Mechanical Fatigue Performance of Patient-Specific Polymer Plates in Oncologic Mandible Reconstruction

Abstract

Mandible defects are conventionally reconstructed using titanium plates. However, titanium causes metallic artifacts which impair radiological imaging. This study aims at evaluating mechanical fatigue of radiolucent fiber-reinforced polyetheretherketone (f-PEEK), polyetheretherketone (PEEK), polyetherketoneketone (PEKK), and polyphenylsulfone (PPSU) polymer plates for mandible reconstruction. A total of 30 plates (titanium [n = 6], f-PEEK [n = 6], PEEK [n = 6], PEKK [n = 6], PPSU [n = 6]) were implanted in synthetic mandibulectomized polyurethane mandibles. Servo-pneumatic mechanical testing with cyclic application of 30–300 N at 3 Hz was conducted. Bite forces were 70% on the unresected and 30% on the resected side. Total number of cycles was set to 250,000. Testing was aborted in case of plate or screw failure. Axial load to failure was tested with a speed of 1 mm/s. Kruskal–Wallis and Dunn’s post hoc tests were used. Titanium, f-PEEK, and PEEK showed no failure in fatigue testing and PPSU (p < 0.001) failed against titanium, f-PEEK, PEEK, and PEKK. Titanium allowed the highest load to failure compared to f-PEEK (p = 0.049), PEEK (p = 0.008), PEKK (p < 0.001), and PPSU (p = 0.007). f-PEEK, PEEK, and PEKK withstood expected physiological bite force. Although titanium plates provided the highest fatigue strength, f-PEEK and PEEK plates showed no failure over 250,000 chewing cycles indicating sufficient mechanical strength for mandible reconstruction.

Plasma Electrolytic Polished Patient-Specific Orbital Implants in Clinical Use—A Technical Note

“…In terms of orbital PSIs, the implants are planned mirroring the other, healthy, orbit. The gold standard material for PSIs remains titanium, but other materials such as PEEK (Polyetheretherketone) have recently been introduced [ 4 , 5 ]. During the usual manufacturing process, titanium patient-specific implants are machine polished.…”

Metallic Artifact Reduction in Midfacial CT Scans Using Patient-Specific Polymer Implants Enhances Image Quality

“…Recently, radiolucent polymer mandible reconstruction plates consisting of polyetheretherketone (PEEK), polyetherketoneketone (PEKK), polyphenylsulfone (PPSU) and polyethylene (PE) were found to significantly reduce streak and blooming artifacts in CT images compared to titanium [ 15 ]. In an ensuing investigation, it was shown that PEEK, fiber enforced PEEK (f-PEEK) and PEKK provide sufficient fatigue strength to withstand chewing cycles over the cause of at least one year after segmental mandibulectomy [ 16 ]. While these are promising results for mandible reconstruction, there are almost no studies analyzing the radiological effects of polymer plates for midfacial reconstruction.…”