A Treatment Algorithm in Craniofacial Reconstruction: Patient-Specific Implants

  • Peter KesslerEmail author


The reconstruction of craniofacial defects is a challenging task even for the experienced surgeon. For an optimal solution, the techniques and principles that have been described in the chapters before must be adapted to the individual situation. The challenges result from the patient’s individual situation, the preoperative planning efforts, from technical aspects as well as from the reconstructive means available. While the use of autografts has been the most widely recommended method, it does have its drawbacks, including long operation times, donor site morbidity, limited donor bone supply, as well as different anatomic and structural problems. The availability of autogenous bone grafts resembling the form of the skull is limited. Therefore, there is a need for alternative materials with adequate mechanical properties and biocompatibility (Blake et al. 1990; Eufinger et al. 1995; Eufinger and Wehmöller 1998, 2002; Klongnoi et al. 2006; Wiltfang et al. 2002, 2003; Schiller et al. 2004; Thorwarth et al. 2005; von Wilmowsky et al. 2008).


Patient-specific Implants Eufinger Skull Bone Defects Apoplectic Insult Polyetheretherketone (PEEK) 
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  1. Balani K, Anderson R, Laha T, Andara M, Tercero J, Crumpler E, Agarwal A. Plasma-sprayed carbon nanotube reinforced hydroxyapatite coatings and their interaction with human osteoblasts in vitro. Biomaterials. 2007;28:618–24.CrossRefPubMedGoogle Scholar
  2. Blake GB, MacFarlane MR, Hinton JW. Titanium in reconstructive surgery of the skull and face. Br J Plast Surg. 1990;43:528–35.CrossRefPubMedGoogle Scholar
  3. Eufinger H, Wehmöller M. Individual prefabricated titanium implants in reconstructive craniofacial surgery: clinical and technical aspects os the first 22 cases. Plast Reconstr Surg. 1998;102:300–8.CrossRefPubMedGoogle Scholar
  4. Eufinger H, Wehmöller M. Microsurgical tissue transfer and individual computer-aided designed and manufactured prefabricated titanium implants for complex craniofacial reconstruction. Scand J Plast Reconstr Surg Hand Surg. 2002;36:326–31.CrossRefPubMedGoogle Scholar
  5. Eufinger H, Wehmöller M, Machtens E, Heuser L, Harders A, Kruse D. Reconstruction of craniofacial bone defects with individual alloplastic implants based on CAK/CAMmanipulated CT-data. J Craniomaxillofac Surg. 1995;23:175–81.CrossRefPubMedGoogle Scholar
  6. Hattar S, Asselin A, Greenspan D, Oboeuf M, Berdal A, Sautier JM. Potential of biomimetic surfaces to promote in vitro osteoblast-like cell differentiation. Biomaterials. 2005;26:839–48.CrossRefPubMedGoogle Scholar
  7. Hon KB, Gill TJ. Selective laser sintering of SiC/polyamide composites. CIRP Annals. 2003;52(1):173–6.CrossRefGoogle Scholar
  8. Hutmacher D, Sittinger M, Risbud M. Scaffold-based tissue engineering: Rationale form computer-aided design and solid free-form fabrication systems. Trends Biotechnol. 2004;22:354–62.CrossRefGoogle Scholar
  9. Jahur-Grodzinski J. Review—biomedical application of functional polymers. Reactive Funct Polym. 1999;39:99–138.CrossRefGoogle Scholar
  10. Klein CP, Patka P, Wolke JG, Blieck-Hogervorst JM, de Groot K. Long-term in vivo study of plasma-sprayed coatings on titanium alloys of tetracalcium phosphate, hydroxyapatite and a-tricalcium phosphate. Biomaterials. 1994;15:146–50.CrossRefPubMedGoogle Scholar
  11. Klongnoi B, Rupprecht S, Kessler P, Thorwarth M, Wiltfang J, Schlegel KA. Influence of platelet-rich plasma on a bioglass and autogenous bone in sinus augmentation. An explorative study. Clin Oral Implants Res. 2006;17:312–20.CrossRefPubMedGoogle Scholar
  12. Li LH, Kim HW, Lee SH, Kong YM, Kim HE. Biocompatibility of titanium implants modified by microarc oxidation and hydroxyapatite coating. J Biomed Mater Res A. 2005;73:48–54.CrossRefPubMedGoogle Scholar
  13. Poeck K. Neurologie. Berlin: Springer; 1987.CrossRefGoogle Scholar
  14. Poukens J, Laeven P, Beerens M, et al. A classification of cranial implants based on the degree of difficulty in computer design and manufacture. Int J Med Robotics Comput Assist Surg. 2008;4(1):46–50.CrossRefGoogle Scholar
  15. Rodil SE, Olivares R, Arzate H. In vitro cytotoxicity of amorphous carbon films. Biomed Mater Eng. 2005;15:101–12.PubMedGoogle Scholar
  16. Schiller C, Rasche C, Wehmöller M, et al. Geometrically structured implants for cranial reconstruction made of biodegradable polyesters and calcium phosphate/calcium carbonate. Biomaterials. 2004;25:1239–47.CrossRefPubMedGoogle Scholar
  17. Thorwarth M, Schultze-Mosgau S, Kessler P, Wiltfang J, Schlegel KA. Bone regeneration in osseous defects using a resorbable nanoparticular hydroxyapatite. J Oral Maxillofac Surg. 2005;63:1626–33.CrossRefPubMedGoogle Scholar
  18. von Wilmowsky C, Vairaktaris E, Pohle D, Rechenwald T, Ltz R, Münstedt H, Koller G, Schmidt M, Neukam FW, Schlegel KA, Nkenke E. Effects of bioactive glass and beta-TCP containing three-dimensional laser sintered polyetheretherketone composites on osteoblasts in vitro. J Biomed Mater Res A. 2008;87A(4):896–902.CrossRefGoogle Scholar
  19. Wiltfang J, Merten HA, Schlegel KA, Schultze-Mosgau S, Kloss FR, Rupprecht S, Kessler P. Degradation characteristics of a- and tri-calcium-phosphate (TCP) in minipigs. J Biomed Mater Res. 2002;63:115–21.CrossRefPubMedGoogle Scholar
  20. Wiltfang J, Kessler P, Buchfelder M, et al. Reconstruction of skull bone defects using the hydroxyapatite cement with calvarial split transplants. J Oral Maxillofac Surg. 2003;62:29–35.CrossRefGoogle Scholar
  21. Zegers T, Ter Laak-Poort M, Koper D, Lethaus B, Kessler P. The therapeutic effect of patient-specific implants in cranioplasty. J Craniomaxillofac Surg. 2017;45:82–6.CrossRefPubMedGoogle Scholar

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© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Clinic of Cranio-Maxillofacial SurgeryMaastricht University Medical CenterMaastrichtNetherlands

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