Patientenspezifische Implantate in der Mund-, Kiefer- und Gesichtschirurgie

Zusammenfassung

Die Verwendung von patientenspezifischen Implantaten zur Rekonstruktion von Defekten des Schädels und der Kiefer hat sich in den letzten Jahren als Standard in der Mund-, Kiefer- und Gesichtschirurgie etabliert. Anfänglich wurden die zum Einsatz kommenden Implantate intraoperativ direkt an die Defektsituation angepasst. Mit dem Fortschritt in der 3-dimensionalen Bildgebung und im Zuge der zunehmenden Digitalisierung wurden zunächst patientenspezifische 3-D-gedruckte Biomodelle zur direkten Anpassung konfektionierter Implantate im Operationssaal verwendet. Heute kommen vermehrt Implantate zum Einsatz, die im Rahmen eines computerassistierten Designprozesses (CAD) und einer anschließenden computerassistierten Herstellung (CAM) vollständig digital geplant werden. Anfangs war die Verwendung dieser CAD/CAM-gefertigten Implantate auf Defekte mit einfachen Geometrien, wie die Rekonstruktion des Schädeldachs, beschränkt. Durch Fortschritte in der digitalen Planung und der digital gestützten Herstellung können CAD/CAM-gefertigte patientenspezifische Implantate heute auch zur Versorgung komplexer Defektsituationen im präventiven und funktionalisierten Design verwendet werden. Neben der Orbitarekonstruktion und der alloplastischen Rekonstruktion des Unterkiefers kommen individualisierte Implantate auch zur komplexen dentalen Rehabilitation und funktionellen Wiederherstellung der Kiefergelenke zum Einsatz.

Abstract

The use of patient-specific implants for reconstruction of osseus craniofacial defects has become a standard in oral and maxillofacial surgery in recent years. Initially the implants used were intraoperatively adapted directly to the defect situation. With progress in 3-dimensional imaging and increasing digitization patient-specific 3-D printed bio-models were used for adaptation of these implants in the operating room. By now the implants used are increasingly manufactured in the completely digital process of computer assisted design (CAD) and subsequent computer-assisted manufacturing (CAM). In the beginning these CAD/CAM-manufactured implants were used for reconstructing defects of simple geometry such as calvaria-reconstruction only. With advances in the digital planning and digitally supported production CAD/CAM-manufactured patient-specific implants can now be used for treatment of complex defect situations in preventive and functionalized design. In addition to the orbital reconstruction and the alloplastic reconstruction of the mandible customized implants also come to use in complex dental rehabilitation and functional restoration of the temporomandibular joint.

Schlüsselwörter

patientenspezifische Implantate - rekonstruktive Chirurgie - CAD/CAM

Key words

patient-specific implants - reconstructive surgery - CAD/CAM

Publication History

Article published online:
17 March 2021

• Literatur

• 1 Eufinger H, Wehmöller M, Machtens E. et al. Reconstruction of craniofacial bone defects with individual alloplastic implants based on CAD/CAM-manipulated CT-data. J Craniomaxillofac Surg 1995; 23: 175-181
• 2 Gellrich NC, Spalthoff S, Zimmerer R. et al. Sekundäre Orbitarekonstruktion. MKG-Chirurg 2020; 13: 165-175
• 3 Rana M, Chui CH, Wagner M. et al. Increasing the accuracy of orbital reconstruction with selective laser-melted patient-specific implants combined with intraoperative navigation. J Oral Maxillofac Surg 2015; 73: 1113-1138
• 4 Spalthoff S, Dittmann J, Zimmerer R. et al. Intraorbital volume augmentation with patient-specific titanium spacers. J Stomatol Oral Maxillofac Surg 2020; 121: 133-139
• 5 Self-Centering Second-Generation Patient-specific Funktionalized Implants for Deep Orbital Reconstruction. J Stomatol Oral Maxillofac Surg 2020; DOI: 10.1016/j.jormas.2020.12.007.
• 6 Fernandes RP, Yetzer JG. Reconstruction of acquired oromandibular defects. Oral Maxillofac Surg Clin North Am 2013; 25: 241-249
• 7 Crawford SD. Condylar axis position, as determined by the occlusion and measured by the CPI instrument, and signs and symptoms of temporomandibular dysfunction. Angle Orthod 1999; 69: 103-115
• 8 Han HH, Kim HY, Lee JY. The pros and cons of computer-aided surgery for segmental mandibular reconstruction after oncological surgery. Arch Craniofac Surg 2017; 18: 149-154
• 9 Wilde F, Winter K, Kletsch K. et al. Mandible reconstruction using patient-specific pre-bent reconstruction plates: comparison of standard and transfer key methods. Int J Comput Assist Radiol Surg 2015; 10: 129-140
• 10 Naros A, Weise H, Tilsen F. et al. Three-dimensional accuracy of mandibular reconstruction by patient-specific pre-bent reconstruction plates using an “in-house” 3D-printer. J Craniomaxillofac Surg 2018; 46: 1645-1651
• 11 Zeller AN, Neuhaus MT, Weissbach LMV. et al. Patient-Specific Mandibular Reconstruction Plates Increase Accuracy and Long-Term Stability in Immediate Alloplastic Reconstruction of Segmental Mandibular Defects. J Maxillofac Oral Surg 2020; 19: 609-615
• 12 Wilde F, Hanken H, Probst F. et al. Multicenter study on the use of patient-specific CAD/CAM reconstruction plates for mandibular reconstruction. Int J Comput Assist Radiol Surg 2015; 10: 2035-2051
• 13 Jehn P, Spalthoff S, Korn P. et al. Patient-specific implant modification for alloplastic bridging of mandibular segmental defects in head and neck surgery. J Craniomaxillofacial Surg 2020; 48: 315-322
• 14 Brånemark PI, Hansson BO, Adell R. et al. Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period. Scand J Plast Reconstr Surg Suppl 1977; 16: 1-132
• 15 Gellrich NC, Rahlf B, Zimmerer R. et al. A new concept for implant-borne dental rehabilitation; how to overcome the biological weak-spot of conventional dental implants?. Head Face Med 2017; 13: 17
• 16 Elledge R, Mercuri LG, Attard A. et al. Review of emerging temporomandibular joint total joint replacement systems. Br J Oral Maxillofac Surg 2019; 57: 722-728
• 17 Mercuri LG, Edibam NR, Giobbe-Hurder A. Fourteen-Year Follow-Up of a Patient-Fitted Total Temporomandibular Joint Reconstruction System. J Oral Maxillofac Surg 2007; 65: 1140-1148
• 18 Sahdev R, Wu BW, Anderson N. et al. A Retrospective Study of Patient Outcomes After Temporomandibular Joint Replacement With Alloplastic Total Joint Prosthesis at Massachusetts General Hospital. J Oral Maxillofac Surg 2019; 77: 280-288