Osteointegration in cranial bone reconstruction: a goal to achieve.
BACKGROUND
The number of cranioplasty procedures is steadily increasing, mainly due to growing indications for decompressive procedures following trauma, tumor or malformations. Although autologous bone is still considered the gold standard for bone replacement in skull, there is an urgent need for synthetic porous implants able to guide bone regeneration and stable reconstruction of the defect. In this respect, hydroxyapatite scaffolds with highly porous architecture are very promising materials, due to the excellent biocompatibility and intrinsic osteogenic and osteoconductive properties that enable deep bone penetration in the scaffold and excellent osteointegration. Osteointegration is here highlighted as a key aspect for the early recovery of bone-like biomechanical performance, for which custom-made porous hydroxyapatite scaffolds play a major role. There are still very few cases documenting the clinical performance of porous scaffolds following cranioplasty.


METHODS
This paper reports 2 clinical cases where large cranial defects were repaired by the aid of porous hydroxyapatite scaffolds with customized shapes and 3D profiles (Fin-Ceramica, Faenza, Italy).


RESULTS
In the long term (i.e., after 2 years), these scaffolds yielded extensive osteointegration through formation and penetration of new organized bone.


CONCLUSIONS
These results confirm that porous hydroxyapatite scaffolds, uniquely possessing chemico-physical and morphological/mechanical properties very close to those of bone, can be considered as a tool to provide effective bone regeneration in large cranial bone defects. Moreover, they may potentially prevent most of the postsurgical drawbacks related to the use of metal or plastic implants.
 Institute of Science and Technology for Ceramics, National Research Council, ISTEC - CNR, Faenza - Italy.
Simone
S
Sprio
 Department of Neurosurgery, Cannizzaro University Hospital of Catania, Catania - Italy.
Marco
M
Fricia
 Department of Neurosurgery, Di Summa - Antonio Perrino Hospital, Brindisi - Italy.
Giuseppe F
GF
Maddalena
 Fin-Ceramica Faenza S.p.A., Faenza - Italy.
Angelo
A
Nataloni
 Institute of Science and Technology for Ceramics, National Research Council, ISTEC - CNR, Faenza - Italy.
Anna
A
Tampieri
D000328:Adult; D064592:Autografts; D016025:Bone Transplantation; D000069343:Bone-Implant Interface; D005260:Female; D006801:Humans; D008297:Male; D010012:Osteogenesis; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures; D012887:Skull Fractures / Q000378:metabolism / Q000601:surgery; D054457:Tissue Scaffolds