title: Novel composite implant in craniofacial bone reconstruction.
abstract: Bioactive glass (BAG) and polymethyl methacrylate (PMMA) have been used in clinical applications. Antimicrobial BAG has the ability to attach chemically to surrounding bone, but it is not possible to bend, drill or shape BAG during the operation. PMMA has advantages in terms of shaping during the operation, but it does not attach chemically to the bone and is an exothermic material. To increase the usefulness of BAG and PMMA in skull bone defect reconstructions, a new composite implant containing BAG and PMMA in craniofacial reconstructions is presented. Three patients had pre-existing large defects in the calvarial and one in the midface area. An additive manufacturing (AM) model was used preoperatively for treatment planning and custom-made implant production. The trunk of the PMMA implant was coated with BAG granules. Clinical and radiological follow-up was performed postoperatively at 1 week, and 3, 6 and 12 months, and thereafter annually up to 5 years. Computer tomography (CT) and positron emission tomography (PET-CT) were performed at 12 and 24 months postoperatively. Uneventful clinical recovery with good esthetic and functional outcome was seen. CT and PET-CT findings supported good clinical outcome. The BAG-PMMA implant seems to be a promising craniofacial reconstruction alternative. However, more clinical experience is needed.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Turku University Hospital, P.O. BOX 52, 20521, Turku, Finland. matti.peltola@tyks.fi
authors.forename: Matti J
authors.initials: MJ
authors.lastname: Peltola
authors.forename: Pekka K
authors.initials: PK
authors.lastname: Vallittu
authors.forename: Ville
authors.initials: V
authors.lastname: Vuorinen
authors.forename: Allan A J
authors.initials: AA
authors.lastname: Aho
authors.forename: Antti
authors.initials: A
authors.lastname: Puntala
authors.forename: Kalle M J
authors.initials: KM
authors.lastname: Aitasalo
mesh_terms: D000328:Adult; D000368:Aged; D001672:Biocompatible Materials; D018786:Bone Substitutes; D003399:Craniotomy / Q000379:methods*; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D005898:Glass; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D016348:Osseointegration / Q000502:physiology; D019904:Polymethyl Methacrylate; D049268:Positron-Emission Tomography; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D019919:Prosthesis Implantation / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012886:Skull / Q000601:surgery*; D012887:Skull Fractures / Q000601:surgery*; D013499:Surface Properties; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D001672:Biocompatible Materials; D018786:Bone Substitutes; D019788:Fluorodeoxyglucose F18; D019904:Polymethyl Methacrylate