Treatment of Large Complex Cranial Bone Defects by Using Hydroxyapatite Ceramic Implants

Ono, Isao; Tateshita, Tohru; Satou, Mitsuo; Sasaki, Tatsuya; Matsumoto, Masato; Kodama, Namio

doi:10.1097/00006534-199908000-00003

Cited by 58 publications

(32 citation statements)

References 16 publications

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“…Some of the examples are: alginate, collagen and chitosan (natural) ceramics, metals and polymers (synthetic). These are called biomaterials as they are considered as good materials to be implanted in the body with the aim of substituting lesioned and/or lost tissues [10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Hydroxyapatite-alginate biocomposite promotes bone mineralization in different length scales in vivo

Paula

Barreto

Rocha-Leão

et al. 2009

Front. Mater. Sci. China

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Tissue engineering is a multidisciplinary research area that aims to develop new techniques and/or biomaterials for medical applications. The objective of the present study was to evaluate the osteogenic potential of a composite of hydroxyapatite and alginate in bone defects with critical sizes, surgically made in the calvaria region of rats. The rats (48 adult males), Rattus norvegicus Wistar, were divided into two groups: control (without composite implantation) and experimental (with composite implantation) and analyzed by optical microscopy at the biological time points 15, 45, 90 and 120 d, and transmission electron microscopy 120 d after the implantation of the biomaterial. It was observed that the biomaterial presented a high degree of fragmentation since the first experimental points studied, and that the fragments were surrounded by new bone after the duration of the project. These areas were studied by analytical transmission electron microscopy using an energy dispersive X-ray spectrometer. Three regions could be distinguished: (1) the biomaterial rich in hydroxyapatite; (2) a thin contiguous region containing phosphorus but without calcium; (3) a region of initial ossification containing mineralizing collagen fibrils with a calcium/phosphorus ratio smaller than the particles of the composite. The intermediate region (without calcium or containing very low amounts of calcium), which just surrounded the composite had not been described in the literature yet, and is probably associated specifically to the biocomposite used. The high performance of the biomaterial observed may be related to the fact that alginate molecules form highly anionic complexes and are capable of adsorbing important factors recognized by integrins from osteoblasts. Regions of fibrotic tissue were also observed mainly in the initial experimental points analyzed. However, it did not significantly influence the final result. In conclusion, the biomaterial presents a great potential for application as bone grafts in the clinical area.

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Section: Introductionmentioning

confidence: 99%

Hydroxyapatite-alginate biocomposite promotes bone mineralization in different length scales in vivo

Paula

Barreto

Rocha-Leão

et al. 2009

Front. Mater. Sci. China

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“…Titanum is used for reconstruction of large skull defects [2]. It may be used for complex defects like those in the case presented, but problems such as extrusion of the titanum material have been reported [9].…”

Section: Discussionmentioning

confidence: 96%

Three-dimensional reconstruction of a defect of the frontozygomatic area by custom made Proplast II implant

2000

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Alloplastic materials are a valid alternative to autologous bone grafts in contour defects of the facial skeleton Biomaterials also reduce donor site morbidity. In addition, alloplastic materials can be contoured exactly as needed. Computed tomography (CT) scan digital data can be computed into three-dimensional data for 1:1 stereolithographic reconstruction of the complete skull or segments as required. The design of an implant for defect reconstruction may even be computed as a mirror image of the unaffected undeformed side. Therefore it is common to perform phantom operations on stereolithographically built models from the patient's head before a complex reconstruction is done. Proplast II has an advantage over other materials, such as hydroxyapatite, titanum, gold, silicone, and polymethylmetacrylate (PMMA), because of the low weight, the fact that the material can be carved with a sharp scalpel, and the possible integration into fibrous and bone tissue. Proplast II is semirigid and can easily be sutured to the bony defect.A 29-year-old male patient presented with a complex bone defect of the frontozygomatic region after a neurosurgical procedure 10 years previously. The skin was soft and mobile, and there was a soft and thin scar above the left orbital rim (Fig. 1). The patient's complaint was of a visible depression over the frontozygomatic suture. Clinical examination showed weakness of the frontalis muscle due to the initial neurosurgical operation. Neurologically, there were no deficits or visual impairment.Production and insertion of implant (Fig. 2) Preoperative investigations included a CT scan with three-dimensional (3-D) reconstruction (Fig. 3). The data were transferred to a laser lithographic molding device. The technique for producing full-scale models is based on laser-curable polymethylmetacrylate (PMMA), which is hardened by laser irradiation (Fig. 4a). Once the skull model was available, the missing part of the frontozygomatic was produced by mirroring the undeformed right area of the frontozygomatic on digital basis. With these data, it was possible to form the missing left part of the frontozygomatic in the model material. This mirrored virtual model was exactly carved to the full size skull model and fixed to the defect with screws (Fig. 4b).This finely adjusted PMMA model was sent to the company which produces custom-made Proplast II implants (Fig. 5) (Genatis, Biofunctional Technology SA, Nyon, Switzerland). Fig. 1Defect of the left frontotemporozygomatic complex in a 29-year-old male patient, due to a neurosurgical procedure 10 years previously

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“…Recent developments in medical engineering have introduced various types of artificial bone to the market [1][2][3][4][5][6][7][8][9][10], and these materials are becoming more frequently and widely used. However, among serious complications is infection.…”

Section: Introductionmentioning

confidence: 99%

Development of a cranium-infection rat model for artificial bone implantation

Inoue¹,

Sakamoto²,

Ochiai³

et al. 2016

Biomed Res Clin Prac

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For the development of infection-resistant artificial bone, a robust animal model that closely mimics clinical infection is necessary. Therefore, we established a rat model of cranial infection. After creating a bone defect in the parietal cranium of rats, either collagen sponge honeycomb or sterile cotton gauze was inserted into the defect, and wounds were then inoculated with Staphylococcus aureus. This method effectively resulted in cranial infection in a manner dependent on the inserted sponge/gauze. In conclusion, we believe this model will be useful as a cranial infection model and will enable studies of materials used in cranioplasty for their infection potential in a state befitting that of a clinical setting.

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Treatment of Large Complex Cranial Bone Defects by Using Hydroxyapatite Ceramic Implants

Cited by 58 publications

References 16 publications

Hydroxyapatite-alginate biocomposite promotes bone mineralization in different length scales in vivo

Hydroxyapatite-alginate biocomposite promotes bone mineralization in different length scales in vivo

Three-dimensional reconstruction of a defect of the frontozygomatic area by custom made Proplast II implant

Development of a cranium-infection rat model for artificial bone implantation

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