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Evaluierung individueller, in der CAD/CAM-Technik gefertigter Bioverit®-Keramik-Implantate zur Wiederherstellung mehrdimensionaler kraniofazialer Defekte am menschlichen Schädel

Evaluation of individual ceramic implants made of Bioverit with CAD/CAM technology to reconstruct multidimensional craniofacial defects of the human skull

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Zusammenfassung

Hintergrund

Knöcherne Defizite im Gesichtsschädel verursacht durch Unterentwicklung, Nichtanlage, Traumata oder Tumoren stehen im Mittelpunkt der rekonstruktiven plastischen Mund-, Kiefer- und Gesichtschirurgie. Zur Rekonstruktion von derartigen Defekten sind Verfahren der autologen Transplantation etabliert. Atrophie und Resorption von frei transplantierten Geweben beeinträchtigen die Langzeitergebnisse von konturbildenden Defekten. Auch werden Entnahmemorbiditäten im Spenderareal beschrieben. Als alternative Methode zur alloplastischen Rekonstruktion stehen computerassistierte Planungs- und Fertigungssysteme (CAD/CMD) zur Verfügung. Die individuelle Implantatplanung und Fertigung wirkt sich positiv auf das Behandlungsergebnis aus.

Material und Methode

In der vorliegenden Studie wurde der Einsatz von CAD-gefertigten, individuellen Biokeramikimplantaten aus Bioverit II® im Bereich des Gesichtsschädels evaluiert. Dabei wurden die klinischen Ergebnisse über einen postoperativen Beobachtungszeitraum von 30 Monaten bewertet und die Patientenakzeptanz erfasst.

Ergebnisse

Die Auswertung umfasst 25 patientenspezifische Bioverit-Implantate im Bereich des Gesichtsschädels. Alle Patienten zeigten sich primär mit dem ästhetischen Ergebnis der Operation zufrieden. Bei drei Patienten entwickelte sich im Beobachtungszeitraum der Wunsch nach einer weiteren Korrektur und einmal kam es zur Fraktur des Implantates.

Schlussfolgerung

Zusammenfassend kann festgestellt werden, dass für spezielle Indikationen der präoperativ benötigte zeitliche, materielle und personelle Aufwand zur individuellen CAD/CAM-Planung und Fertigung der Implantate, durch die damit verbundenen Vorteile wie Volumenstabilität, verkürzte Operationszeiten, fehlende Donormorbidität und einfache Bearbeitbarkeit des Materials weitgehend ausgeglichen werden kann.

Abstract

Background

Restrictions in the bone structure of the craniomandibular region caused by malformation, traumata or malignant tumours are currently of interest in reconstructive oral and maxillofacial surgery. Methods of autologous bone transplantation are well established for reconstruction of those defects. The reconstruction and remodeling of contour-shaping defects is more difficult due to atrophy and resorption of free-transplantable tissues. Artificially induced harmful effects have been reported on harvesting in the donor area. Further available methods of alloplastic reconstruction are computer-assisted design and manufacturing systems (CAD/CAM). The advantages of individual design and fabrication are obvious in the manufacturing of defect-specific implants.

Material and methods

In the present study the application of individual CAD-based reconstructed bioceramic implants made of Bioverit II was evaluated in the region of the facial skull. Clinical results, patient acceptance and the analysis of the postoperative observation period of 30  months are reviewed.

Results

Altogether 25 individual Bioverit ceramics were implanted in the facial region. All patients were satisfied with the aesthetic results of the implantations after primary surgery. Three patients developed a need for further correction during the observation period; one implant fracture was observed.

Conclusion

Finally, it can be stated that the preoperative expenditures in time, experts, technology and fabrication of individual CAD/CAM planned and manufactured implants are justified by the following advantages: fixed volume, reduced operating time, lack of donor morbidity, easy subsequent treatment of the material and the aesthetic results achieved.

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Authors and Affiliations

  1. Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie/Plastische Chirurgie, Friedrich-Schiller-Universität, Erlanger Allee 101, 07747, Jena

    P. Schleier, W. Zenk & D. Schumann

  2. Institut für Materialwissenschaften und Werkstofftechnologie, Friedrich-Schiller-Universität Jena

    J. Beinemann & W. Fried

  3. Jena

    H. Siebert

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  1. H. Siebert
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  2. P. Schleier
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  3. J. Beinemann
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  6. D. Schumann
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Correspondence to P. Schleier.

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Siebert, H., Schleier, P., Beinemann, J. et al. Evaluierung individueller, in der CAD/CAM-Technik gefertigter Bioverit®-Keramik-Implantate zur Wiederherstellung mehrdimensionaler kraniofazialer Defekte am menschlichen Schädel. Mund Kiefer GesichtsChir 10, 185–191 (2006). https://doi.org/10.1007/s10006-006-0687-z

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