Reduction of CT Artifacts Using Polyetheretherketone (PEEK), Polyetherketoneketone (PEKK), Polyphenylsulfone (PPSU), and Polyethylene (PE) Reconstruction Plates in Oral Oncology

Lommen, Julian; Schorn, Lara; Sproll, Christoph; Haussmann, Jan; Kübler, Norbert R.; Budach, Wilfried; Rana, Majeed; Tamaskovics, Bálint

doi:10.1016/j.joms.2022.03.004

Cited by 18 publications

(26 citation statements)

References 42 publications

(33 reference statements)

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“…In the wake of scientific efforts to counter these problems, polymer materials are increasingly being investigated as possible substitutes. Just recently it was shown that the polymer materials PEEK, PEKK, PPSU, and PE cause significantly fewer artifacts in CT imaging when used as mandible reconstruction plates compared to titanium tested on human cadavers [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…Due to sophisticated fitting accuracy, the use of PSI in mandibular reconstruction is widely accepted [ 4 ]. However, titanium plates cause significant streak and blooming artifacts in computer tomography (CT) images thwarting thorough radiological assessment of implant surrounding tissues [ 5 ]. This phenomenon disadvantageously affects postoperative radiological tumor follow-up as well as adjuvant radiotherapy strongly dependent on a high-resolution, artifact-free planning CT [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…As a counterpart to this, it could be shown that various types of polymer reconstruction plates consisting of polyetheretherketone (PEEK), polyetherketoneketone (PEKK), polyphenylsulfone (PPSU), and polyethylene (PE) cause significantly fewer artifacts in CT images leading to better image quality [ 5 ]. Because bite forces after segmental mandibulectomy remain limited, presumably frangible polymer reconstruction materials have become of enormous scientific interest [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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

Lommen

Schorn

Sproll

et al. 2022

JCM

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Lommen

Schorn

Sproll

et al. 2022

JCM

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“…Moreover, the RFID ports in this study uses a plastic material, polyetheretherketone (PEEK), as the needle guide, which differs from the stainless steel in conventional TEs. As PEEK has a relatively lower HU than other metals, this potentially reduces the artifacts on CT imaging [20].…”

Section: Discussionmentioning

confidence: 99%

Dosimetric Effect of Injection Ports in Tissue Expanders on Post-Mastectomy Volumetric Modulated Arc Therapy (VMAT) Planning for Left-Sided Breast Cancer

et al. 2022

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This study aimed to compare the dosimetric effect of traditional metallic ports and radio frequency identification (RFID) ports (Motiva Flora®) on post-mastectomy volumetric modulated arc therapy (VMAT) planning for left-sided breast cancer. Computed tomography (CT) simulation was performed on an anthropomorphic torso phantom by attaching two types of tissue expander on the left chest wall. For the comparison of CT artifacts, five points of interest were selected and compared: point A = central chest wall, B = medial chest wall, point C = lateral chest wall, point D = axilla, and point E = left anterior descending artery. VMAT planning using two partial arcs with a single isocenter was generated, and dosimetric parameters were investigated. Compared to metallic ports, RFID ports tremendously decreased distortion on CT images, with the exception of point D. The V5Gy, V10Gy, V15Gy, V20Gy, V30Gy, and Dmean values of the heart in RFID ports were lower than those in metallic ports. The V5Gy, V15Gy, V20Gy, V30Gy, and Dmean values of the ipsilateral lung in RFID ports were also lower than those in metallic ports. RFID ports showed superior dosimetric results for doses to the heart and lungs as compared to that in metallic ports.

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“…The advantages of PSI-based orthognathic surgery are well described, and the procedure has been proven for many years [ 20 , 21 , 22 , 23 ]. Furthermore, augmentative procedures have been established in which PEEK bone implants can be used to adequately replace bone defects or malpositions [ 24 , 25 , 26 , 27 , 28 , 29 ]. In recent years, the great benefit of PEEK bone augmentations for the treatment of facial asymmetries has been discovered.…”

Section: Introductionmentioning

confidence: 99%

Simultaneous PSI-Based Orthognathic and PEEK Bone Augmentation Surgery Leads to Improved Symmetric Facial Appearance in Craniofacial Malformations

Kerkfeld

Schorn

Depprich

et al. 2022

JPM

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(1) The aim of the present study was to compare the outcome of facial symmetry after simultaneous digitally planned patient-specific implant (PSI-) based orthognathic surgery and polyether ether ketone (PEEK) bone augmentation in patients with craniofacial malformations. (2) To evaluate the outcome of the two different surgical approaches (conventional PSI-based orthognathic surgery versus simultaneous PSI-based orthognathic surgery with PEEK bone augmentation), a comparison of five different groups with a combination of the parameters (A) with vs. without laterognathia, (B) syndromic vs. non-syndromic, and (C) surgery with vs. without PEEK bone augmentation was conducted. The digital workflow comprised cone beam CT (CBCT) scans and virtual surgery planning for all patients in order to produce patient specific cutting guides and osteosynthesis plates. Additionally, deformed skulls were superimposed by a non-deformed skull and/or the healthy side was mirrored to produce PSI PEEK implants for augmentation. Retrospective analyses included posterior–anterior conventional radiographs as well as en face photographs taken before and nine months after surgery. (3) Simultaneous orthognathic surgery with PEEK bone augmentation significantly improves facial symmetry compared to conventional orthognathic surgery (6.5%P (3.2–9.8%P) (p = 0.001). (4) PSI-based orthognathic surgery led to improved horizontal bone alignment in all patients. Simultaneous PEEK bone augmentation enhanced facial symmetry even in patients with syndrome-related underdevelopment of both soft and hard tissues.

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Reduction of CT Artifacts Using Polyetheretherketone (PEEK), Polyetherketoneketone (PEKK), Polyphenylsulfone (PPSU), and Polyethylene (PE) Reconstruction Plates in Oral Oncology

Cited by 18 publications

References 42 publications

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

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

Dosimetric Effect of Injection Ports in Tissue Expanders on Post-Mastectomy Volumetric Modulated Arc Therapy (VMAT) Planning for Left-Sided Breast Cancer

Simultaneous PSI-Based Orthognathic and PEEK Bone Augmentation Surgery Leads to Improved Symmetric Facial Appearance in Craniofacial Malformations

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