di Rienzo A, Colasanti R, Dobran M, Formica F, Della Costanza M, Carrassi E, Aiudi D, Iacoangeli M. Management of infected hydroxyapatite cranioplasty: Is salvage feasible? BRAIN AND SPINE 2022; 2:100907. [PMID: 36248178 PMCID: PMC9560697 DOI: 10.1016/j.bas.2022.100907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/13/2022] [Accepted: 06/19/2022] [Indexed: 11/30/2022]
Abstract
Introduction The use of hydroxyapatite cranioplasties has grown progressively over the past few decades. The peculiar biological properties of this material make it particularly suitable for patients with decompressive craniectomy where bone reintegration is a primary objective. However, hydroxyapatite infection rates are similar to those of other reconstructive materials. Research question We investigated if infected hydroxyapatite implants could be saved or not. Materials and methods We present a consecutive series over a 10-year period of nine patients treated for hydroxyapatite cranioplasty infection. Clinical and radiological data from admission and follow-up, photo and video material documenting the different phases of infection assessment and treatment, and final outcomes were retrospectively reviewed in an attempt to identify the best options and possible pitfalls in a case-by-case decision-making process. Results Five unilateral and four bifrontal implants became infected. Wound rupture with cranioplasty exposure was the most common presentation. At revision, all implants were ossified, requiring a new craniotomy to clean the purulent epidural collections. The cranioplasty was fully saved in one hemispheric and 2 bifrontal implants and partially saved in the remaining 2 bifrontal implants. A complete cranioplasty removal was needed in the other 4 cases, but immediate cranial reconstruction was possible in 2. Skin defects were covered by free flaps in 3 cases. Four patients underwent adjunctive hyperbaric therapy, which was effective in one case. Discussion and conclusion In our experience, infected hydroxyapatite cranioplasty management is complex and requires a multidisciplinary approach. Salvage of a hydroxyapatite implant is possible under specific circumstances. We present a series of 9 patients treated for hydroxyapatite cranioplasty infection. One hemispheric and 2 bifrontal implants were fully saved, 2 bifrontal only partially. A complete removal was needed in 4 cases, but immediate cranial reconstruction was possible in 2. Infected hydroxyapatite cranioplasties salvage is complex, but possible under specific circumstances.
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Montero J, Becerro A, Pardal-Peláez B, Quispe-López N, Blanco JF, Gómez-Polo C. Main 3D Manufacturing Techniques for Customized Bone Substitutes. A Systematic Review. MATERIALS 2021; 14:ma14102524. [PMID: 34066290 PMCID: PMC8152095 DOI: 10.3390/ma14102524] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/01/2021] [Accepted: 05/09/2021] [Indexed: 12/12/2022]
Abstract
Clinicians should be aware of the main methods and materials to face the challenge of bone shortage by manufacturing customized grafts, in order to repair defects. This study aims to carry out a bibliographic review of the existing methods to manufacture customized bone scaffolds through 3D technology and to identify their current situation based on the published papers. A literature search was carried out using "3D scaffold", "bone regeneration", "robocasting" and "3D printing" as descriptors. This search strategy was performed on PubMed (MEDLINE), Scopus and Cochrane Library, but also by hand search in relevant journals and throughout the selected papers. All the papers focusing on techniques for manufacturing customized bone scaffolds were reviewed. The 62 articles identified described 14 techniques (4 subtraction + 10 addition techniques). Scaffold fabrication techniques can be also be classified according to the time at which they are developed, into Conventional techniques and Solid Freeform Fabrication techniques. The conventional techniques are unable to control the architecture of the pore and the pore interconnection. However, current Solid Freeform Fabrication techniques allow individualizing and generating complex geometries of porosity. To conclude, currently SLA (Stereolithography), Robocasting and FDM (Fused deposition modeling) are promising options in customized bone regeneration.
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14
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Amelot A, Nataloni A, François P, Cook AR, Lejeune JP, Baroncini M, Hénaux PL, Toussaint P, Peltier J, Buffenoir K, Hamel O, Hieu PD, Chibbaro S, Kehrli P, Lahlou MA, Menei P, Lonjon M, Mottolese C, Peruzzi P, Mahla K, Scarvada D, Le Guerinel C, Caillaud P, Nuti C, Pommier B, Faillot T, Iakovlev G, Goutagny S, Lonjon N, Cornu P, Bousquet P, Sabatier P, Debono B, Lescure JP, Vicaut E, Froelich S. Security and reliability of CUSTOMBONE cranioplasties: A prospective multicentric study. Neurochirurgie 2021; 67:301-309. [PMID: 33667533 DOI: 10.1016/j.neuchi.2021.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 02/07/2021] [Accepted: 02/13/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Repairing bone defects generated by craniectomy is a major therapeutic challenge in terms of bone consolidation as well as functional and cognitive recovery. Furthermore, these surgical procedures are often grafted with complications such as infections, breaches, displacements and rejections leading to failure and thus explantation of the prosthesis. OBJECTIVE To evaluate cumulative explantation and infection rates following the implantation of a tailored cranioplasty CUSTOMBONE prosthesis made of porous hydroxyapatite. One hundred and ten consecutive patients requiring cranial reconstruction for a bone defect were prospectively included in a multicenter study constituted of 21 centres between December 2012 and July 2014. Follow-up lasted 2 years. RESULTS Mean age of patients included in the study was 42±15 years old (y.o), composed mainly by men (57.27%). Explantations of the CUSTOMBONE prosthesis were performed in 13/110 (11.8%) patients, significantly due to infections: 9/13 (69.2%) (p<0.0001), with 2 (15.4%) implant fracture, 1 (7.7%) skin defect and 1 (7.7%) following the mobilization of the implant. Cumulative explantation rates were successively 4.6% (SD 2.0), 7.4% (SD 2.5), 9.4% (SD 2.8) and 11.8% (SD 2.9%) at 2, 6, 12 and 24 months. Infections were identified in 16/110 (14.5%): 8/16 (50%) superficial and 8/16 (50%) deep. None of the following elements, whether demographic characteristics, indications, size, location of the implant, redo surgery, co-morbidities or medical history, were statistically identified as risk factors for prosthesis explantation or infection. CONCLUSION Our study provides relevant clinical evidence on the performance and safety of CUSTOMBONE prosthesis in cranial procedures. Complications that are difficulty incompressible mainly occur during the first 6 months, but can appear at a later stage (>1 year). Thus assiduous, regular and long-term surveillances are necessary.
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Affiliation(s)
- A Amelot
- Neurosurgery department, Hôpital de Bretonneau, Tours, France.
| | - A Nataloni
- Clinical research department, Finceramica Faenza S.p.A, Ravenna, Italy
| | - P François
- Neurosurgery department, Hôpital de Bretonneau, Tours, France
| | - A-R Cook
- Neurosurgery department, Hôpital de Bretonneau, Tours, France
| | - J-P Lejeune
- Neurosurgery department, CHRU Lille, Lille, France
| | - M Baroncini
- Neurosurgery department, CHRU Lille, Lille, France
| | - P-L Hénaux
- Neurosurgery department, CHU Rennes, Rennes, France
| | - P Toussaint
- Neurosurgery department, CHU Amiens, Amiens, France
| | - J Peltier
- Neurosurgery department, CHU Amiens, Amiens, France
| | - K Buffenoir
- Neurosurgery department, CHU Nantes, Nantes, France
| | - O Hamel
- Neurosurgery department, CHU Nantes, Nantes, France
| | - P Dam Hieu
- Neurosurgery department, CHU Brest, Brest, France
| | - S Chibbaro
- Neurosurgery department, CHU Strasbourg, Strasbourg, France
| | - P Kehrli
- Neurosurgery department, CHU Angers, Angers, France
| | - M A Lahlou
- Neurosurgery department, CHU Strasbourg, Strasbourg, France
| | - P Menei
- Neurosurgery department, CHU Angers, Angers, France
| | - M Lonjon
- Neurosurgery department, CHU Nice, Nice, France
| | - C Mottolese
- Neurosurgery department, CHU Neurologique Lyon, Lyon, France
| | - P Peruzzi
- Neurosurgery department, CHU Maison Blanche, Reims, France
| | - K Mahla
- Neurosurgery department, clinique du Tonkin, Villeurbanne, France
| | - D Scarvada
- Neurosurgery department, CHU La Timone, Marseille, France
| | - C Le Guerinel
- Neurosurgery department, CHU Henri Mondor, Creteil, France
| | - P Caillaud
- Neurosurgery department, CH de la Côte Basque, Bayonne, France
| | - C Nuti
- Neurosurgery department, CHU St Etienne, St Etienne, France
| | - B Pommier
- Neurosurgery department, CHU St Etienne, St Etienne, France
| | - T Faillot
- Neurosurgery department, CHU Hôpital Beaujon, Clichy, France
| | - G Iakovlev
- Neurosurgery department, CHU Hôpital Beaujon, Clichy, France
| | - S Goutagny
- Neurosurgery department, CHU Hôpital Beaujon, Clichy, France
| | - N Lonjon
- Neurosurgery department, CHU Gui de Chauliac, Montpellier, France
| | - P Cornu
- Neurosurgery department, CHU Pitié-Salpêtrière, Paris, France
| | - P Bousquet
- Neurosurgery department, Clinique des Cèdres, Cornebarrieu, France
| | - P Sabatier
- Neurosurgery department, Clinique des Cèdres, Cornebarrieu, France
| | - B Debono
- Neurosurgery department, Clinique des Cèdres, Cornebarrieu, France
| | - J-P Lescure
- Neurosurgery department, Clinique des Cèdres, Cornebarrieu, France
| | - E Vicaut
- Clinical research unit (URC), Hôpital de Lariboisière, APHP, Paris, France
| | - S Froelich
- Neurosurgery department, Hôpital de Lariboisière, APHP, Paris, France
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Sengupta SK, Kumar AN, Maurya V, Bajaj H, Yadav KK, G. AK, Faujdar DS. Bony Union and Flap Resorption in Cranioplasty with Autologous Subcutaneous Pocket Preserved Bone Flap: Early Report on an Ambidirectional CT Scan-Based Study. INDIAN JOURNAL OF NEUROSURGERY 2021. [DOI: 10.1055/s-0040-1714317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Introduction Absence of sufficient number of prospective randomized controlled studies and comparatively small sample size and short follow-up period of most of the studies, available so far, have left ambiguity and lack of standardization of different aspects of cranioplasty.
Materials and Methods This is an early report of a computed tomography scan image-based ambidirectional study on cranioplasties performed with autologous subcutaneous pocket preserved bone flaps. Retrospective arm compared bony union and factors influencing it between cranioplasties and craniotomies. Patients with poor bony union and aseptic resorption were followed up in the prospective arm.
Results Retrospective arm of the study, followed up for five years (mean 32.2 months), comprised 42 patients as cases (Group 1) and 29 as controls (Group 2). Twenty-seven individuals (64.3%) in Group 1 had good bony union, as compared with 20 (68.9%) good unions in Group 2 out of the 29 patients. Four patients (9.5%) in Group 1 showed evidence of flap resorption, a finding absent in any patient in Group 2. Age, sex, smoking habits, superficial skin infection, and method of fixation did not appear to have any implication on bony union. Craniotomies done using Gigli saws fared better as compared with those done with pneumatic saw with lesser flap size–craniectomy size discrepancy, though it was not statistically significant. Fifteen patients have been included in the Prospective arm at the time of submission of this article.
Conclusion Ours is a study with a small sample size, unable to put its weight on any side, but can surely add some more data to help the Neurosurgeons in choosing the best for their patients.
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Affiliation(s)
- Sudip Kumar Sengupta
- Department of Neurosurgery, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - Andrews Navin Kumar
- Department of Maxillofacial Surgery, Command Medical Dental Centre (Eastern Command), Kolkata, West Bengal, India
| | - Vinay Maurya
- Department of Radiodiagnosis, Base Hospital Delhi Cantonment, New Delhi, India
| | - Harish Bajaj
- Department of Neurosurgery, Command Hospital (Eastern Command), Kolkata, West Bengal, India
| | - Krishan Kumar Yadav
- Department of Neurosurgery, Command Hospital (Eastern Command), Kolkata, West Bengal, India
| | - Ashwath K. G.
- Department of Neurosurgery, Command Hospital (Eastern Command), Kolkata, West Bengal, India
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Iaccarino C, Kolias A, Adelson PD, Rubiano AM, Viaroli E, Buki A, Cinalli G, Fountas K, Khan T, Signoretti S, Waran V, Adeleye AO, Amorim R, Bertuccio A, Cama A, Chesnut RM, De Bonis P, Estraneo A, Figaji A, Florian SI, Formisano R, Frassanito P, Gatos C, Germanò A, Giussani C, Hossain I, Kasprzak P, La Porta F, Lindner D, Maas AIR, Paiva W, Palma P, Park KB, Peretta P, Pompucci A, Posti J, Sengupta SK, Sinha A, Sinha V, Stefini R, Talamonti G, Tasiou A, Zona G, Zucchelli M, Hutchinson PJ, Servadei F. Consensus statement from the international consensus meeting on post-traumatic cranioplasty. Acta Neurochir (Wien) 2021; 163:423-440. [PMID: 33354733 PMCID: PMC7815592 DOI: 10.1007/s00701-020-04663-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/28/2020] [Indexed: 12/26/2022]
Abstract
Background Due to the lack of high-quality evidence which has hindered the development of evidence-based guidelines, there is a need to provide general guidance on cranioplasty (CP) following traumatic brain injury (TBI), as well as identify areas of ongoing uncertainty via a consensus-based approach. Methods The international consensus meeting on post-traumatic CP was held during the International Conference on Recent Advances in Neurotraumatology (ICRAN), in Naples, Italy, in June 2018. This meeting was endorsed by the Neurotrauma Committee of the World Federation of Neurosurgical Societies (WFNS), the NIHR Global Health Research Group on Neurotrauma, and several other neurotrauma organizations. Discussions and voting were organized around 5 pre-specified themes: (1) indications and technique, (2) materials, (3) timing, (4) hydrocephalus, and (5) paediatric CP. Results The participants discussed published evidence on each topic and proposed consensus statements, which were subject to ratification using anonymous real-time voting. Statements required an agreement threshold of more than 70% for inclusion in the final recommendations. Conclusions This document is the first set of practical consensus-based clinical recommendations on post-traumatic CP, focusing on timing, materials, complications, and surgical procedures. Future research directions are also presented.
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Dabadi S, Dhungel RR, Sharma U, Shrestha D, Gurung P, Shrestha R, Pant B. Customized Cost-Effective Polymethyl-Methacrylate Cranioplasty Implant Using Three-Dimensional Printer. Asian J Neurosurg 2021; 16:150-154. [PMID: 34211884 PMCID: PMC8202387 DOI: 10.4103/ajns.ajns_441_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/11/2021] [Accepted: 01/26/2021] [Indexed: 01/01/2023] Open
Abstract
There is no doubt that many synthetic materials used in cranioplasty have given good result regarding patient's calvarial shape. However, the use of these materials is costly to the patient and requires complex intraoperative process. There has been a long history regarding the use of acrylic bone cement called as polymethyl-methacrylate (PMMA) as an implant due to its desirable properties. Here, we present three cases of simple, cost effective manually sculpted calvarial defect using three-dimensional (3D) printer. Sharing the achievement and challenges, we want to focus that the 3D customized implant of PMMA can be used as bone substitute.
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Affiliation(s)
- Sambardhan Dabadi
- Department of Biomedical Engineering, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Raju Raj Dhungel
- Department of Biomedical Engineering, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Upama Sharma
- Department of Neurosurgery, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Dinuj Shrestha
- Department of Neurosurgery, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Pritam Gurung
- Department of Neurosurgery, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Resha Shrestha
- Department of Neurosurgery, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Basant Pant
- Department of Neurosurgery, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
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Babilotte J, Martin B, Guduric V, Bareille R, Agniel R, Roques S, Héroguez V, Dussauze M, Gaudon M, Le Nihouannen D, Catros S. Development and characterization of a PLGA-HA composite material to fabricate 3D-printed scaffolds for bone tissue engineering. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 118:111334. [PMID: 33254966 DOI: 10.1016/j.msec.2020.111334] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/30/2020] [Accepted: 08/02/2020] [Indexed: 02/03/2023]
Abstract
Additive manufacturing is a rising field in bone tissue engineering. Additive fabrication offers reproducibility, high precision and rapid manufacture of custom patient-specific scaffolds. The development of appropriate composite materials for biomedical applications is critical to reach clinical application of these novel biomaterials. In this work, medical grade poly(lactic-co-glycolic) acid (PLGA) was mixed with hydroxyapatite nanoparticles (nHA) to fabricate 3D porous scaffolds by Fused Deposition Modeling. We have first confirmed that the composite material could be printed in a reproductive manner. Physical characterization demonstrated a low degradation of the material during manufacturing steps and an expected loading and homogeneous distribution of nHA. In vitro biodegradation of the scaffolds showed modifications of morphological and physicochemical properties over time. The composite scaffolds were biocompatible and high cell viability was observed in vitro, as well as a maintain of cell proliferation. As expected, the addition of nHA displayed a positive impact on osteodifferentiation in vitro. Furthermore, a limited inflammatory reaction was observed after subcutaneous implantation of the materials in the rat. Overall, this study suggests that this composite material is suitable for bone tissue engineering applications.
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Affiliation(s)
| | - Benoit Martin
- Univ. Bordeaux, INSERM, BioTis U1026, 33076 Bordeaux, France
| | - Vera Guduric
- Univ. Bordeaux, INSERM, BioTis U1026, 33076 Bordeaux, France
| | - Reine Bareille
- Univ. Bordeaux, INSERM, BioTis U1026, 33076 Bordeaux, France
| | - Rémy Agniel
- CY Cergy Paris Université, Maison Internationale de la Recherche, Lab. ERRMECe, 95031 Neuville-Oise, France
| | - Samantha Roques
- Univ. Bordeaux, CIC1401, CHU Bordeaux, INSERM, 33076 Bordeaux, France
| | - Valérie Héroguez
- Laboratoire de Chimie des Polymères Organiques, CNRS, Bordeaux INP, UMR5629, 33607 Pessac, France
| | - Marc Dussauze
- Univ. Bordeaux, Institut des Sciences Moléculaires, UMR 5255 CNRS, 33405 Talence, France
| | - Manuel Gaudon
- CNRS, Univ. Bordeaux, Bordeaux INP, ICMCB, UMR5026, 33608 Pessac, France
| | | | - Sylvain Catros
- Univ. Bordeaux, INSERM, BioTis U1026, CHU Bordeaux, Dentistry and Oral Health Department, 33076 Bordeaux, France.
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In vitro and in vivo investigation of osteogenic properties of self-contained phosphate-releasing injectable purine-crosslinked chitosan-hydroxyapatite constructs. Sci Rep 2020; 10:11603. [PMID: 32665560 PMCID: PMC7360623 DOI: 10.1038/s41598-020-67886-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 05/18/2020] [Indexed: 01/05/2023] Open
Abstract
Bone fracture repair is a multifaceted, coordinated physiological process that requires new bone formation and resorption, eventually returning the fractured bone to its original state. Currently, a variety of different approaches are pursued to accelerate the repair of defective bones, which include the use of 'gold standard' autologous bone grafts. However, such grafts may not be readily available, and procedural complications may result in undesired outcomes. Considering the ease of use and tremendous customization potentials, synthetic materials may become a more suitable alternative of bone grafts. In this study, we examined the osteogenic potential of guanosine 5′-diphosphate-crosslinked chitosan scaffolds with the incorporation of hydroxyapatite, with or without pyrophosphatase activity, both in vitro and in vivo. First, scaffolds embedded with cells were characterized for cell morphology, viability, and attachment. The cell-laden scaffolds were found to significantly enhance proliferation for up to threefold, double alkaline phosphatase activity and osterix expression, and increase calcium phosphate deposits in vitro. Next, chitosan scaffolds were implanted at the fracture site in a mouse model of intramedullary rod-fixed tibial fracture. Our results showed increased callus formation at the fracture site with the scaffold carrying both hydroxyapatite and pyrophosphatase in comparison to the control scaffolds lacking both pyrophosphatase and hydroxyapatite, or pyrophosphatase alone. These results indicate that the pyrophosphatase-hydroxyapatite composite scaffold has a promising capacity to facilitate bone fracture healing.
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Custom-Made Porous Hydroxyapatite Cranioplasty in Patients with Tumor Versus Traumatic Brain Injury: A Single-Center Case Series. World Neurosurg 2020; 138:e922-e929. [PMID: 32272268 DOI: 10.1016/j.wneu.2020.03.144] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Cranioplasty is a common neurosurgical procedure with the goal of restoring skull integrity. Custom-made porous hydroxyapatite prostheses have long been used for cranial reconstruction in patients with traumatic brain injury. We present a large consecutive series of 2 groups of patients undergoing cranioplasty with hydroxyapatite custom bone and compare the adverse events (AEs) between the 2 groups. METHODS We examined a series of consecutive patients who underwent cranioplasty using custom-made porous hydroxyapatite implants following tumor resection and traumatic brain injury at a single center between March 2003 and May 2018. The implants were designed and produced according to the surgeon's specifications and based on the patient's computed tomography scan data obtained through a standardized protocol. AEs were recorded. RESULTS Information on 38 patients with tumor and 39 patients with traumatic brain injury was collected and analyzed. A significant difference in the timing of surgery was found between the 2 groups; single-stage surgery was performed in 84% of patients in the tumor versus 8% of those in the traumatic brain injury group (P < 0.0001). The rate of AEs was not significantly different between the 2 groups (P = 0.4309) and was not related to the timing of surgery. CONCLUSIONS Custom-made hydroxyapatite cranioplasty is a solution for cranial reconstruction in patients with cranial tumors. The low incidence of AEs in a consecutive series of patients with either trauma or tumors demonstrates that these prostheses represent a safe solution independent of the characteristics of cases.
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Szathmari A, Morgado A, Beuriat P, Petrescu P, Di Rocco F, Mottolese C. Cranioplasty for bone defects after craniosynostosis surgery. Case series with literature review. Neurochirurgie 2020; 66:97-101. [DOI: 10.1016/j.neuchi.2019.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 10/02/2019] [Accepted: 10/13/2019] [Indexed: 10/24/2022]
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Spennato P, Canella V, Aliberti F, Russo C, Ruggiero C, Nataloni A, Lombardo M, Cinalli G. Hydroxyapatite ceramic implants for cranioplasty in children: a retrospective evaluation of clinical outcome and osteointegration. Childs Nerv Syst 2020; 36:551-558. [PMID: 31786632 DOI: 10.1007/s00381-019-04423-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 10/29/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cranioplasty in children is a controversial and challenging issue, since there is still no consensus on the ideal material. Main problems in paediatric age are represented by the child's growing skull, the lower bone thickness and the high incidence of cerebrospinal fluid (CSF) disorders or brain swelling. Autologous bone is still considered the "gold standard". When it is not available, a wide range of alloplastic materials have been proposed. Hydroxyapatite, a ceramic-based derivative, bears a chemical composition very similar to the human natural bone, making this material a valuable alternative to other cranioplasty solutions. METHODS All patients implanted with a custom-made porous hydroxyapatite device at Santobono-Pausilipon Hospital in Naples were retrospectively reviewed. A follow-up CT scan of the skull was performed from 1 up to 48 months postoperatively to document the bone ingrowth as well as the osteointegration process. The bone density was measured as according to the Hounsfield scale at the bone-implant interface. RESULTS Between 2014 and 2018, 11 patients (7 males, 4 females) underwent cranioplasty with hydroxyapatite ceramic implants (HAP). Patients' age ranged between 3 and 16 years old. Initial aetiology was trauma in most cases. Two subjects were implanted with HAP as primary cranioplasty, 9 as revision surgery following previous cranioplasty failure. Sites of the cranial defect were unilateral fronto-temporo-parietal (N = 8), unilateral frontal (N = 1) and bifrontal (N = 2). Two patients with large bilateral defects received two prostheses. In one of these, the two prostheses were explanted and replaced with two back-up implants (accounting for a total of 15 implants in 11 patients). Osteointegration was measurable for 12 out of 15 implanted devices. The mean percentage was about 51%. There were six asymptomatic prosthesis fractures (40%), all occurring within 6 months from implant. In one case, the bifrontal prostheses were explanted and replaced. This was the only patient who underwent revision surgery. CONCLUSION Hydroxyapatite ceramic implants represent a valid alternative to other cranioplasty solutions. Where coaptation occurs correctly, with good osteointegration, implant mechanical resistance increases over time.
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Affiliation(s)
- Pietro Spennato
- Department of Neurosurgery Santobono-Pausipilon children's hospital, Naples, Italy.
| | | | - Ferdinado Aliberti
- Department of Neurosurgery Santobono-Pausipilon children's hospital, Naples, Italy
| | - Carmela Russo
- Department of Neuroradiology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Claudio Ruggiero
- Department of Neurosurgery Santobono-Pausipilon children's hospital, Naples, Italy
| | | | - Milena Lombardo
- Department of Neurosurgery Santobono-Pausipilon children's hospital, Naples, Italy
| | - Giuseppe Cinalli
- Department of Neurosurgery Santobono-Pausipilon children's hospital, Naples, Italy
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Iaccarino C, Kolias AG, Roumy LG, Fountas K, Adeleye AO. Cranioplasty Following Decompressive Craniectomy. Front Neurol 2020; 10:1357. [PMID: 32063880 PMCID: PMC7000464 DOI: 10.3389/fneur.2019.01357] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 12/09/2019] [Indexed: 11/13/2022] Open
Abstract
Cranioplasty (CP) after decompressive craniectomy (DC) for trauma is a neurosurgical procedure that aims to restore esthesis, improve cerebrospinal fluid (CSF) dynamics, and provide cerebral protection. In turn, this can facilitate neurological rehabilitation and potentially enhance neurological recovery. However, CP can be associated with significant morbidity. Multiple aspects of CP must be considered to optimize its outcomes. Those aspects range from the intricacies of the surgical dissection/reconstruction during the procedure of CP, the types of materials used for the reconstruction, as well as the timing of the CP in relation to the DC. This article is a narrative mini-review that discusses the current evidence base and suggests that no consensus has been reached about several issues, such as an agreement on the best material for use in CP, the appropriate timing of CP after DC, and the optimal management of hydrocephalus in patients who need cranial reconstruction. Moreover, the protocol-driven standards of care for traumatic brain injury (TBI) patients in high-resource settings are virtually out of reach for low-income countries, including those pertaining to CP. Thus, there is a need to design appropriate prospective studies to provide context-specific solid recommendations regarding this topic.
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Affiliation(s)
- Corrado Iaccarino
- Neurosurgery Unit, University Hospital of Parma, Parma, Italy.,Emergency Neurosurgery Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Angelos G Kolias
- Division of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.,NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Louis-Georges Roumy
- Department of Neurosurgery, Humanitas University and Research Hospital, Milan, Italy
| | - Kostas Fountas
- Department of Neurosurgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Amos Olufemi Adeleye
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom.,Division of Neurological Surgery, Department of Surgery, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
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Morselli C, Zaed I, Tropeano MP, Cataletti G, Iaccarino C, Rossini Z, Servadei F. Comparison between the different types of heterologous materials used in cranioplasty: a systematic review of the literature. J Neurosurg Sci 2019; 63:723-736. [PMID: 31599560 DOI: 10.23736/s0390-5616.19.04779-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The choice of heterologous materials for cranioplasty after decompressive craniectomy is still difficult. The aim of this study is to examine the association between material of choice and related complications to suggest the best treatment option. EVIDENCE ACQUISITION A systematic review was performed for articles reporting cranioplasty comparing the following heterologous implants: titanium, poli-methyl-methacrylate (PMMA), polyetheretherketone (PEEK) and hydroxyapatite (HA). Extracted data included implant materials and incidence of the most frequent complications. EVIDENCE SYNTHESIS The final selection resulted in 106 papers but according to our rules only 27 studies were included in the final analysis. Among a total of 1688 custom-made prosthesis implanted, 649 were titanium (38.49%), 298 PMMA (17.56%), 233 PEEK (13.82%), and 508 were HA (30.13%). A total of 348 complications were recorded out of 1688 reported patients (20.64%). In the titanium group, 139 complications were recorded (21.42%); in the PMMA group 57 (19.26%), in the PEEK group 49 (21.03%) and in the HA group 103 (20.3%). If we examine a summary of the reported complications clearly related to cranioplasty (postoperative infections, fractures and prosthesis displacement) versus type of material in multicentric and prospective studies we can see how HA group patients have less reported infections and cranioplasty explantation after infections than PMMA, PEEK and titanium. On the contrary HA patients seem to have a higher number of prosthesis displacement again if compared with the other materials. Since these data are not derived from a statistically correct analysis they should be used only to help to differentiate the properties of the various heterologous cranioplasties. CONCLUSIONS The ideal material for all heterologous cranioplasty has not yet been identified. The choice of material should be based on the clinical data of patients, such as the craniectomy size, presence of seizures, possibility of recovery, good long-term outcome associated with a cost analysis.
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Affiliation(s)
- Carlotta Morselli
- Humanitas University, Pieve Emanuele, Milan, Italy.,Department of Neuroscience, Sapienza University, Rome, Italy
| | - Ismail Zaed
- Department of Neurosurgery, Humanitas University and Research Hospital, Milan, Italy -
| | | | | | - Corrado Iaccarino
- Department of Neurosurgery, University Hospital of Parma, Parma, Italy
| | - Zefferino Rossini
- Department of Neurosurgery, Humanitas University and Research Hospital, Milan, Italy
| | - Franco Servadei
- Department of Neurosurgery, Humanitas University and Research Hospital, Milan, Italy
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Beuriat PA, Lohkamp LN, Szathmari A, Rousselle C, Sabatier I, Di Rocco F, Mottolese C. Repair of Cranial Bone Defects in Children Using Synthetic Hydroxyapatite Cranioplasty (CustomBone). World Neurosurg 2019; 129:e104-e113. [DOI: 10.1016/j.wneu.2019.05.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/04/2019] [Accepted: 05/06/2019] [Indexed: 11/17/2022]
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VanKoevering KK, Zopf DA, Hollister SJ. Tissue Engineering and 3-Dimensional Modeling for Facial Reconstruction. Facial Plast Surg Clin North Am 2019; 27:151-161. [PMID: 30420069 DOI: 10.1016/j.fsc.2018.08.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Three-dimensional (3D) printing has transformed craniofacial reconstruction over the last 2 decades. For cutaneous oncologic surgeons, several 3D printed technologies are available to assist with craniofacial bony reconstruction and preliminary soft tissue reconstructive efforts. With improved accessibility and simplified design software, 3D printing has opened the door for new techniques in anaplastology. Tissue engineering has more recently emerged as a promising concept for complex auricular and nasal reconstruction. Combined with 3D printing, several groups have demonstrated promising preclinical results with cartilage growth. This article highlights the applications and current state of 3D printing and tissue engineering in craniofacial reconstruction.
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Affiliation(s)
- Kyle K VanKoevering
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, 1500 East Medical Center Drive, 1904 Taubman Center, Ann Arbor, MI 48109, USA.
| | - David A Zopf
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Scott J Hollister
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, 313 Ferst Drive Northwest, Atlanta, GA 30332, USA
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Reconstruction of Secondary Calvarial Defects with Ex Situ Split Calvarial Bone Grafts. Plast Reconstr Surg 2019; 143:223-233. [DOI: 10.1097/prs.0000000000005129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Frassanito P, Massimi L, Tamburrini G, Bianchi F, Nataloni A, Canella V, Caldarelli M. Custom-made hydroxyapatite for cranial repair in a specific pediatric age group (7-13 years old): a multicenter post-marketing surveillance study. Childs Nerv Syst 2018; 34:2283-2289. [PMID: 29987377 DOI: 10.1007/s00381-018-3905-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 07/04/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND CustomBone Service (CBS) is a patient-specific, biocompatible, and osteoconductive device made of porous hydroxyapatite, indicated for cranial reconstruction in adults and children. Adult literature data report a failure rate of about 8%. The aim of this Post-Marketing Surveillance study is to verify the hypothesis that CBS in children aged 7-13 years old shows a failure rate not superior to adults. MATERIALS AND METHODS Inclusion criteria were age at implantation ranging 7-13 years old, with at least 1 year elapsed from the date of surgery. The degree of satisfaction of surgeons and patients was assessed. RESULTS Data about 76 implants in 67 patients (M:F = 41:26) were obtained from 28 centers across 7 European countries. The mean age at surgery was 10.03 ± 1.72 years, with age stratification almost equally distributed. Fifty-nine subjects received one CBS, 7 subjects two and one subject received three CBS. Main etiologies were trauma (60.5%), malformation (11.8%), bone tumor (10.5%), and cerebral tumor (7.9%). Main indications to CBS were decompression (47.4%), autologous bone resorption (18.4%), tumor resection (11.8%), malformation (9.2%), comminuted fracture (5.3%), and other materials rejection (5.3%). Main implantation sites were fronto-parieto-temporal (26.3%), parietal (23.7%), frontal (11.8%), fronto-temporal (10.5%), and parieto-temporal (7.9%). CBS was chosen as first line of treatment in 63.1% of the cases. Mean follow-up was about 36 months. Eleven adverse events (14.5%) were reported in nine devices. Five CBS required explantation (three cases of infection, one fracture, and one mobilization). Failure rate was 6.58%, which is statistically not superior to the explantation rate recorded in adults (two-sided 95%, CI 2.2-14.7%). Satisfaction of surgeons and patients was of about 95%. CONCLUSION CBS is a safe and effective solution for cranial repair in pediatric patients. In particular, over the age of 7, CBS shows a rate of failure as low as in adults.
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Affiliation(s)
- Paolo Frassanito
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo Agostino Gemelli, 8, 00168, Rome, Italy.
| | - Luca Massimi
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianpiero Tamburrini
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Federico Bianchi
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Massimo Caldarelli
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Rome, Italy
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Hydroxyapatite cranioplasty: a retrospective evaluation of osteointegration in 17 cases. Acta Neurochir (Wien) 2018; 160:2117-2124. [PMID: 30276548 DOI: 10.1007/s00701-018-3694-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Cranial reconstruction with autologous bone is still the gold standard although several biomaterials are available to re-establish the integrity of the cranial vault. Due to their biological and morphological characteristics, hydroxyapatite implants show promising results in small clinical cohort studies, especially within the paediatric population. Its biocompatibility and osteoconductivity should allow the formation of osseous bridging at the skull-prosthesis interface. OBJECTIVE To examine the possible occurrence of osteointegration and to quantify it. METHODS A retrospective study of patients with a hydroxyapatite implant from 2010 to 2014 at our neurosurgical department was conducted. Demographic, surgical and radiological data were studied. A senior neuroradiologist, a staff member neurosurgeon and a resident neurosurgeon independently performed the radiological evaluation. A new software analysis technique was developed to objectively quantify the degree of osteointegration. RESULTS Seventeen implants were evaluated with an average patient age of 39 years and a mean follow-up of 155 weeks. Through radiologic evaluation, osseous bridging was deemed higher than 50% in six prostheses and higher than 75% in three. In five patients, no osteointegration could be seen. The remaining patients exhibited sparse signs of osteointegration, estimated between 10 and 50%. Software analysis showed an average osteointegration ratio of 37.4% with a 400-HU filter and 27.3% with a 700-HU filter. CONCLUSION In this small retrospective study of cranial hydroxyapatite implants, osteointegration did occur and to a degree of more than 50% in 1/3 of the patients.
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The first step of patient-specific design calvarial implant: A quantitative analysis of fresh parietal bones. EUROPEAN JOURNAL OF PLASTIC SURGERY 2018. [DOI: 10.1007/s00238-018-1411-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Autologous Bone Is Inferior to Alloplastic Cranioplasties: Safety of Autograft and Allograft Materials for Cranioplasties, a Systematic Review. World Neurosurg 2018; 117:443-452.e8. [DOI: 10.1016/j.wneu.2018.05.193] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/25/2018] [Accepted: 05/26/2018] [Indexed: 11/19/2022]
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Clinical Outcomes of Digital Three-Dimensional Hydroxyapatite in Repairing Calvarial Defects. J Craniofac Surg 2018; 29:618-621. [DOI: 10.1097/scs.0000000000004335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Classification of the Residual Cranial Defects and Selection of Reconstruction Materials. J Craniofac Surg 2018; 28:1694-1701. [PMID: 28806376 DOI: 10.1097/scs.0000000000003752] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The cranial defects are complex in nature and are due to various causes. Therefore, there is a need for a common term of reference to these defects. This requirement stood as a prime reason for proposing a classification system for cranial defects. The classification is based on 2 decades of experience in cranioplasty. This efficient and simple way of representation would fill the existing lacunae for a systematic communication on cranial defects. Over the ages the evolution of reconstruction and grafting had undergone a massive progress. Therefore, it is essential to enumerate all available graft and bio-materials for restoring the cranial defects. The aetiology for these defects, age and sex of the patient, site and size of the defect, associated systemic conditions, cost factor, and operator's choice are the factors that play key role in the selection of the reconstructive material. This article discusses on these factors in cranioplasty. High success rate with excellent function and cosmetic outcome in using a variety of materials, as shared in this article. The advantages of autografts cannot be matched by any existing alloplast. However, in case of larger defects, for a better cosmetic outcome and to reduce the donor site morbidity, alloplasts are the most widely preferred material of choice.
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Long-Term Follow-Up Comparative Study of Hydroxyapatite and Autologous Cranioplasties: Complications, Cosmetic Results, Osseointegration. World Neurosurg 2017; 111:e395-e402. [PMID: 29277595 DOI: 10.1016/j.wneu.2017.12.082] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/11/2017] [Accepted: 12/13/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE A three-dimensional reconstruction technique using the CustomBone (CB) prosthesis allows custom-made cranioplasty (CP) possessing osseointegration properties owing to its porous hydroxyapatite (HA) composition. This reconstruction technique has replaced less expensive techniques such as subcutaneously preserved autologous bone (SP). Our primary objective was to evaluate complications between CB and SP CP techniques. A secondary objective was to assess cosmetic results and osseointegration of CPs. METHODS This single-center study comprised patients undergoing delayed CB or SP CP after craniectomy between 2007 and 2014. A prospective interview was conducted to collect all data, including 2-year follow-up clinical and radiologic data. Cosmetic results were assessed by a qualitative score, and osseointegration was assessed by measuring relative fusion at the CP margins. RESULTS Of 100 patients undergoing CB or SP CP between 2007 and 2014, 92 (CB, n = 44; SP, n = 48) participated in the prospective interview. No significant difference in complication rates was observed between the 2 groups. The main complication specific to the CB group was fracture of the prosthesis observed in 20.8% patients. A higher rate of good cosmetic results was observed in the CB group (92.5% vs. 74.3%, P = 0.031). In the CB group, 51% of patients demonstrated no signs of bone fusion of the CP. CONCLUSIONS Although the CB prosthesis is associated with cosmetic advantages, the porous hydroxyapatite composition makes it fragile in the short-term and long-term, and effective osseointegration remains uncertain.
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Palazzolo V, Tronchet A, Valsecchi S, Bellocchi S, Gervasoni C, Spotti S, Francesco AD, Colombo L, Riccio S, Ronchi P. Removal of a Frontal Sinus Osteoma and Reconstruction by a Custom-Made Implant with Neuronavigation Assistance. Craniomaxillofac Trauma Reconstr 2017; 11:305-313. [PMID: 30574275 DOI: 10.1055/s-0037-1607066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 07/02/2017] [Indexed: 10/18/2022] Open
Abstract
The authors report the surgical treatment of an extensive right frontal sinus osteoma assisted by neuronavigation and reconstruction by a hydroxyapatite custom-made implant. The patient presents with ptosis, hypoglobus, and proptosis of the right eye, without any visual impairment. Computed tomographic (CT) scan showed a very large bony mass involving right frontal sinus and displacing the orbital roof. A stereolithographic model-guided planning was carried out to obtain a practical simulation of the surgical operation and it was submitted to a new CT scan to acquire the reference point to realize the neuronavigation assistance, and to achieve the template to realize the hydroxyapatite custom-made implant. Intraoperatively, with the help of neuronavigation assistance, osteotomies were performed by piezoelectric device. The reconstruction was made using a hydroxyapatite custom-made implant. The procedure was damage free, the bony mass was excised, and the orbital roof was repaired without any adverse effects. Postsurgical CT scan and scintigraphy showed a good reconstruction and a good-quality osteoblasts activity on the borders of the implant. Osteoma is a benign slow-growing bone tumor, usually involving the frontal sinus. Navigational assistance offers a very important help to perform safe osteotomies. Hydroxyapatite custom-made implant seems to be an excellent reconstructive method.
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Affiliation(s)
- Vincenzo Palazzolo
- Department of Maxillofacial Surgery, Sant'Anna Hospital, San Fermo Della Battaglia, Como, Italy
| | - Anita Tronchet
- Department of Maxillofacial Surgery, Sant'Anna Hospital, San Fermo Della Battaglia, Como, Italy
| | - Stefano Valsecchi
- Department of Maxillofacial Surgery, Sant'Anna Hospital, San Fermo Della Battaglia, Como, Italy
| | - Silvio Bellocchi
- Department of Neurosurgery, Sant'Anna Hospital, San Fermo Della Battaglia, Como, Italy
| | - Carlo Gervasoni
- Department of Maxillofacial Surgery, Sant'Anna Hospital, San Fermo Della Battaglia, Como, Italy
| | - Stefano Spotti
- Department of Maxillofacial Surgery, Sant'Anna Hospital, San Fermo Della Battaglia, Como, Italy
| | - Andrea Di Francesco
- Department of Maxillofacial Surgery, Sant'Anna Hospital, San Fermo Della Battaglia, Como, Italy
| | - Luigi Colombo
- Department of Maxillofacial Surgery, Sant'Anna Hospital, San Fermo Della Battaglia, Como, Italy
| | - Stefano Riccio
- Department of Maxillofacial Surgery, Sant'Anna Hospital, San Fermo Della Battaglia, Como, Italy
| | - Paolo Ronchi
- Department of Maxillofacial Surgery, Sant'Anna Hospital, San Fermo Della Battaglia, Como, Italy
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Bertol LS, Schabbach R, Loureiro Dos Santos LA. Different post-processing conditions for 3D bioprinted α-tricalcium phosphate scaffolds. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:168. [PMID: 28916883 DOI: 10.1007/s10856-017-5989-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 09/05/2017] [Indexed: 06/07/2023]
Abstract
The development of 3D printing hardware, software and materials has enabled the production of bone substitute scaffolds for tissue engineering. Calcium phosphates cements, such as those based on α-tricalcium phosphate (α-TCP), have recognized properties of osteoinductivity, osteoconductivity and resorbability and can be used to 3D print scaffolds to support and induce tissue formation and be replaced by natural bone. At present, however, the mechanical properties found for 3D printed bone scaffolds are only satisfactory for non-load bearing applications. This study varied the post-processing conditions of the 3D powder printing process of α-TCP cement scaffolds by either immersing the parts into binder, Ringer's solution or phosphoric acid, or by sintering in temperatures ranging from 800 to 1500 °C. The porosity, composition (phase changes), morphology, shrinkage and compressive strength were evaluated. The mechanical strength of the post-processed 3D printed scaffolds increased compared to the green parts and was in the range of the trabecular bone. Although the mechanical properties achieved are still low, the high porosity presented by the scaffolds can potentially result in greater bone ingrowth. The phases present in the scaffolds after the post-processing treatments were calcium-deficient hydroxyapatite, brushite, monetite, and unreacted α-TCP. Due to their chemical composition, the 3D printed scaffolds are expected to be resorbable, osteoinductive, and osteoconductive.
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Affiliation(s)
- Liciane Sabadin Bertol
- Laboratory of Biomaterials (Labiomat), Materials Departament, Federal University of Rio Grande do Sul, Av. Bento Gonçalves, 9500, 91501-970, Porto Alegre, RS, Brazil.
| | - Rodrigo Schabbach
- Laboratory of Biomaterials (Labiomat), Materials Departament, Federal University of Rio Grande do Sul, Av. Bento Gonçalves, 9500, 91501-970, Porto Alegre, RS, Brazil
| | - Luis Alberto Loureiro Dos Santos
- Laboratory of Biomaterials (Labiomat), Materials Departament, Federal University of Rio Grande do Sul, Av. Bento Gonçalves, 9500, 91501-970, Porto Alegre, RS, Brazil
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Abstract
BACKGROUND The authors sought to ascertain the upper limits of secondary skull defect size amenable to autogenous reconstructions and to examine outcomes of a surgical series. Published data for autogenous and alloplastic skull reconstructions were also examined to explore associations that might guide treatment. METHODS A retrospective review of autogenously reconstructed secondary skull defects was undertaken. A structured literature review was also performed to assess potential differences in reported outcomes between autogenous bone and synthetic alloplastic skull reconstructions. Weighted risks were calculated for statistical testing. RESULTS Ninety-six patients underwent autogenous skull reconstruction for an average defect size of 93 cm (range, 4 to 506 cm) at a mean age of 12.9 years. The mean operative time was 3.4 hours, 2 percent required allogeneic blood transfusions, and the average length of stay was less than 3 days. The mean length of follow-up was 28 months. There were no postoperative infections requiring surgery, but one patient underwent secondary grafting for partial bone resorption. An analysis of 34 studies revealed that complications, infections, and reoperations were more commonly reported with alloplastic than with autogenous reconstructions (relative risk, 1.57, 4.8, and 1.48, respectively). CONCLUSIONS Autogenous reconstructions are feasible, with minimal associated morbidity, for patients with skull defect sizes as large as 500 cm. A structured literature review suggests that autogenous bone reconstructions are associated with lower reported infection, complication, and reoperation rates compared with synthetic alloplasts. Based on these findings, surgeons might consider using autogenous reconstructions even for larger skull defects. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Roseti L, Parisi V, Petretta M, Cavallo C, Desando G, Bartolotti I, Grigolo B. Scaffolds for Bone Tissue Engineering: State of the art and new perspectives. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 78:1246-1262. [PMID: 28575964 DOI: 10.1016/j.msec.2017.05.017] [Citation(s) in RCA: 644] [Impact Index Per Article: 92.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 05/02/2017] [Accepted: 05/04/2017] [Indexed: 12/31/2022]
Abstract
This review is intended to give a state of the art description of scaffold-based strategies utilized in Bone Tissue Engineering. Numerous scaffolds have been tested in the orthopedic field with the aim of improving cell viability, attachment, proliferation and homing, osteogenic differentiation, vascularization, host integration and load bearing. The main traits that characterize a scaffold suitable for bone regeneration concerning its biological requirements, structural features, composition, and types of fabrication are described in detail. Attention is then focused on conventional and Rapid Prototyping scaffold manufacturing techniques. Conventional manufacturing approaches are subtractive methods where parts of the material are removed from an initial block to achieve the desired shape. Rapid Prototyping techniques, introduced to overcome standard techniques limitations, are additive fabrication processes that manufacture the final three-dimensional object via deposition of overlying layers. An important improvement is the possibility to create custom-made products by means of computer assisted technologies, starting from patient's medical images. As a conclusion, it is highlighted that, despite its encouraging results, the clinical approach of Bone Tissue Engineering has not taken place on a large scale yet, due to the need of more in depth studies, its high manufacturing costs and the difficulty to obtain regulatory approval. PUBMED search terms utilized to write this review were: "Bone Tissue Engineering", "regenerative medicine", "bioactive scaffolds", "biomimetic scaffolds", "3D printing", "3D bioprinting", "vascularization" and "dentistry".
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Affiliation(s)
- Livia Roseti
- RAMSES Laboratory, Rizzoli RIT - Research, Innovation & Technology Department, Istituto di Ricerca Codivilla Putti, Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136 Bologna, Italy.
| | - Valentina Parisi
- RAMSES Laboratory, Rizzoli RIT - Research, Innovation & Technology Department, Istituto di Ricerca Codivilla Putti, Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136 Bologna, Italy.
| | - Mauro Petretta
- RAMSES Laboratory, Rizzoli RIT - Research, Innovation & Technology Department, Istituto di Ricerca Codivilla Putti, Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136 Bologna, Italy.
| | - Carola Cavallo
- RAMSES Laboratory, Rizzoli RIT - Research, Innovation & Technology Department, Istituto di Ricerca Codivilla Putti, Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136 Bologna, Italy.
| | - Giovanna Desando
- RAMSES Laboratory, Rizzoli RIT - Research, Innovation & Technology Department, Istituto di Ricerca Codivilla Putti, Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136 Bologna, Italy.
| | - Isabella Bartolotti
- RAMSES Laboratory, Rizzoli RIT - Research, Innovation & Technology Department, Istituto di Ricerca Codivilla Putti, Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136 Bologna, Italy.
| | - Brunella Grigolo
- RAMSES Laboratory, Rizzoli RIT - Research, Innovation & Technology Department, Istituto di Ricerca Codivilla Putti, Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136 Bologna, Italy; Laboratory of Immunorheumatology and Tissue Regeneration, Istituto di Ricerca Codivilla Putti, Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136 Bologna, Italy.
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Hikita A, Chung UI, Hoshi K, Takato T. Bone Regenerative Medicine in Oral and Maxillofacial Region Using a Three-Dimensional Printer<sup/>. Tissue Eng Part A 2017; 23:515-521. [PMID: 28351222 DOI: 10.1089/ten.tea.2016.0543] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Bone grafts currently used for the treatment of large bone defect or asymmetry in oral and maxillofacial region include autologous, allogeneic, and artificial bones. Although artificial bone is free from the concerns of donor site morbidity, limitation of volume, disease transmission, and ethical issues, it lacks osteogenic and osteoinductive activities. In addition, molding of the artificial bone is an issue especially when it is used for the augmentation of bone as onlay grafts. To solve this problem, additive manufacturing techniques have been applied to fabricate bones which have outer shapes conformed to patients' bones. We developed a custom-made artificial bone called a computed tomography (CT)-bone. Efficacy of CT-bone was proven in a clinical research and clinical trial, showing good manipulability, stability, and patient satisfaction. However, low replacement rate of artificial bones by endogenous bones remain an unsolved issue. Loading of cells and growth factors will improve the bone replacement by inducing osteogenic and osteoinductive activities. In addition, the three-dimensional bioprinting technique will facilitate bone regeneration by placing cells and biological substances into appropriate sites.
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Affiliation(s)
- Atsuhiko Hikita
- 1 Department of Cartilage and Bone Regeneration (Fujisoft), Graduate School of Medicine, The University of Tokyo , Bunkyo-ku, Japan
| | - Ung-Il Chung
- 2 Department of Bioengineering, Graduate School of Engineering, The University of Tokyo , Bunkyo-ku, Japan
| | - Kazuto Hoshi
- 3 Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, The University of Tokyo , Bunkyo-ku, Japan
| | - Tsuyoshi Takato
- 3 Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, The University of Tokyo , Bunkyo-ku, Japan
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Abstract
Cranioplasty remains a difficult procedure for all craniofacial surgeons, particularly when concerning the reconstruction of large lacunae in the skull. Considering the significant clinical and economic impact of the procedure, the search for materials and strategies to provide more comfortable and reliable surgical procedures is one of the most important challenges faced by modern craniofacial medicine.The purpose of this study was to compare the available data regarding the safety and clinical efficacy of materials and techniques currently used for the reconstruction of the skull. Accordingly, the scientific databases were searched for the following keywords autologous bone, biomaterials, cranial reconstruction, cranioplasty, hydroxyapatite, polyetheretherketone, polymethylmethacrylate, and titanium. This literature review emphasizes the benefits and weaknesses of each considered material commonly used for cranioplasty, especially in terms of infectious complications, fractures, and morphological outcomes.As regards the latter, this appears to be very similar among the different materials when custom three-dimensional modeling is used for implant development, suggesting that this criterion is strongly influenced by implant design. However, the overall infection rate can vary from 0% to 30%, apparently dependent on the type of material used, likely in virtue of the wide variation in their chemico-physical composition. Among the different materials used for cranioplasty implants, synthetics such as polyetheretherketone, polymethylmethacrylate, and titanium show a higher primary tear resistance, whereas hydroxyapatite and autologous bone display good biomimetic properties, although the latter has been ascribed a variable reabsorption rate of between 3% and 50%.In short, all cranioplasty procedures and materials have their advantages and disadvantages, and none of the currently available materials meet the criteria required for an ideal implant. Hence, the choice of cranioplasty materials is still essentially reliant on the surgeon's preference.
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Cranioplasty and Craniofacial Reconstruction: A Review of Implant Material, Manufacturing Method and Infection Risk. APPLIED SCIENCES-BASEL 2017. [DOI: 10.3390/app7030276] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hydroxyapatite ceramic implants for cranioplasty in children: a single-center experience. Childs Nerv Syst 2017; 33:343-348. [PMID: 28013335 DOI: 10.1007/s00381-016-3327-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The use of hydroxyapatite ceramic (HAC) implants for the treatment of skull defects in pediatric patients started 2010 at our institution. Ceramic implants facilitate osteoblast migration and therefore optimize osteointegration with the host bone. The purpose of this study is to report a single-center experience with this treatment modality. METHODS A retrospective review of all patients from July 2010 through June 2014 undergoing a cranioplasty using hydroxyapatite ceramic implant and managed at a single institution was performed. Indication for cranioplasty, the hospital course, and follow-up were reviewed. Bone density was measured in Hounsfield Units (HU) and osteointegration was calculated using Mimics Software® (Mimics Innovation Suite v17.0 Medical, Materialize, Leuven, Belgium). RESULTS Over the 4-year period, six patients met criteria for the study. Five patients had an osteointegration of nearly 100%. One patient had an incomplete osteointegration with a total bone-implant contact area of 69%. The mean bone density was 2800 HU (2300-3000 HU). Bone density alone is estimated to have a Hounsfield value between 400 and 2000 HU depending on the body region and bone quality. There were no major complications, and the patients were highly satisfied with the esthetical result. CONCLUSION Hydroxyapatite ceramic implants for cranioplasty in pediatric patients are a good choice for different indications. The implants show excellent osteointegration and esthetical results.
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Ono H, Sase T, Tanaka Y, Takasuna H. Histological assessment of porous custom-made hydroxyapatite implants 6 months and 2.5 years after cranioplasty. Surg Neurol Int 2017; 8:8. [PMID: 28217387 PMCID: PMC5288982 DOI: 10.4103/2152-7806.198735] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/03/2016] [Indexed: 11/26/2022] Open
Abstract
Background: In cranial reconstruction, the features of artificial bone differ. Custom-made porous hydroxyapatite (HAp) implants for cranioplasty have been used all over the world because of their good cosmetic, biocompatibility, and osteoconductive properties. Surgical techniques were analyzed, and histological assessment of new bone formation in the hydroxyapatite was performed. Methods: Over a 6-year time period, 41 patients underwent cranioplasty using a custom-made three-dimensional hybrid pore structured hydroxyapatite (3DHPoHAp) implant. The surgical techniques and histological evaluations of 3DHPoHAp in 2 cases, removed 6 months and 2.5 years after cranioplasty, are described. Results: Using 3DHPoHAp, cranioplasty was successfully performed for all patients. The implant fit the bone defect exactly, and surgical manoeuvres were simple and easy. All implants were firmly fixed using a titanium plate, and postoperative infection occurred in 1 patient (2.4%). New bone formation was seen in 2 cases 6 months and 2.5 years after cranioplasty. Osteoblasts were progressing to the stoma at various depths, and bone tissue had ripened. Furthermore, lamellar structure was observed in the case at 2.5 years. Conclusions: In this study, there was a low infection rate, and new bone formation was seen in vivo after cranioplasty. This study also demonstrated that the 3DHPoHAp implant is a good candidate for cranial bone implants because its good osteoconductivity and biocompatibility.
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Affiliation(s)
- Hajime Ono
- Department of Neurosurgery, St. Marianna University School of Medicine, Toyoko Hospital, Kawasaki City, Japan
| | - Taigen Sase
- Department of Neurosurgery, St. Marianna University School of Medicine, Toyoko Hospital, Kawasaki City, Japan
| | - Yuichiro Tanaka
- Department of Neurosurgery, St. Marianna University School of Medicine, Kawasaki-shi, Kanagawa, Japan
| | - Hiroshi Takasuna
- Department of Neurosurgery, St. Marianna University School of Medicine, Kawasaki-shi, Kanagawa, Japan
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Luongo F, Mangano FG, Macchi A, Luongo G, Mangano C. Custom-Made Synthetic Scaffolds for Bone Reconstruction: A Retrospective, Multicenter Clinical Study on 15 Patients. BIOMED RESEARCH INTERNATIONAL 2016; 2016:5862586. [PMID: 28070512 PMCID: PMC5192311 DOI: 10.1155/2016/5862586] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/23/2016] [Indexed: 02/07/2023]
Abstract
Purpose. To present a computer-assisted-design/computer-assisted-manufacturing (CAD/CAM) technique for the design, fabrication, and clinical application of custom-made synthetic scaffolds, for alveolar ridge augmentation. Methods. The CAD/CAM procedure consisted of (1) virtual planning/design of the custom-made scaffold; (2) milling of the scaffold into the exact size/shape from a preformed synthetic bone block; (3) reconstructive surgery. The main clinical/radiographic outcomes were vertical/horizontal bone gain, any biological complication, and implant survival. Results. Fifteen patients were selected who had been treated with a custom-made synthetic scaffold for ridge augmentation. The scaffolds closely matched the shape of the defects: this reduced the operation time and contributed to good healing. A few patients experienced biological complications, such as pain/swelling (2/15: 13.3%) and exposure of the scaffold (3/15: 20.0%); one of these had infection and complete graft loss. In all other patients, 8 months after reconstruction, a well-integrated newly formed bone was clinically available, and the radiographic evaluation revealed a mean vertical and horizontal bone gain of 2.1 ± 0.9 mm and 3.0 ± 1.0 mm, respectively. Fourteen implants were placed and restored with single crowns. The implant survival rate was 100%. Conclusions. Although positive outcomes have been found with custom-made synthetic scaffolds in alveolar ridge augmentation, further studies are needed to validate this technique.
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Affiliation(s)
| | - Francesco Guido Mangano
- Department of Surgical and Morphological Science, Dental School, Insubria University, 21100 Varese, Italy
| | - Aldo Macchi
- Department of Surgical and Morphological Science, Dental School, Insubria University, 21100 Varese, Italy
| | - Giuseppe Luongo
- Department of Oral and Maxillofacial Surgery, Federico II University, 80131 Naples, Italy
| | - Carlo Mangano
- Department of Dental Sciences, Vita Salute San Raffaele University, 20132 Milan, Italy
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Beuriat PA, Szathmari A, Grassiot B, Di Rocco F, Mottolese C. Pourquoi peut-on utiliser une plastie en hydroxyapatite pour réparer une perte de substance osseuse de la boîte crânienne chez les enfants : expérience à propos de 19 cas. Neurochirurgie 2016; 62:251-257. [DOI: 10.1016/j.neuchi.2016.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/25/2016] [Accepted: 04/09/2016] [Indexed: 11/26/2022]
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Kanno Y, Nakatsuka T, Saijo H, Fujihara Y, Atsuhiko H, Chung UI, Takato T, Hoshi K. Computed tomographic evaluation of novel custom-made artificial bones, "CT-bone", applied for maxillofacial reconstruction. Regen Ther 2016; 5:1-8. [PMID: 31245494 PMCID: PMC6581798 DOI: 10.1016/j.reth.2016.05.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 05/06/2016] [Accepted: 05/18/2016] [Indexed: 11/27/2022] Open
Abstract
Introduction We fabricated custom-made artificial bones using three-dimensionally layered manufacturing (3D printing) process, and have applied them to patients with facial deformities. We termed this novel artificial bone the “CT-bone”. The aim of the present study was to evaluate the middle- and long-term safety and effectiveness of the CT-bones after transplantation. Methods The subject areas involved were 23 sites of 20 patients with facial bone deformities due to congenital abnormality, tumor, or trauma. The CT-bones were used for augmentation; they were evaluated by CT images, minimally for 1 year and maximally for 7 years and 3 months (3 years and 1 month on average) after transplantation. Results No serious systemic events due to the CT-bone graft were found during the observation period (1 year postoperatively). In 4 sites of 4 patients, the CT-bones were removed due to local infection of the surgical wounds at 1–5 years postoperatively. Compatibility of the shapes between the CT-bone and the recipient bone was confirmed to be good during the operation in all of the 20 cases, implying that the CT-bones could be easily installed onto the recipient sites. During the CT evaluation (<7 years and 3 months), no apparent chronological change was seen in the shape of the CT-bones. Sufficient bone union was confirmed in 19 sites. The inner CT values of the CT-bones increased in all the sites. The longer the postoperative period, greater increases in the CT values of the CT-bones tended to be observed. Conclusions The CT-bone showed maintenance of the original shape and good bone replacement, based on the middle- and long-term follow-ups. In the future, we would make an intelligent type of artificial bones in which bone regeneration is induced by gradually releasing angiogenesis-inducing factors and/or bone-regeneration-inducing factors at the three-dimensionally controlled positions. We fabricated custom-made artificial bones, using a 3D printing process, and have applied them to patients with facial deformities.
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Affiliation(s)
- Yuki Kanno
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyoku, Tokyo 113-0033, Japan
| | - Takashi Nakatsuka
- Department of Plastic and Reconstructive Surgery, Saitama Medical School, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan
| | - Hideto Saijo
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyoku, Tokyo 113-0033, Japan
| | - Yuko Fujihara
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyoku, Tokyo 113-0033, Japan
| | - Hikita Atsuhiko
- Department of Cartilage & Bone Regeneration (Fujisoft), Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyoku, Tokyo 113-0033, Japan
| | - Ung-Il Chung
- University of Tokyo Graduate Schools of Engineering and Medicine, Hongo 7-3-1, Bunkyoku, Tokyo 113-0033, Japan
| | - Tsuyoshi Takato
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyoku, Tokyo 113-0033, Japan
| | - Kazuto Hoshi
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyoku, Tokyo 113-0033, Japan
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De Water VR, Rubio EJDS, Schouten JW, Koudstaal MJ. Deformation of a Titanium Calvarial Implant following Trauma: A Case Report. Craniomaxillofac Trauma Reconstr 2016; 9:158-61. [PMID: 27162574 PMCID: PMC4858418 DOI: 10.1055/s-0035-1567810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 07/18/2015] [Indexed: 10/22/2022] Open
Abstract
Alloplastic material is widely used for the reconstruction of calvarial defects. The objective of this article is to describe the effect of mechanical impact on a titanium calvarial implant and to discuss mechanical properties of alternative implant materials. The patient is a 19-year-old man who was involved in a traffic accident and underwent decompressive craniectomy for an extensive subdural hematoma. Reimplantation of the skull flap was complicated by infection and the flap had to be removed. The remaining cranial defect was closed with a titanium plate. The recovery was without complications. One year later, the patient was hit on the titanium plate, during a soccer match, by the elbow of a fellow player. The implant deflected inward, leaving a visible indentation of the cranial vault. Fortunately, there were no significant neurological symptoms and radiography did not show any signs of damage or pressure on the brain parenchyma. The patient had no aesthetic complaints regarding the shape. Thus, there was no indication to remove the plate. This case illustrates the limits of the protection offered by titanium cranioplasty.
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Affiliation(s)
- Valerie R. De Water
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Joost W. Schouten
- Department of Neurosurgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maarten J. Koudstaal
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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Iaccarino C, Viaroli E, Fricia M, Serchi E, Poli T, Servadei F. Preliminary Results of a Prospective Study on Methods of Cranial Reconstruction. J Oral Maxillofac Surg 2015; 73:2375-8. [DOI: 10.1016/j.joms.2015.07.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 07/10/2015] [Accepted: 07/10/2015] [Indexed: 11/17/2022]
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Bonda DJ, Manjila S, Selman WR, Dean D. The Recent Revolution in the Design and Manufacture of Cranial Implants: Modern Advancements and Future Directions. Neurosurgery 2015; 77:814-24; discussion 824. [PMID: 26171578 PMCID: PMC4615389 DOI: 10.1227/neu.0000000000000899] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Large format (i.e., >25 cm) cranioplasty is a challenging procedure not only from a cosmesis standpoint, but also in terms of ensuring that the patient's brain will be well-protected from direct trauma. Until recently, when a patient's own cranial flap was unavailable, these goals were unattainable. Recent advances in implant computer-aided design and 3-dimensional (3-D) printing are leveraging other advances in regenerative medicine. It is now possible to 3-D-print patient-specific implants from a variety of polymer, ceramic, or metal components. A skull template may be used to design the external shape of an implant that will become well integrated in the skull, while also providing beneficial distribution of mechanical force in the event of trauma. Furthermore, an internal pore geometry can be utilized to facilitate the seeding of banked allograft cells. Implants may be cultured in a bioreactor along with recombinant growth factors to produce implants coated with bone progenitor cells and extracellular matrix that appear to the body as a graft, albeit a tissue-engineered graft. The growth factors would be left behind in the bioreactor and the graft would resorb as new host bone invades the space and is remodeled into strong bone. As we describe in this review, such advancements will lead to optimal replacement of cranial defects that are both patient-specific and regenerative.
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Affiliation(s)
- David J. Bonda
- Department of Neurological Surgery, University Hospitals Case Medical Center, 10900 Euclid Avenue, Cleveland, OH 44106
| | - Sunil Manjila
- Department of Neurological Surgery, University Hospitals Case Medical Center, 10900 Euclid Avenue, Cleveland, OH 44106
| | - Warren R. Selman
- Department of Neurological Surgery, University Hospitals Case Medical Center, 10900 Euclid Avenue, Cleveland, OH 44106
| | - David Dean
- Department of Plastic Surgery, The Ohio State University, 460 West 12th Ave., 10th Floor, Rm. 1004, Columbus, OH 43210
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Carloni R, Hersant B, Bosc R, Le Guerinel C, Meningaud JP. Soft tissue expansion and cranioplasty: For which indications? J Craniomaxillofac Surg 2015; 43:1409-15. [PMID: 26189146 DOI: 10.1016/j.jcms.2015.06.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/19/2015] [Accepted: 06/15/2015] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The aim of this study was to better define indications for scalp tissue expansion before cranioplasty, and to describe our methodology for calculate the surface of tissue needed, by combining a preoperative analysis of both the size of the defect and the quality of skin above. MATERIAL AND METHODS A retrospective analysis of patients who underwent expansion before cranioplasty between 2009 and 2015 was conducted. Information was collected on the etiology, size and location of the defect, and reasons of skin contracture. Data concerning expansion and cranioplasty were reviewed. RESULTS Among 47 patients who underwent operation for cranioplasty, five (10.6%) required previous scalp tissue expansion. The etiology of the bone defect was tumoral in three cases, posttraumatic in one case, and a decompressive craniectomy in one case. The mean surface of the bone defect was 69.6 ± 18.7 cm(2). The locations of the defects were fronto-temporo-parietal, frontal, temporo-frontal, on the vertex, and occipital. The cause associated with the skin contracture was an infection in four cases and a delayed cranioplasty in one case. A round-profile expander and a custom-made porous hydroxyapatite implant were used for all patients. CONCLUSIONS The accurate assessment of tissue needed before cranioplasty is as essential as the choice of the material used for bone reconstruction. After previous infected cranioplasty or delayed reconstruction of large defects, scalp tissue expansion should be proposed.
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Affiliation(s)
- R Carloni
- Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France.
| | - B Hersant
- Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France
| | - R Bosc
- Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France
| | - C Le Guerinel
- Department of Neurosurgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France
| | - J P Meningaud
- Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France
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