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V A, Rajaraman V, Ariga P, Nallaswamy D. Maxillofacial Reconstruction With Three Dimensional Resin Bone Substitutes as an Alternative to Transition Group of Metals: A Structured Review. Cureus 2024; 16:e57396. [PMID: 38694639 PMCID: PMC11062478 DOI: 10.7759/cureus.57396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/01/2024] [Indexed: 05/04/2024] Open
Abstract
In recent years, novel technologies and techniques have allowed today the production of controlled architecture materials. Although autogenous bone graft substitutes remain the gold standard, enormous defects require supplementary alloplastic substitutes for reconstruction. Polymers have lately been explored for the same purpose and their biological performance has been under research since the last decade. The aim of this review is to analyse maxillofacial reconstruction with three-dimensional resin bone substitutes. A Problem Intervention Comparison Outcomes (PICO) analysis was done and a search was carried out in the Cochrane Database, PubMed, Google Scholar etc databases and a hand search was done to collect the related literature. All articles for maxillofacial reconstruction with three-dimensional resin bone substitutes were scrutinised. The manuscripts published from 1990 till May 2021, were included in this review. A total of 106 articles were obtained from a PICO-based keyword search, and 91 manuscripts were retrieved after excluding the duplicates. Out of these 57 manuscripts were excluded on the basis of title and abstract. From the remaining 34 studies, 17 were excluded after reading the full text based on the inclusion and exclusion criteria. During data extraction, four studies were removed and finally, 13 studies were included in this research. From this scoping review, we could conclude that polymethylmethacrylate and polylactic acid formulations are very promising resin bone substitutes for 3-dimensional reconstruction of maxillofacial defects. However, rigorous long-term clinical trials are needed to validate this conclusion.
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Affiliation(s)
- Ashok V
- Department of Prosthodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Vaishnavi Rajaraman
- Department of Prosthodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Padma Ariga
- Department of Prosthodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Deepak Nallaswamy
- Department of Prosthodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Kopačin V, Zubčić V, Mumlek I, Mužević D, Rončević A, Lazar AM, Pavić AK, Koruga AS, Krivdić Z, Martinović I, Koruga N. Personalized 3D-printed cranial implants for complex cranioplasty using open-source software. Surg Neurol Int 2024; 15:39. [PMID: 38468644 PMCID: PMC10927182 DOI: 10.25259/sni_906_2023] [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: 11/10/2023] [Accepted: 01/19/2024] [Indexed: 03/13/2024] Open
Abstract
Background Cranioplasty is a routine neurosurgery treatment used to correct cranial vault abnormalities. Utilization of 3D printing technology in the field of cranioplasty involving the reconstruction of cranial defects emerged as an advanced possibility of anatomical reshaping. The transformative impact of patient-specific 3D printed implants, focuses on their remarkable accuracy, customization capabilities, and enhanced biocompatibility. Methods The precise adaptation of implants to patient-specific anatomies, even in complex cases we presented, result in improved aesthetic outcomes and reduced surgical complications. The ability to create highly customized implants addresses the functional aspects of cranial defects and considers the psychological impact on patients. Results By combining technological innovation with personalized patient care, 3D printed cranioplasty emerges as a transformative avenue in cranial reconstruction, ultimately redefining the standards of success in neurosurgery. Conclusion 3D printing allows an excellent cranioplasty cosmesis achieved at a reasonable price without sacrificing patient outcomes. Wider implementation of this strategy can lead to significant healthcare cost savings.
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Affiliation(s)
- Vjekoslav Kopačin
- Department of Diagnostic and Interventional Radiology, University Hospital Center, Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia
| | - Vedran Zubčić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia
- Department of Maxillofacial and Oral Surgery, University Hospital Center, Osijek, Croatia
| | - Ivan Mumlek
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia
- Department of Maxillofacial and Oral Surgery, University Hospital Center, Osijek, Croatia
| | - Dario Mužević
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia
- Department of Neurosurgery, University Hospital Center, Osijek, Croatia
| | - Alen Rončević
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia
- Department of Neurosurgery, University Hospital Center, Osijek, Croatia
| | - Ana-Maria Lazar
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia
- Department of Maxillofacial and Oral Surgery, University Hospital Center, Osijek, Croatia
| | - Ana Kvolik Pavić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia
- Department of Maxillofacial and Oral Surgery, University Hospital Center, Osijek, Croatia
| | - Anamarija Soldo Koruga
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia
- Department of Neurology, University Hospital Center, Osijek, Croatia
| | - Zdravka Krivdić
- Department of Diagnostic and Interventional Radiology, University Hospital Center, Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia
| | - Ivana Martinović
- Department of Information Sciences, Faculty of Humanities and Social Sciences, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Nenad Koruga
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia
- Department of Neurosurgery, University Hospital Center, Osijek, Croatia
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Le Bars P, Bandiaky ON, Le Guéhennec L, Clouet R, Kouadio AA. Different Polymers for the Base of Removable Dentures? Part I: A Narrative Review of Mechanical and Physical Properties. Polymers (Basel) 2023; 15:3495. [PMID: 37688123 PMCID: PMC10490543 DOI: 10.3390/polym15173495] [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: 06/30/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023] Open
Abstract
Even before considering their introduction into the mouth, the choice of materials for the optimization of the prosthesis depends on specific parameters such as their biocompatibility, solidity, resistance, and longevity. In the first part of this two-part review, we approach the various mechanical characteristics that affect this choice, which are closely related to the manufacturing process. Among the materials currently available, it is mainly polymers that are suitable for this use in this field. Historically, the most widely used polymer has been polymethyl methacrylate (PMMA), but more recently, polyamides (nylon) and polyether ether ketone (PEEK) have provided interesting advantages. The incorporation of certain molecules into these polymers will lead to modifications aimed at improving the mechanical properties of the prosthetic bases. In the second part of the review, the safety aspects of prostheses in the oral ecosystem (fragility of the undercuts of soft/hard tissues, neutral pH of saliva, and stability of the microbiota) are addressed. The microbial colonization of the prosthesis, in relation to the composition of the material used and its surface conditions (roughness, hydrophilicity), is of primary importance. Whatever the material and manufacturing process chosen, the coating or finishes dependent on the surface condition remain essential (polishing, non-stick coating) for limiting microbial colonization. The objective of this narrative review is to compile an inventory of the mechanical and physical properties as well as the clinical conditions likely to guide the choice between polymers for the base of removable prostheses.
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Affiliation(s)
- Pierre Le Bars
- Department of Prosthetic Dentistry, Faculty of Dentistry, Nantes University, 1 Place Alexis Ricordeau, 44042 Nantes, France; (L.L.G.); (R.C.); (A.A.K.)
- Oniris, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, Nantes Université, UMR 1229, 44000 Nantes, France;
| | - Octave Nadile Bandiaky
- Oniris, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, Nantes Université, UMR 1229, 44000 Nantes, France;
| | - Laurent Le Guéhennec
- Department of Prosthetic Dentistry, Faculty of Dentistry, Nantes University, 1 Place Alexis Ricordeau, 44042 Nantes, France; (L.L.G.); (R.C.); (A.A.K.)
- Oniris, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, Nantes Université, UMR 1229, 44000 Nantes, France;
| | - Roselyne Clouet
- Department of Prosthetic Dentistry, Faculty of Dentistry, Nantes University, 1 Place Alexis Ricordeau, 44042 Nantes, France; (L.L.G.); (R.C.); (A.A.K.)
- Oniris, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, Nantes Université, UMR 1229, 44000 Nantes, France;
| | - Alain Ayepa Kouadio
- Department of Prosthetic Dentistry, Faculty of Dentistry, Nantes University, 1 Place Alexis Ricordeau, 44042 Nantes, France; (L.L.G.); (R.C.); (A.A.K.)
- Department of Prosthetic Dentistry, Faculty of Dentistry, University Hospital Center, Abidjan P.O. Box 612, Côte d’Ivoire
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Li M, Zhang T, Zhang R, Zhang H, Zhang D, Hu N, Wang Y. Systematic Retrospective Analysis of Risk Factors and Preventive Measures of Bone Cement Leakage in Percutaneous Kyphoplasty. World Neurosurg 2023; 171:e828-e836. [PMID: 36592691 DOI: 10.1016/j.wneu.2022.12.117] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE In this study, we aimed to analyze the risk factors of bone cement leakage in percutaneous kyphoplasty (PKP) treatment of osteoporotic vertebral compression fractures (OVCFs), and provide suggestions for reducing bone cement leakage. METHODS A retrospective study of 517 cases of OVCFs treated with PKP were divided into 2 groups according to whether they had bone cement leakage or not, leakage group (n = 72) and non-leakage group (n = 445). The risk factors of leakage were systematically analyzed using clinical baseline data, imaging observation data, and surgery-related factors. To select the statistically significant results (P < 0.05) among the risk factors mentioned above, we used the binary logistic regression method to identify the main risk factors. RESULTS The univariate analysis of clinical baseline data,imaging observation data, and surgery-related factors showed that bone mineral density (BMD) (P < 0.001), hypertension (P < 0.05), injury factors (P < 0.01), cortical defect (P < 0.001), grade of vertebral compression (P < 0.001), surgical approach (P < 0.05), stage of bone cement injection (P < 0.01), and balloon pressure (P < 0.05) were the risk factors for bone cement leakage. The recovery rate of vertebral height, and the Cobb angle correction rate were lower in the bone cement leakage group (P < 0.001). The correction effect of kyphosis after operation was limited. Binary logistic analysis results showed that BMD (odds ratio [OR] 5.605), cortical defect (OR 3.115), and stage of bone cement injection (OR 2.385) were bone cement leakage-independent risk factors. CONCLUSIONS Impairment of BMD value, defects of cortical bone, and inappropriate stage of bone cement injection will increase the risk of bone cement leakage in PKP treatment and limit PKP effects.
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Affiliation(s)
- Mi Li
- Harbin Medical University, Harbin, Heilongjiang, China; Department of Orthopedic Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Tao Zhang
- Department of Orthopedic Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Rui Zhang
- Department of Orthopedic Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Hanjun Zhang
- Department of Orthopedic Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - DaPeng Zhang
- Department of Orthopedic Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Naiwu Hu
- Department of Orthopedic Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yansong Wang
- Harbin Medical University, Harbin, Heilongjiang, China; Department of Spine Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
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Slimani M, Baus A, Bich CS, de Rousiers A, Duhoux A, Brachet M, Duhamel P, Bey E. Methylmetacrylate (PMMA) cranioplasty technique: Technical interest of intraoperative modeling and review of the literature. ANN CHIR PLAST ESTH 2022; 68:99-105. [PMID: 36229276 DOI: 10.1016/j.anplas.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 09/09/2022] [Accepted: 09/15/2022] [Indexed: 11/01/2022]
Abstract
Reconstruction of bone loss in the cranial vault may be necessary for functional or aesthetic reasons following trauma, decompression craniectomy, or craniofacial malformations. Many techniques have been described in the literature, using various materials, each with its own advantages and drawbacks. Reconstruction with polymethylmetacrylate cement has the advantage of a durable result and relative ease of use. In this article we present our cement cranioplasty technique through 4 clinical cases of cranial vault reconstruction, by direct intraoperative modeling on the bone defect. This accessible, effective method, applicable to all sizes of defect, remains an attractive option in the arsenal of techniques available today.
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Msallem B, Maintz M, Halbeisen FS, Meyer S, Sigron GR, Sharma N, Cao S, Thieringer FM. Biomechanical Evaluation of Patient-Specific Polymethylmethacrylate Cranial Implants for Virtual Surgical Planning: An In-Vitro Study. MATERIALS 2022; 15:ma15051970. [PMID: 35269201 PMCID: PMC8911603 DOI: 10.3390/ma15051970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/19/2022] [Accepted: 03/01/2022] [Indexed: 02/06/2023]
Abstract
Cranioplasty with freehand-molded polymethylmethacrylate implants is based on decades of experience and is still frequently used in clinical practice. However, data confirming the fracture toughness and standard biomechanical tests are rare. This study aimed to determine the amount of force that could be applied to virtually planned, template-molded, patient-specific implants (n = 10) with an implant thickness of 3 mm, used in the treatment of a temporoparietal skull defect (91.87 cm2), until the implant cracks and finally breaks. Furthermore, the influence of the weight and porosity of the implant on its force resistance was investigated. The primary outcome showed that a high force was required to break the implant (mean and standard deviation 1484.6 ± 167.7 N), and this was very strongly correlated with implant weight (Pearson’s correlation coefficient 0.97; p < 0.001). Secondary outcomes were force application at the implant’s first, second, and third crack. Only a moderate correlation could be found between fracture force and the volume of porosities (Pearson’s correlation coefficient 0.59; p = 0.073). The present study demonstrates that an implant thickness of 3 mm for a temporoparietal skull defect can withstand sufficient force to protect the brain. Greater implant weight and, thus, higher material content increases thickness, resulting in more resistance. Porosities that occur during the described workflow do not seem to reduce resistance. Therefore, precise knowledge of the fracture force of polymethylmethacrylate cranial implants provides insight into brain injury prevention and serves as a reference for the virtual design process.
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Affiliation(s)
- Bilal Msallem
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (B.M.); (N.S.); (S.C.); (F.M.T.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
| | - Michaela Maintz
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
| | - Florian S. Halbeisen
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland;
| | - Simon Meyer
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (B.M.); (N.S.); (S.C.); (F.M.T.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
- Correspondence:
| | - Guido R. Sigron
- Clinic of Oral and Cranio-Maxillofacial Surgery, Cantonal Hospital Aarau, CH-5001 Aarau, Switzerland;
| | - Neha Sharma
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (B.M.); (N.S.); (S.C.); (F.M.T.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
| | - Shuaishuai Cao
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (B.M.); (N.S.); (S.C.); (F.M.T.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
| | - Florian M. Thieringer
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (B.M.); (N.S.); (S.C.); (F.M.T.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
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Comparison of the Surgical Outcomes of Cranioplasty Using Titanium, Customized Polymethylmethacrylate, and Liquid Polymethylmethacrylate in Maharaj Nakhon Chiang Mai Hospital, Thailand. J Craniofac Surg 2022; 33:1521-1524. [PMID: 34999614 DOI: 10.1097/scs.0000000000008463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Cranioplasty is a standard procedure used to restore skull defects after craniectomy. Many different materials are used in cranioplasty. The study aim was to compare the surgical outcomes of cranioplasty using different materials: liquid polymethylmethacrylate (PMMA), customized PMMA, and titanium. The authors retrospectively reviewed the outcomes of cranioplasty performed from 2016 to 2021. Data collection included patient characteristics and complications, including postoperative infection, hematoma, implant exposure, and subgaleal cerebrospinal fluid collection. Eighty-five patients received cranioplasty with different materials: titanium, 14; customized PMMA, 31; and liquid PMMA, 40. There were no significant differences in the basic patient characteristics among the 3 cranioplasty groups except for lower age in the customized PMMA group. There were no significant differences between superficial and deep infections, implant exposure, postoperative hematoma, or seizure. However, subgaleal cerebrospinal fluid collection was more common in the liquid PMMA group than in the customized PMMA group (P = 0.02). This study showed that good outcomes were achieved by cranioplasty performed with different materials (titanium, customized PMMA, and liquid PMMA).
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Hajduk B, Bednarski H, Jarka P, Janeczek H, Godzierz M, Tański T. Thermal and optical properties of PMMA films reinforced with Nb 2O 5 nanoparticles. Sci Rep 2021; 11:22531. [PMID: 34795332 PMCID: PMC8602437 DOI: 10.1038/s41598-021-01282-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/20/2021] [Indexed: 11/25/2022] Open
Abstract
The article presents the thermal and physical properties of PMMA composite films with the addition of Nb2O5 nanoparticles. The addition of nanoparticles to PMMA mainly influenced the optical transmission and glass transition temperature of composite films compared to pure PMMA. It is clearly visible in the results of the conducted ellipsometric and differential scanning calorimetry tests. X-ray studies showed that the heat treatment of the samples resulted in the ordering of the polymer structure (flattening of the polymer chains). Examining the surface of the samples with scanning electron microscopy, it can be seen that Nb2O5 nanoparticles formed unusual, branched formations resembling "snowflakes".
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Affiliation(s)
- B Hajduk
- Centre of Polymer and Carbon Materials, Polish Academy of Sciences, 34 Marie Curie-Skłodowska str., 41-819, Zabrze, Poland.
| | - H Bednarski
- Centre of Polymer and Carbon Materials, Polish Academy of Sciences, 34 Marie Curie-Skłodowska str., 41-819, Zabrze, Poland
| | - P Jarka
- Department of Engineering Materials and Biomaterials, Silesian University of Technology, 18a Konarskiego str., 41-100, Gliwice, Poland.
| | - H Janeczek
- Centre of Polymer and Carbon Materials, Polish Academy of Sciences, 34 Marie Curie-Skłodowska str., 41-819, Zabrze, Poland
| | - M Godzierz
- Centre of Polymer and Carbon Materials, Polish Academy of Sciences, 34 Marie Curie-Skłodowska str., 41-819, Zabrze, Poland
| | - T Tański
- Department of Engineering Materials and Biomaterials, Silesian University of Technology, 18a Konarskiego str., 41-100, Gliwice, Poland
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Yoon HG, Ko Y, Kim YS, Bak KH, Chun HJ, Na MK, Yang S, Yi HJ, Choi KS. Efficacy of 3D-Printed Titanium Mesh-Type Patient-Specific Implant for Cranioplasty. Korean J Neurotrauma 2021; 17:91-99. [PMID: 34760819 PMCID: PMC8558026 DOI: 10.13004/kjnt.2021.17.e25] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/20/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Autologous bone grafting for cranioplasty is associated with a high infection rate and bone absorption. Synthetic implant materials for cranioplasty have been developed. In this study, we evaluated the efficacy of titanium mesh-type patient-specific implants (PSIs) for patients with skull defects using the dice similarity coefficient (DSC), clinical outcomes, and artifacts caused by implants. Methods This retrospective study included 40 patients who underwent cranioplasty with a titanium mesh PSI at our institution. Based on preoperative and postoperative computed tomography scans, we calculated DSC and artifacts. Results The calculated DSC of 40 patients was 0.75, and the noise was 13.89% higher in the region of interest (ROI) near the implanted side (average, 7.64 hounsfield unit [HU]±2.62) than in the normal bone (average, 6.72 HU±2.35). However, the image signal-to-noise ratio did not significantly differ between the ROI near the implanted side (4.77±1.78) and normal bone (4.97±1.88). The patients showed no significant perioperative complications that required a secondary operation. Conclusion Titanium mesh-type PSIs for cranioplasty have excellent DSC values with lower artifacts and complication rates.
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Affiliation(s)
- Hong-Gyu Yoon
- Department of Neurosurgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Yong Ko
- Department of Neurosurgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Young-Soo Kim
- Department of Neurosurgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Koang-Hum Bak
- Department of Neurosurgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Hyoung-Joon Chun
- Department of Neurosurgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Min-Kyun Na
- Department of Neurosurgery, College of Medicine, Hanyang University, Seoul, Korea
| | | | - Hyeong-Joong Yi
- Department of Neurosurgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Kyu-Sun Choi
- Department of Neurosurgery, College of Medicine, Hanyang University, Seoul, Korea
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Reconstruction of the Occipital and Parietal Congenital Defect with 3D Custom-Made Titanium Prosthesis: A Case Report with Four and a Half Years of Follow-Up and a Brief Review of Literature. Case Rep Dent 2021; 2021:7027701. [PMID: 34721909 PMCID: PMC8550828 DOI: 10.1155/2021/7027701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022] Open
Abstract
Management of patients with congenital skull defects requires a multidisciplinary approach. Considering the defect's location and size, brain protection, and the cosmetic outcome makes such reconstructions challenging. Due to limited resemblance to skull contour and donor site morbidity of autogenous bone grafts, alloplastic materials are widely used for skull reconstructions. Titanium alloys have proper strength values, low infection rates, favorable osseointegration property, and excellent marginal adaptability when manufactured by computer-aided design (CAD) and computer-aided manufacturing (CAM). A 13-year-old female patient presented with congenital defects at the superior third of occipital bone and posterior thirds of the bilateral parietal bones. On CT scan, the exact size and shape of the defect were determined. Using CAD/CAM, a 3D virtual model of the prosthesis was designed and then printed with titanium alloy (TiAl6V4) via additive manufacturing method. The prosthesis was placed on the defect in a total surgery time of only 90 minutes. On 4.5 years of follow-up, the contour of the skull was ideal and the skin over the defect and neurologic status was intact. Due to their biocompatibility and rigidity, custom-made titanium prostheses are promising options for reconstructing complex skull defects.
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de Oliveira Limírio JPJ, Gomes JMDL, Alves Rezende MCR, Lemos CAA, Rosa CDDRD, Pellizzer EP. Mechanical properties of polymethyl methacrylate as a denture base: Conventional versus CAD-CAM resin - A systematic review and meta-analysis of in vitro studies. J Prosthet Dent 2021; 128:1221-1229. [PMID: 34030891 DOI: 10.1016/j.prosdent.2021.03.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 12/18/2022]
Abstract
STATEMENT OF PROBLEM The development of polymethyl methacrylate (PMMA) computer-aided design and computer-aided manufacturing (CAD-CAM) resin blocks with reported improved mechanical properties has simplified complete denture production. However, whether the objective of improved mechanical properties has been achieved compared with conventional heat-polymerized PMMA is not yet clear. PURPOSE The purpose of this systematic review and meta-analysis was to evaluate the mechanical properties of denture base resins manufactured by conventional heat-polymerization and by CAD-CAM in terms of flexural strength, flexural modulus, and surface roughness. MATERIAL AND METHODS Electronic databases (PubMed/MEDLINE, Scopus, Web of Science) were independently searched by 2 researchers for relevant studies published up to November 2020. The population, intervention, comparison, and outcome (PICO) question was, "Does the conventionally manufactured, heat-polymerized PMMA resin, as a denture base, demonstrate the same mechanical properties as the CAD-CAM resin block?" In addition, a meta-analysis was based on the inverse variance method. Flexural strength, flexural modulus, and surface roughness were analyzed through the continuous outcome evaluated by mean difference and standard deviation, with 95% confidence intervals. To evaluated heterogeneity, the I2 value (≤25%=low, ≥50%=moderate and ≥75%=high) and the P value were considered. P<.10 indicated statistical difference for heterogeneity. The effects of meta-analysis were based on the results of heterogeneity as per the studies. RESULTS Thirteen in vitro studies were included in the analysis. A total of 507 specimens were evaluated, 222 conventional and 285 CAD-CAM. In terms of flexural strength, the data showed no significant difference when conventional heat-polymerized PMMA was compared with CAD-CAM PMMA resins (P=.06; mean difference=18.28; 95% confidence interval:-0.42 to 36.97). In terms of flexural modulus, there was a significant difference for the CAD-CAM PMMA group (P=.01; mean difference=589.22; 95% confidence interval: 117.95 to 1060.48). In terms of surface roughness, a significant difference was observed between the groups (P=.02; mean difference=-0.53; 95% confidence interval: -0.97 to -0.09) with the conventional heat-polymerized PMMA resin having higher surface roughness values. CONCLUSIONS The mechanical properties of CAD-CAM PMMA resins were generally improved when compared with heat-polymerized polymethyl methacrylate resin.
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Affiliation(s)
| | - Jéssica Marcela de Luna Gomes
- Postgraduate student, Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
| | | | - Cleidiel Aparecido Araújo Lemos
- Adjunct Professor, Department of Dentistry (Division of Prosthodontics), Federal University of Juiz de Fora (UFJF-GV), Governador Valadres, Minas Gerai, Brazil
| | - Cleber Davi Del Rei Daltro Rosa
- Postgraduate student, Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
| | - Eduardo Piza Pellizzer
- Full Professor, Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
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12
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D'Arienzo A, Ipponi E, Ruinato AD, De Franco S, Colangeli S, Andreani L, Capanna R. Proximal Humerus Reconstruction after Tumor Resection: An Overview of Surgical Management. Adv Orthop 2021; 2021:5559377. [PMID: 33828866 PMCID: PMC8004366 DOI: 10.1155/2021/5559377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/10/2021] [Indexed: 02/07/2023] Open
Abstract
Proximal humerus is one of the anatomical sites that are most frequently involved by bone and soft tissue malignant tumors. Alone or in association with adjuvant treatments, surgery represents the main therapeutic option to treat and eradicate these diseases. Once the first-line option, in the last decades, amputation lost its role as treatment of choice for the large majority of cases in favor of the modern limb sparing surgery that promises to preserve anatomy and-as much as possible-upper limb functionality. Currently, the main approaches used to replace proximal humerus after a wide resection in oncologic surgery can be summarized in biological reconstructions (allografts and autografts), prosthetic reconstructions (anatomic endoprostheses, total reverse shoulder prostheses), and graft-prosthetic composite reconstructions. The purpose of this overview is to present nowadays surgical options for proximal humerus reconstruction in oncological patients, with their respective advantages and disadvantages.
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Affiliation(s)
- Antonio D'Arienzo
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Edoardo Ipponi
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | | | - Silvia De Franco
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Simone Colangeli
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Lorenzo Andreani
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Rodolfo Capanna
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
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13
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da Silva Júnior EB, de Aragão AH, de Paula Loureiro M, Lobo CS, Oliveti AF, de Oliveira RM, Ramina R. Cranioplasty with three-dimensional customised mould for polymethylmethacrylate implant: a series of 16 consecutive patients with cost-effectiveness consideration. 3D Print Med 2021; 7:4. [PMID: 33548008 PMCID: PMC7866687 DOI: 10.1186/s41205-021-00096-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/31/2021] [Indexed: 02/08/2023] Open
Abstract
Background Different methods of cranioplasty for the reconstruction of bony skull defects exist. In the absence of the autologous bone flap, a customised manufactured implant may be the optimal choice, but this implant has several limitations regarding its technical standardisation and better cost-effectiveness. Methods This study presents a series of 16 consecutive patients who had undergone cranioplasty with customised three-dimensional (3D) template moulds for polymethylmethacrylate (PMMA) implants manufactured after 3D modelling on a specific workstation. The virtual images were transformed into a two-piece physical model using a 3D printer for the biomaterials. PMMA implant was produced intraoperatively with the custom mould. Cosmetic results were analysed by comparing pre- and postoperative 3D computed tomography (CT) images and asking if the patient was satisfied with the result. Results The average total time for planning and production of customised mould was 10 days. The 16 patients were satisfied with the result, and CT images presented harmonious symmetry when comparing pre- and postoperative scans. Cases of postoperative infection, bleeding, or reoperation in this series were not observed. Conclusion Cranioplasty with high-technology customised 3D moulds for PMMA implants can allow for an aesthetic reconstruction with a fast and cost-effective manufacturing process and possibly with low complication rates.
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Affiliation(s)
- Erasmo Barros da Silva Júnior
- Department of Neurosurgery, Instituto de Neurologia de Curitiba, Jeremias Maciel Perretto, 300 - Campo Comprido, Curitiba, Paraná, 81210-310, Brazil.
| | - Afonso Henrique de Aragão
- Department of Neurosurgery, Instituto de Neurologia de Curitiba, Jeremias Maciel Perretto, 300 - Campo Comprido, Curitiba, Paraná, 81210-310, Brazil
| | | | | | | | | | - Ricardo Ramina
- Department of Neurosurgery, Instituto de Neurologia de Curitiba, Jeremias Maciel Perretto, 300 - Campo Comprido, Curitiba, Paraná, 81210-310, Brazil
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14
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Zhu S, Chen Y, Lin F, Chen Z, Jiang X, Zhang J, Wang J. Complications following titanium cranioplasty compared with nontitanium implants cranioplasty: A systematic review and meta-analysis. J Clin Neurosci 2020; 84:66-74. [PMID: 33485602 DOI: 10.1016/j.jocn.2020.12.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/31/2020] [Accepted: 12/06/2020] [Indexed: 01/11/2023]
Abstract
Decompressive craniectomy is widely used to treat medically refractory intracranial hypertension. There were still few studies focusing on the complications between titanium cranioplasty with non-titanium materials cranioplasty. Our systematic review and meta-analysis aimed to assess the complications following titanium cranioplasty and to make a comparison with nontitanium materials. A systematic review was used to review titanium cranioplasty characters in recent articles. A systematic literature review and meta-analysis were performed by using PubMed/MEDLINE, Scopus, the Cochrane databases and Embase for studies reporting on cranioplasty procedures that compared complication outcomes between titanium with non-titanium materials. The final 15 studies met inclusion criteria and represented 2258 cranioplasty procedures (896 titanium, 1362 nontitanium materials). Overall complications included surgical site infection, hematoma, implant exposure, seizure, cerebrospinal fluid leak, imprecise fitting. Titanium cranioplasty was associated with a significant decrease in overall complications rate (OR, 0.72; P = 0.007), hematoma rate (OR, 0.31; P = 0.0003) and imprecise fitting rate (OR, 0.35; P = 0.04). However, it also suggested that titanium cranioplasty can be greatly increased implant exposure rate (OR, 4.11; P < 0.00001). Our results confirmed the advantages of titanium cranioplasty in reducing complications including hematoma, imprecise fitting, and also suggested that clinicians should pay more attention to postoperative implant exposure. With new synthetic materials emerging, it would also be interesting to study the cost-effect and functional outcomes associated with cranioplasty materials.
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Affiliation(s)
- Sihan Zhu
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, China
| | - Yinsheng Chen
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, China
| | - Fuhua Lin
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, China
| | - Zhenghe Chen
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, China
| | - Xiaobing Jiang
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, China
| | - Ji Zhang
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, China
| | - Jian Wang
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, China.
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15
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Park SY, An JH, Kwon H, Choi SY, Lim KY, Kwak HH, Hussein KH, Woo HM, Park KM. Custom-made artificial eyes using 3D printing for dogs: A preliminary study. PLoS One 2020; 15:e0242274. [PMID: 33216792 PMCID: PMC7678976 DOI: 10.1371/journal.pone.0242274] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/29/2020] [Indexed: 01/02/2023] Open
Abstract
Various incurable eye diseases in companion animals often result in phthisis bulbi and eye removal surgery. Currently, the evisceration method using silicone balls is useful in animals; however, it is not available to those with impaired cornea or severe ocular atrophy. Moreover, ocular implant and prostheses are not widely used because of the diversity in animal size and eye shape, and high manufacturing cost. Here, we produced low-cost and customized artificial eyes, including implant and prosthesis, using computer-aided design and three-dimensional (3D) printing technique. For 3D modeling, the size of the artificial eyes was optimized using B-mode ultrasonography. The design was exported to STL files, and then printed using polycaprolactone (PCL) for prosthesis and mixture of PCL and hydroxyapatite (HA) for ocular implant. The 3D printed artificial eyes could be produced in less than one and half hour. The prosthesis was painted using oil colors and biocompatible resin. Two types of eye removal surgery, including evisceration and enucleation, were performed using two beagle dogs, as a preliminary study. After the surgery, the dogs were clinically evaluated for 6 months and then histopathological evaluation of the implant was done. Ocular implant was biocompatible and host tissue ingrowth was induced after in vivo application. The custom-made prosthesis was cosmetically excellent. Although long-term clinical follow-up might be required, the use of 3D printed-customized artificial eyes may be beneficial for animals that need personalized artificial eye surgery.
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Affiliation(s)
- So-Young Park
- Department of Ophthalmology and Surgery, College of Veterinary Medicine, Chungbuk National University, Cheongju, Korea
| | - Jeong-Hee An
- Department of Ophthalmology and Surgery, College of Veterinary Medicine, Chungbuk National University, Cheongju, Korea
| | - Hyun Kwon
- Department of Ophthalmology and Surgery, College of Veterinary Medicine, Chungbuk National University, Cheongju, Korea
| | - Seo-Young Choi
- Department of Ophthalmology and Surgery, College of Veterinary Medicine, Chungbuk National University, Cheongju, Korea
| | - Ka-Young Lim
- Department of Ophthalmology and Surgery, College of Veterinary Medicine, Chungbuk National University, Cheongju, Korea
| | - Ho-Hyun Kwak
- Department of Surgery, College of Veterinary Medicine, Kangwon National University, Chuncheon, Korea
| | - Kamal Hany Hussein
- Department of Surgery, College of Veterinary Medicine, Kangwon National University, Chuncheon, Korea
- Department of Animal Surgery, College of Veterinary Medicine, Assiut University, Assiut, Egypt
| | - Heung-Myong Woo
- Department of Surgery, College of Veterinary Medicine, Kangwon National University, Chuncheon, Korea
| | - Kyung-Mee Park
- Department of Ophthalmology and Surgery, College of Veterinary Medicine, Chungbuk National University, Cheongju, Korea
- * E-mail:
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16
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Cardona MJ, Turner C, Ross C, Baird E, Black RA. An improved process for the fabrication and surface treatment of custom-made titanium cranioplasty implants informed by surface analysis. J Biomater Appl 2020; 35:602-614. [PMID: 32915666 PMCID: PMC7756070 DOI: 10.1177/0885328220957899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cranioplasty implants are routinely fabricated from commercially pure titanium plates by maxillofacial prosthetists. The differing fabrication protocols adopted by prosthetists working at different hospital sites gives rise to considerable variations in surface topography and composition of cranioplasty implants, with residues from the fabrication processes having been found to become incorporated into the surface of the implant. There is a growing recognition among maxillofacial prosthetists of the need to standardise these protocols to ensure quality and consistency of practice within the profession. In an effort to identify and eliminate the source of the inclusions associated with one such fabrication protocol, the present study examined the surfaces of samples subjected to each of the manufacturing steps involved. Surface and elemental analysis techniques identified the main constituent of the surface inclusions to be silicon from the glass beads used to texture the surface of the implant during fabrication. Subsequent analysis of samples prepared according to a revised protocol resulted in a more homogeneous titanium dioxide surface as evidenced by the reduction in area occupied by surface inclusions (from 8.51% ± 2.60% to 0.93% ± 0.62%). These findings may inform the development of improved protocols for the fabrication of titanium cranioplasty plates.
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Affiliation(s)
- Milovan Joe Cardona
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Catherine Turner
- The West of Scotland Regional Maxillofacial Laboratory, Queen Elizabeth University Hospital, Glasgow, UK
| | - Calum Ross
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Elaine Baird
- The West of Scotland Regional Maxillofacial Laboratory, Queen Elizabeth University Hospital, Glasgow, UK
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17
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Milhomem AC, Jorge IMDS, da Costa EL, Vinaud MC, Lino Júnior RDS. Polymethyl Methacrylate (PMMA) in the Treatment of a Case of Hemifacial Microsomia. Aesthet Surg J Open Forum 2020; 2:ojaa002. [PMID: 33791622 PMCID: PMC7780458 DOI: 10.1093/asjof/ojaa002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2020] [Indexed: 11/12/2022] Open
Abstract
Hemifacial microsomia (HMF) is a morphological alteration characterized by facial deformities. These alterations are a consequence of a congenital anomalous development of the first and second branchial arches. It may present a genetic or environmental origin or a mixture of both and is considered mostly multifactorial. The clinical presentation varies; however, some characteristics are predominant such as unilateral mandible hypoplasia, agenesis or malformation of the auricular pavilion, and agenesis or malformation of the eye globe. The aim of this paper was to report a clinical case of a patient with late diagnosis of HMF which presented multiple deformities and received treatment with polymethyl methacrylate (PMMA) implant in different concentrations. Aiming for facial harmony, the PMMA implant occurred in the following regions: canine fossa, nasolabial sulcus, mandible, Bichat Ball, chin outline, lip contour, nose base, columella, nose tip, and dorsum. The treatment resulted in significant improvement in the facial symmetry. Level of Evidence: 5
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Affiliation(s)
| | | | | | - Marina Clare Vinaud
- Tropical Pathology and Public Health Institute, Federal University of Goias, Goiânia, GO, Brazil
| | - Ruy de Souza Lino Júnior
- Tropical Pathology and Public Health Institute, Federal University of Goias, Goiânia, GO, Brazil
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18
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Wang W, Vincent A, Bahrami A, Shokri T, Inman J, Ducic Y. Progressive Scalp Thinning Over Mesh Cranioplasty and the Role of Lipotransfer. Laryngoscope 2019; 130:1926-1931. [DOI: 10.1002/lary.28463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/07/2019] [Accepted: 11/20/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Weitao Wang
- Otolaryngology and Facial Plastic Surgery Associates Fort Worth Texas U.S.A
| | - Aurora Vincent
- Otolaryngology and Facial Plastic Surgery Associates Fort Worth Texas U.S.A
| | - Arash Bahrami
- Department of Otolaryngology–Head and Neck Surgery Philadelphia College of Osteopathic Medicine Philadelphia Pennsylvania U.S.A
| | - Tom Shokri
- Department of Otolaryngology–Head and Neck Surgery The Pennsylvania State University Hershey Pennsylvania U.S.A
| | - Jared Inman
- Department of Otolaryngology Head and Neck Surgery Loma Linda University Medical Center Loma Linda California U.S.A
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates Fort Worth Texas U.S.A
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19
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Giese H, Meyer J, Engel M, Unterberg A, Beynon C. Polymethylmethacrylate patient-matched implants (PMMA-PMI) for complex and revision cranioplasty: analysis of long-term complication rates and patient outcomes. Brain Inj 2019; 34:269-275. [PMID: 31657239 DOI: 10.1080/02699052.2019.1683895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Cranioplasty (CP) is associated with high complication rates and patient-matched implants (PMI) are frequently used for CP. However, only limited data are available regarding complication rates of PMI-based CP after complex or failed primary CP. Here we report our experience with the use of polymethylmethacrylate (PMMA) PMI for this purpose.Method: We analyzed all patients with complex or failed primary CP and subsequent implantation of PMMA-PMI between 2010 and 2015 at our institution.Results: A total of 67 patients (29 females, 38 males) with a mean age of 43 years (range: 13-74 years) were included in the study. Primary PMI-CP was performed in 18 patients with destructive or osteolytic bone tumors. Secondary PMI-CP was performed in 49 patients. Complications occurred in 14 patients with an overall complication rate of 21.7% during a mean follow-up of 39.7 ± 23.4 month. Approximately two-thirds of the patients reported a good quality of life after the initial event and subsequent CP. The majority of patients (>90%) was satisfied with the cosmetic result.Conclusion: Surgical CP with PMMA-PMI appears to be a suitable method for patients with failed or complex CP. Complication rates are comparable to those reported for primary CP.
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Affiliation(s)
- Henrik Giese
- Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | - Jennifer Meyer
- Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | - Michael Engel
- Department of Oral and Maxillofacial Diseases, University of Heidelberg, Heidelberg, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | - Christopher Beynon
- Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
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20
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Leão RDS, Moraes SLDD, Gomes JMDL, Lemos CAA, Casado BGDS, Vasconcelos BCDE, Pellizzer EP. Influence of addition of zirconia on PMMA: A systematic review. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 106:110292. [PMID: 31753402 DOI: 10.1016/j.msec.2019.110292] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 09/23/2019] [Accepted: 10/07/2019] [Indexed: 11/28/2022]
Abstract
The objective of this systematic review is to evaluate the effect of the incorporation of zirconia (ZrO2) particles on the mechanical properties of PMMA (polymethyl methacrylate), and to establish which characteristics of this material yield the best results aiming their biomedical applicability. This study was carried out in accordance with the Items of Preferred Reports for Systematic Reviews and Meta-Analyzes (PRISMA) and is registered in PROSPERO under registration number: CRD42018095801. The searches were carried out in the PubMed, MEDLINE, Scopus and Cochrane Library databases for articles published up until April 2018. After the different stages of the article selection process, eight articles were selected for qualitative and quantitative analysis. All were in vitro studies, totaling 536 evaluated samples. The concentrations of zirconia ranged from 0.5% to 20% and the particle sizes were between 15 nm and 10 μm. The incorporation of zirconia particles did not increase the flexural strength of PMMA in only one study. While the concentration of zirconia influences PMMA, the type of acrylic resin, size, and silanization of zirconia particles did not influence the results. Thus, the addition of zirconia particles showed a positive effect on PMMA enhancing their use in the medical and dental field, especially when certain anatomical areas requires higher strength of the materials, providing longevity for the rehabilitation.
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Affiliation(s)
- Rafaella de Souza Leão
- Department of Prosthodontics, Dentistry School, University of Pernambuco (UPE), Camaragibe, Brazil
| | | | - Jéssica Marcela de Luna Gomes
- Department of Dental Materials and Prosthodontics, Araçatuba Dental School, São Paulo State University (UNESP), Araçatuba, Brazil
| | | | | | | | - Eduardo Piza Pellizzer
- Department of Dental Materials and Prosthodontics, Araçatuba Dental School, São Paulo State University (UNESP), Araçatuba, Brazil
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21
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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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Long-Term Complications of Cranioplasty Using Stored Autologous Bone Graft, Three-Dimensional Polymethyl Methacrylate, or Titanium Mesh After Decompressive Craniectomy: A Single-Center Experience After 596 Procedures. World Neurosurg 2019; 128:e841-e850. [PMID: 31082551 DOI: 10.1016/j.wneu.2019.05.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/01/2019] [Accepted: 05/02/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Cranioplasty is a technically simple procedure intended to repair defects of the skull to provide protection after craniectomy, improve functional outcomes, and restore cosmesis. Several materials have been used for the restoration of skull defects, including autologous bone grafts (AGs), polymethyl methacrylate (PMMA) flaps, and titanium mesh (T-mesh). However, the long-term results of cranioplasty after use of these materials are controversial. METHODS Medical records of 596 patients who underwent cranioplasty at our medical center between 2009 and 2015 with at least 2.5 years of follow-up were retrospectively reviewed. Patients were classified into 3 groups according to the materials used: AG, three-dimensional PMMA, and T-mesh. Demographic and clinical characteristics and postoperative complications were analyzed. RESULTS Cranioplasty with AG had the highest bone flap depression rate (4.9%; P = 0.02) and was associated with a 26% long-term bone flap resorption. Younger age was a risk factor for bone flap resorption. T-mesh had a higher risk of postoperative skin erosion and bone exposure (17%; P = 0.004). Patients with diabetes, previous craniotomy, or hydrocephalus showed a higher risk of postoperative skin erosion. PMMA was associated with the highest rate of postoperative infection (14.4% <3 months, 28.1% >3 months; P < 0.05), and previous craniotomy may increase the infection risk after cranioplasty with PMMA. CONCLUSIONS Complications after cranioplasty are high, and the various types of cranioplasty materials used are associated with different complications. Surgeons need to be aware of these potential complications and should choose the appropriate material for each individual patient.
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Milhomem AC, Alves LM, de Souza Jorge IM, Costa EL, Vinaud MC, de Souza Lino Júnior R. Facial trauma reconstruction with polymethyl methacrylate-A case report. J Cosmet Dermatol 2018; 17:1037-1040. [PMID: 30246431 DOI: 10.1111/jocd.12786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/15/2018] [Accepted: 08/20/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Polymethyl methacrylate (PMMA) is a dermatologic filler commonly used in esthetic procedures. However, it can also be used in more severe cases such as reconstruction of facial traumas. AIMS The aim of this report was to describe the use of PMMA in a nasal reconstruction of a patient victim of an automobilist accident which presented previous rejection of autograft. PATIENT A young female patient, 26 y, victim of automobilist accident, with no bone support due to trauma both in the mandibulum and maxilla, presented fracture of several facial bones. Presented rejection of a bone autograft from the skullcap implanted on the nose. In order to harmonize the facial aspect, a nasal fill with PMMA for the anatomic reconstruction of the nose was performed. RESULTS AND CONCLUSIONS PMMA promoted the recovery of facial and nasal esthetic characteristics of the patient ensuring a satisfactory result.
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Affiliation(s)
| | - Luciano Moreira Alves
- Radiologist from the Urgencies Hospital of Aparecida de Goiani (HUAPA), Goiânia, GO, Brazil
| | | | | | - Marina Clare Vinaud
- Tropical Pathology and Public Health Institute, Federal University of Goias, Goiânia, GO, Brazil
| | - Ruy de Souza Lino Júnior
- Tropical Pathology and Public Health Institute, Federal University of Goias, Goiânia, GO, Brazil
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Effect of Pressure, Post-Pressing Time, and Polymerization Cycle on the Degree of Conversion of Thermoactivated Acrylic Resin. Int J Dent 2018; 2018:5743840. [PMID: 30186326 PMCID: PMC6114067 DOI: 10.1155/2018/5743840] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/29/2018] [Accepted: 07/18/2018] [Indexed: 11/17/2022] Open
Abstract
Herein, the effect of different post-pressing times and pressure in two cycles of polymerization on the degree of conversion (DC) of thermally activated acrylic resin (TRRA) is analyzed to optimize the polymerization of this material. After post-pressing for 0, 6, or 12 h, polymerization was performed with or without a pressure of 60 psi (0.41 MPa) in a short (4 h) or a long (11 h) cycle, totaling 12 groups. To determine the DC, PMMA specimens were analyzed by Fourier transform infrared spectroscopy. The influence of each factor alone on the DC was studied by experimental planning. The statistical tests used were three-way ANOVA, t-test, Tukey's test, and Levene's test, with a margin of error of 5%. Two groups prepared with post-pressing times of 12 h had the lowest DC (p < 0.001). Post-pressing times of 0 and 6 h did not yield statistically different results. Pressure increased the DC in only one group (long cycle +12 h, p=0.001). The short cycle resulted in a higher DC than the long cycle in 2 groups (with pressure +0 h, p=0.002; without pressure +6 h, p=0.015), while the long cycle yielded a statistically higher DC in only one group (with pressure +12 h, p < 0.001). The polymerization showed satisfactory DC in all 12 groups. Small differences found among the specimens indicate that the pressure, post-pressing time, and polymerization cycles herein were not influential factors for the DC of PMMA.
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