Degradable injectable bone cement in maxillofacial surgery: indications and clinical experience in 27 patients.
BACKGROUND
A carbonated apatite cement (NORIAN SRS) was used as a bone mineral substitute for the calvaria or viscerocranium in 27 patients. It has the consistency of a paste and hardens at physiologic pH and body temperature due to dahllite crystallization, which has the stoichiometric formula Ca(8.8)(HPO(4))(0.7)(PO(4))(4.5)(CO(3))(0.7)(OH)(1.3).


METHODS
The cement was used for posttraumatic bone defects in the orbital, periorbital or malar regions (nine patients), posttraumatic deformities of the frontal bone (six patients), tumour-dependent bony defects of the calvaria (two patients) and posttraumatic or cystic defects of the mandible (five patients). In another five patients, the material was used to augment the atrophic anterior mandible in combination with the insertion of dental implants. Follow-up varied between 6 and 40 months (mean: 29 months).


RESULTS
There was no inflammatory reaction surrounding the implanted material. There was no sign of infection in any of the patients and only one case of partial wound dehiscence with superficially exposed material. The defect fillings and augmentations were successful in all patients. None of the 19 dental implants which were inserted in combination with the material showed any sign of infection or loosening. Also, there was no loosening of the implants after loading (mean follow-up: 15 months). From the check-up radiographs, the material could be seen as a dense, radio-opaque structure. There were no material fractures or dislocations. Radiologically, the material seemed to be completely replaced by bony tissue after 30 months.


CONCLUSIONS
Our 5-year clinical experience suggests that the material is a suitable bone mineral substitute for cranio-maxillofacial surgery especially for moderate-sized defects of the calvaria and forehead bone. It has advantages over preformed, solid bone substitute materials, and, due to its initial plasticity and eventual great compressive strength, it can also stabilize dental endosseous implants in the atrophic mandible.
Wolff
Klaus-Dietrich
KD
Department of Oral and Maxillofacial Plastic Surgery, Germany. klaus.wolff@ruhr-uni-bochum.de
Swaid
Sami
S
Nolte
Dirk
D
Böckmann
Roland A
RA
Hölzle
Frank
F
Müller-Mai
Christian
C
D020341:Absorbable Implants; D000328:Adult; D000368:Aged; D000540:Alveolar Ridge Augmentation / Q000379:methods; D001031:Apatites / Q000737:chemistry / Q000627:therapeutic use*; D001672:Biocompatible Materials / Q000737:chemistry; D001843:Bone Cements / Q000737:chemistry / Q000627:therapeutic use*; D018786:Bone Substitutes / Q000737:chemistry / Q000627:therapeutic use*; D019245:Compressive Strength; D015921:Dental Implants; D004548:Elasticity; D005147:Facial Bones / Q000293:injuries / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery; D008336:Mandibular Diseases / Q000601:surgery; D008875:Middle Aged; D010012:Osteogenesis / Q000502:physiology; D019292:Skull Base Neoplasms / Q000601:surgery; D016896:Treatment Outcome
D001031:Apatites; D001672:Biocompatible Materials; D001843:Bone Cements; D018786:Bone Substitutes; D015921:Dental Implants; C030782:carboapatite