Individual CAD/CAM Fabricated Glass-Bioceramic Implants in Reconstructive Surgery of the Bony Orbital Floor

Background: The aim of the study was to present a set of preliminary cases from an ongoing program of reconstructive procedures using a new technique in the treatment of severe enophthalmos and diplopia after the primary treatment of orbital floor fractures had rendered insufficient results. Methods: Glass-bioceramic implants were shaped from computed tomography coordinates with computer-assisted design and computer-assisted manufacturing. In this prefabrication process, the implants were milled individually out of a solid block of Bioverit II (3di Gmbh, Jena, Germany). The adequacy of this reconstruction for treating malfunction and aesthetic deficits was evaluated. Results: Eight patients with orbital floor fractures underwent successful surgery. The results were encouraging, with all patients showing a good functional and aesthetic outcome. Conclusions: Computer-assisted design/computer-assisted manufacturing implants made of Bioverit II can be used for a very accurate and successful secondary reconstruction of the orbital floor. However, it addresses only a few aspects of the treatment of orbital floor fractures and should be considered as an equal alternative to other reconstruction methods.

[1]  A. Dancey,et al.  Iliac bone grafts for orbital wall reconstruction. , 2004, Plastic and reconstructive surgery.

[2]  L. Mawn,et al.  The Bioceramic Orbital Implant: A New Generation of Porous Implants , 2000, Ophthalmic plastic and reconstructive surgery.

[3]  R. Marmulla,et al.  Computer-assisted bone segment navigation. , 1998, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[4]  C. Czerny,et al.  Follow-up study of treatment of orbital floor fractures: relation of clinical data and software-based CT-analysis. , 2003, International journal of oral and maxillofacial surgery.

[5]  H Niederdellmann,et al.  Surgical planning of computer-assisted repositioning osteotomies. , 1999, Plastic and reconstructive surgery.

[6]  [Navigation-supported surgery in the head and neck region]. , 2003, Laryngo- rhino- otologie.

[7]  R. Pearl Surgical Management of Volumetric Changes in the Bony Orbit , 1987, Annals of plastic surgery.

[8]  M J Hawes,et al.  Surgery on orbital floor fractures. Influence of time of repair and fracture size. , 1983, Ophthalmology.

[9]  S. Tuncer,et al.  Reconstruction of Orbital Floor Fracture Using Solvent-Preserved Bone Graft , 2004, Plastic and reconstructive surgery.

[10]  Yinghui Tan,et al.  Assessment of internal orbital reconstructions for pure blowout fractures: cranial bone grafts versus titanium mesh. , 2003, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[11]  H. Schubert,et al.  Rasterelektronenmikroskopische Untersuchung des Zellwachstums auf maschinell bearbeitbarer Biovitrokeramik und Glaskohlenstoff in vitro und in vivo , 1985 .

[12]  S. Koscielny,et al.  Untersuchungen zum Einfluss von Biokeramiken auf biologische Leistungen von Mikroorganismen , 2001, HNO.

[13]  L. Mawn,et al.  The Bioceramic Orbital Implant: Experience With 107 Implants , 2003, Ophthalmic plastic and reconstructive surgery.

[14]  U. Spetzger,et al.  Individual prefabricated titanium implants and titanium mesh in skull base reconstructive surgery. A report of cases , 2004, European Archives of Oto-Rhino-Laryngology and Head & Neck.

[15]  G. Geyer,et al.  Plastischer Verschluss knöcherner Schädellücken mit einem ionomeren Knochenersatzmaterial , 1992 .

[16]  Ken Matsuda,et al.  A simple method of harvesting a thin iliac bone graft for reconstruction of the orbital wall. , 2003, Plastic and reconstructive surgery.

[17]  S. Koscielny,et al.  Untersuchungen zum Einfluss von Biokeramiken auf die Phagozytoserate humaner Leukozyten , 2002, HNO.

[18]  A. Katsumata,et al.  Measurement accuracy of reconstructed 2-D images obtained by multi-slice helical computed tomography. , 2004, Clinical oral implants research.

[19]  K. Jahnke,et al.  Reconstruction of the Stapes Superstructure with a Combined Glass-Ceramic (Bioverit®) Implant in Guinea Pigs , 2002, ORL.

[20]  Beat Hammer,et al.  In vivo efficacy of bone-marrow-coated polycaprolactone scaffolds for the reconstruction of orbital defects in the pig. , 2003, Journal of biomedical materials research. Part B, Applied biomaterials.

[21]  Siegfried Jank,et al.  Orbital floor reconstruction with flexible Ethisorb patches: a retrospective long-term follow-up study. , 2003, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.