Reconstruction of Cranial Vault Defect with Polyetheretherketone Implants

Brandicourt, Pierre; Delanoë, F.; Roux, Franck‐Emmanuel; Jalbert, F.; Brauge, David; Lauwers, F.

doi:10.1016/j.wneu.2017.04.049

Cited by 42 publications

(36 citation statements)

References 32 publications

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“…18 Advantages of computer-designed, prefabricated implants have been demonstrated and include improved cosmetic outcome as well as minimization of the procedure time needed for implant insertion. 16 However, in most series, expensive commercial and industrial 3D printers (approximately US$37,000-US$310,000) or expensive com-mercial implants (approximately US$10,000) 3,5,8,13,18,21,22,26,[30][31][32] were used, which are prohibitive for use in low-and middle-income countries.…”

Section: Discussionmentioning

confidence: 99%

Cranioplasty with a low-cost customized polymethylmethacrylate implant using a desktop 3D printer

Morales-Gómez¹,

Garcia-Estrada²,

Leos-Bortoni³

et al. 2019

Journal of Neurosurgery

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OBJECTIVE Cranioplasty implants should be widely available, low in cost, and customized or easy to mold during surgery. Although autologous bone remains the first choice for repair, it cannot always be used due to infection, fragmentation, bone resorption, or other causes, which led to use of synthetic alternatives. The most frequently used allogenic material for cranial reconstructions with long-term results is polymethylmethacrylate (PMMA). Three-dimensional printing technology has allowed the production of increasingly popular customized, prefabricated implants. The authors describe their method and experience with a customized PMMA prosthesis using a precise and reliable low-cost implant that can be customized at any institution with open-source or low-cost software and desktop 3D printers. METHODS A review of 22 consecutive patients undergoing CT-based, low-cost, customized PMMA cranioplasty over a 1-year period at a university teaching hospital was performed. Preoperative data included patient sex and age; CT modeling parameters, including the surface area of the implant (defect); reason for craniectomy; date(s) of injury and/or resections; the complexity of the defect; and associated comorbidities. Postoperative data included morbiditiy and complications, such as implant exposure, infection, hematoma, seroma, implant failure, and seizures; the cost of the implant; and cosmetic outcome. RESULTS Indications for the primary craniectomy were traumatic brain injury (16, 73%), tumor resection (3, 14%), infection (1, 4%), and vascular (2, 9%). The median interval between previous surgery and PMMA cranioplasty was 12 months. The operation time ranged from 90 to 150 minutes (mean 126 minutes). The average cranial defect measured 65.16 cm (range 29.31-131.06 cm). During the recovery period, there was no sign of infection, implant rejection, or wound dehiscence, and none of the implants had to be removed over a follow-up ranging from 1 to 6 months. The aesthetic appearance of all patients was significantly improved, and the implant fit was excellent. CONCLUSIONS The use of a customized PMMA was associated with excellent patient, family, and surgeon satisfaction at follow-up at a fraction of the cost associated with commercially available implants. This technique could be an attractive option to all patients undergoing cranioplasty.

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Section: Discussionmentioning

confidence: 99%

Cranioplasty with a low-cost customized polymethylmethacrylate implant using a desktop 3D printer

Morales-Gómez¹,

Garcia-Estrada²,

Leos-Bortoni³

et al. 2019

Journal of Neurosurgery

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“…37 patients were conducted with reconstruction by the customized PEEK prosthesis during 2007 and 2015. Their clinical data were then analyzed by Brandicourt et al [251] Thereinto, one infection (2.7%) whose prosthesis was removed and 6 patients (16%) being re-operated by that maxillofacial surgery team were described. Thirty patients (81%) in total showed their satisfaction in aesthetic aspects.…”

Section: Craniofacial Bonementioning

confidence: 99%

Recent Developments of Biomaterials for Additive Manufacturing of Bone Scaffolds

Zhang

et al. 2020

Adv Healthcare Materials

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Recent years have witnessed surging demand for bone repair/regeneration implants due to the increasing number of bone defects caused by trauma, cancer, infection, and arthritis worldwide. In addition to bone autografts and allografts, biomaterial substitutes have been widely used in clinical practice. Personalized implants with precise and personalized control of shape, porosity, composition, surface chemistry, and mechanical properties will greatly facilitate the regeneration of bone tissue and satiate the clinical needs. Additive manufacturing (AM) techniques, also known as 3D printing, are drawing fast growing attention in the fabrication of implants or scaffolding materials due to their capability of manufacturing complex and irregularly shaped scaffolds in repairing bone defects in clinical practice. This review aims to provide a comprehensive overview of recent progress in the development of materials and techniques used in the additive manufacturing of bone scaffolds. In addition, clinical application, pre-clinical trials and future prospects of AM based bone implants are also summarized and discussed.

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“…Polyetherketoneketone (PEKK) and polyetheretherketone (PEEK) are used in orthopedics, spine, and craniofacial surgeries. [ 8–11 ] Both PEEK and PEKK, which are considered the most outstanding bone tissue substitute alternatives to metallic implants in medical fields, [ 12, 13 ] have higher strength (on a per mass basis) and biocompatibility than many metals with considerable weight. [ 14 ] Although PEEK is the most commonly used ultraperformance polymer in the aerospace industry and biomedical applications, PEKK has mechanical, thermal, and chemical resistance properties similar to PEEK [ 15 ] and is substantially easier to 3D print than PEEK.…”

Section: Introductionmentioning

confidence: 99%

Effect of processing parameters on flexural properties of 3D‐printed polyetherketoneketone using fused deposition modeling

Cheng

Liu

et al. 2020

Polymer Engineering & Sci

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Polyetherketoneketone (PEKK) is an engineering plastic with ultrahigh mechanical performance and has attracted considerable attention in the medical and technical fields. Printing parameters during fused deposition modeling (FDM) for PEKK have a significant impact on final part quality. In this study, a relationship between the process parameters and flexural properties of PEKK was investigated by conducting three‐point bending tests, and scanning electron microscopy was employed to analyze the microstructure of fracture surfaces. Nozzle temperature, layer thickness, and infill density affected flexural properties by changing the porosity and interlayer bonding strength. Interlayer separation is the main failure mode of the upright orientation samples, while intralayer failure is likely to occur in the on‐edge orientation samples. The flexural properties of FDM‐printed PEKK under optimum parameters are comparable to those of mandibular bones, indicating that PEKK is a potential candidate for repairing mandibular defects. The results highlighted in this study are fundamental to the optimal design of complex ultralight, highly efficient structures.

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Reconstruction of Cranial Vault Defect with Polyetheretherketone Implants

Abstract: The use of a PEEK prosthesis in cranial vault defect reconstruction is a reliable technique with a high patient satisfaction rate and few complications. Corrections of the temporal muscle atrophy by fat grafting may be performed in addition, without increasing the rate of complications.

Cited by 42 publications

References 32 publications

Cranioplasty with a low-cost customized polymethylmethacrylate implant using a desktop 3D printer

Cranioplasty with a low-cost customized polymethylmethacrylate implant using a desktop 3D printer

Recent Developments of Biomaterials for Additive Manufacturing of Bone Scaffolds

Effect of processing parameters on flexural properties of 3D‐printed polyetherketoneketone using fused deposition modeling

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