title: Osteointegration in Custom-made Porous Hydroxyapatite Cranial Implants: From Reconstructive Surgery to Regenerative Medicine.
abstract: BACKGROUND
  Custom-made porous hydroxyapatite (HA) implant (Fin-Ceramica Faenza S.p.A., Italy) is a biomimetic, osteoconductive material. Margin fusion at the bone-implant edge, cell proliferation within implant pores, and osteointegration in an animal model have already been described.
  
  
  METHODS
  Radiological, microtomographical, and histological analyses were performed on two patients who underwent surgical explantation of cranial implants after postoperative complication. Primary devices explanted after 2 years showed areas of newly formed bone strictly osteointegrated with pores of the prosthesis. These prostheses showed a focal zone of resorption in correspondence of the newly formed bone, and no signs of inflammation or cytotoxicity were observed. A back-up prosthesis, explanted from the same patient after 6 months because of an infection, did not show presence of newly formed bone both on the surface and in the internal part of the prosthesis.
  
  
  CONCLUSIONS
  Custom-made porous HA implant is an osteoconductive material able to promote osteogenesis, osteointegrate with bone tissue, provide an effective cranial reconstruction, and restore functional features of the skull. However, complete bone healing is still a complex and long process.
authors.affiliation: Department of Neurosurgery, Cannizzaro University Hospital, Catania, Italy. Electronic address: marco.fricia@aoec.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Fricia
authors.affiliation: Department of Neurosurgery, Cannizzaro University Hospital, Catania, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Passanisi
authors.affiliation: Laboratory of Biocompatibility, Technological Innovations, and Advanced Therapies, Department RIT Rizzoli-Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Salamanna
authors.affiliation: Laboratory of Biocompatibility, Technological Innovations, and Advanced Therapies, Department RIT Rizzoli-Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Annapaola
authors.initials: A
authors.lastname: Parrilli
authors.affiliation: Laboratory of Biocompatibility, Technological Innovations, and Advanced Therapies, Department RIT Rizzoli-Rizzoli Orthopaedic Institute, Bologna, Italy; Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Giavaresi
authors.affiliation: Laboratory of Biocompatibility, Technological Innovations, and Advanced Therapies, Department RIT Rizzoli-Rizzoli Orthopaedic Institute, Bologna, Italy; Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Milena
authors.initials: M
authors.lastname: Fini
mesh_terms: D003399:Craniotomy; D017886:Durapatite; D021621:Imaging, Three-Dimensional; D016348:Osseointegration / Q000502:physiology*; D019919:Prosthesis Implantation; D019651:Plastic Surgery Procedures; D044968:Regenerative Medicine; D012086:Reoperation; D012886:Skull / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D055114:X-Ray Microtomography
chemical_list: D017886:Durapatite
keywords: Cranioplasty; Hydroxyapatite; Osteointegration; Regenerative medicine; Traumatic brain injury