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

Abstract

(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.

Hanna’s Modified Sagittal Split Osteotomy (HSSO): An Alternative to Inverted L Osteotomy—Merging Function and Aesthetics for Enhanced Stability, Attractiveness, and Nerve Protection

“…These residual asymmetries and contour deformities are particularly prevalent in cases resulting in a vertical discrepancy between the proximal and distal segments of the mandible. Correction requires the use of patient-specific angle onlay implants [ 63 , 64 , 65 ]. PEEK implants are typically used for this due to the low complication rate reported in the literature [ 66 ]; however, when complications do arise and the prosthesis must be removed, it can be very challenging due to the porous property of the material [ 67 ].…”

Probing real-world Central European population midfacial skeleton symmetry for maxillofacial surgery

“…At best, no extra correction is required, and traditional symmetry-based approaches may be used. If there is a substantial offset during the planning of the implant, manual corrections through manual adjustment or, for example, the use of a standardized skull [ 2 ] may have to be used.…”

“…It also relates to computer-aided surgical (CAS) procedures in oral and maxillofacial surgery (OMFS) because they are based on symmetry. If no facial symmetry or extensive defects in the facial skeleton are present, other methods for creating patient-specific implants (PSIs) must be applied, such as the superimposition strategy, where a model of a standard skull may be utilised as a template to replace missing or significantly asymmetric parts, and PSI manufacturing can proceed regularly [ 2 ]. Alternatively, the initial situation of the facial skeleton can be printed three-dimensionally, and PSIs can be moulded by hand on the printed model [ 3 ].…”

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

“…After 3D scanning (magnetic resonance imaging (MRI), computed tomography (CT) or cone beam computed tomography (CBCT)), PSIs are digitally planned and 3D printed using selective laser melting techniques (in case of titanium implants) [ 1 , 2 ]. Most often they are used for orbital wall reconstruction after trauma [ 2 ], but they are also frequently used for mandibular reconstruction [ 3 ] or even for orthognathic surgery [ 4 ]. In terms of orbital PSIs, the implants are planned mirroring the other, healthy, orbit.…”

“…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.…”