Mandibular Angle Contouring Using Porous Polyethylene Stock or PEEK-based Patient Specific Implants. A Critical Analysis

Abstract

Contour augmentation and mandibular angle modification surgery is becoming increasingly. The aim of this research is to compare technique and outcomes in augmentations done with standard implants or PEEK-based patient specific implants (PSI) in mandibular angle. Data from surgical planning, operative and post-operative of 6 months follow-up were revised for 21 patients who were submitted to facial surgery using a stock implant obtained from companies currently on the market or 3D implants created with CAD/CAM technology using PEEK 3D printing. Surgical time, intra-operative and post-operative complications were compared, analyzing the advantages and disadvantage of each technique. Statistical analyses using t-test and chi-squared were performed considering P value< 0.05 for statistical differences. Twelve patients were operated on with stock implants and nine patients with PSI. The surgical time was 15 minutes less for the 3D implant surgeries (P = 0.021) and intraoperatively only the stock implants needed modifications with wear and adaptation methods; post-operative infections were observed in both groups with no significant differences (P > 0.05). The 3D implants had greater levels of facial symmetry than the stock implants, although they did not present significant differences.Considering the limitations of this study, mandibular angle implants with a PEEK-based 3D CAD/CAM are efficient, stable and have a low complication rate; the CAD/CAM strategy is useful in facial surgery and can be integrated as a standard for surgical planning in facial makeover surgery.

A Multi-Criteria Assessment Strategy for 3D Printed Porous Polyetheretherketone (PEEK) Patient-Specific Implants for Orbital Wall Reconstruction

“…Furthermore, PEEK PSIs have also been used in craniofacial defects reconstruction [56], in midface reconstruction as an alternative to composite free tissue transfer or maxillary obturators [57,58]. In addition, PEEK onlay implants have been utilized in zygoma contour augmentation [31,32] and mandibular angle reconstructive surgeries [59]. While the use of CAD/CAM milled PEEK orbital implants have been documented in the literature [60,61], the production of porous, mesh-like orbital implants by FFF is relatively new.…”

Mandibular recontouring with polyetheretherketone (PEEK) patient-specific implants

“…PTFE, on the other hand, carries an increased risk of infections, seroma formation and extrusion. Computer-designed implants have revolutionised the approach to treatment of complex bone defects, becoming an excellent alternative to traditional techniques 16 17. The advances in 3D CT scanning techniques led first to improved evaluation and surgical planning of craniofacial reconstruction, and later to the possibility of manufacturing custom-made alloplastic prostheses.…”

Reconstruction of Mandibular Contour Defect Using Patient-Specific Titanium Implant Manufactured by Selective Laser Melting Method

“… 3 , 6 Recently, patient-specific implants were manufactured using polyether ether ketone or Ti using the CAD/ computer-assisted manufacturing method. 2 , 7 , 10 , 11 , 16 In this case report, we introduced 2 patients who resolved the asymmetry that occurred after mandibuloplasty with PSTI with 3D printing using the SLM method. Mommaerts et al 7 also reported a case series of mandibular angle and border augmentation using PSTI manufactured in the same way and presented guidelines.…”

“… 7 However, if surgery is performed for esthetic purposes, such as for the patients in this case report, extraoral scar may also be a problem, so the intraoral approach is usually preferred. 2 , 16 To improve the surgical accuracy in the intraoral approach with limited field of view, sufficient dissection of the mandibular border must be performed anteriorly, posteriorly, and medially, beyond the application range of the PSTI. 7 Furthermore, screw fixation should be performed, maintaining the PSTI as close to the bone as possible.…”