Effect of postoperative radiation therapy on mandibular reconstruction using a modular endoprosthesis – A pilot study

Biomechanical and Mechanostat analysis of a titanium layered porous implant for mandibular reconstruction: The effect of the topology optimization design

A porous scaffold/implant is considered a potential method to repair bone defects, but its mechanical stability and biomechanics during the repair process are not yet clear. A mandibular titanium implant was proposed and designed with layered porous structures similar to that of the bone tissue, both in structure and mechanical properties. Topology was used to optimize the design of the porous implant and fixed structure. The finite element analysis was combined with bone "Mechanostat" theory to evaluate the stress and osteogenic property of the layered porous implant with 3 different fixation layouts (Model I with 4 screws, Model II with 5 screws and Model III with 6 screws) for mandibular reconstruction. The results showed that Model III could effectively reduce the stress shielding effect, stress within the optimized implant, defective mandible, and screws were respectively dropped 48.18%, 44.23%, and 57.27% compared to Model I, and the porous implant had a significant stress transmission effect and maintained the same stress distribution as the intact mandible after the mandibular defect was repaired. The porous implant also showed a significant mechanical stimulation effect on the growth and healing of the bone tissue according to the bone "Mechanostat" theory. The combination of porous structure with the topology technique is a promising option to improve the mechanical stability and osteogenesis of the implant, and could provide a new solution for mandibular reconstruction.

Reconstruction of Orbital Walls with Bone Cement in a Maxillectomy Patient

Orbital wall defects occur because of trauma and secondary to oncologic surgery. Reconstruction of orbital bones is of most importance to ensure normal eye functions and cosmesis. Acrylic resin materials can be used instead of a bone in orbital wall defects that are secondary to the resection of tumors invading the orbita. Polymethyl methacrylate is one of the acrylic resin materials. In this study, the orbital wall reconstruction technique with bone cement after maxillectomy and results are reported.

Tissue response after implantation of pure titanium and bioresorbable screws in scapula with postoperative irradiation: an experimental study on rats

OBJECTIVE

The study focuses on the comparison of tissue reaction to titanium and bioresorbable implants with and without postoperative irradiation on an animal model.

MATERIALS AND METHODS

Thirty-nine LEW/W rats were randomly assigned to experimental or control groups. One titanium and one bioresorbable screw (poly-L-lactide [PLLA] and L- and D-lactide poly-L/D-lactide [PDLLA]) were implanted into the left scapulas of 24 rats. Half of them received 30 Gy to the operation site and the other half received 42 Gy. In the control groups, 3 rats received 30 Gy, and 6 rats received 42 Gy to the scapula area without operation; and 6 rats had implants inserted as in the experimental group, but received no postoperative irradiation. The scapulas were removed 14 or 30 days after irradiation and a histologic analysis was performed.

RESULTS

The host tissue reaction to titanium and PLLA-PDLLA screws without postoperative irradiation was of similar intensity. In irradiated animals, the inflammatory tissue reaction was more evident around the titanium screws than around the bioresorbable screws, irrespective of the radiation dose and of the time that elapsed from the irradiation. The reaction was more evident on the 14th day than on the 30th day after the last radiation dose (70 and 86 days after surgery, respectively). The intensity of the inflammatory tissue reaction, irrespective of the implant type, was more intense in the group irradiated with 42 Gy.

CONCLUSIONS

PLLA-PDLLA implants appear to cause less tissue reaction after irradiation and could be safer reconstructive devices than titanium implants for patients undergoing surgery and adjuvant radiotherapy for cancer.