Implants used in craniomaxillofacial surgery mainly refer to either standard plates and screws with different dimension and shape or to dental implants. In both fields, the implants are not customized, but can be used off the shelf. With the ongoing developing individualization processes in medicine, we learned more and more to implement 3D-Voxel-based data of the individual patient into the process of treatment planning, surgery and post-operative control. By this, we learnt the limitations and benefits of standard, pre-formed and the use of individual patient-specific implants in all fields of CMF surgery.
The next level to upscale individual implants led to functionalization of implants, e.g. position control – with or without navigation - of the implant during and at the end of surgery; a further achievement was to avoid typical adverse effects of reconstructive procedures by implementing a preventive design, e.g. a fully circular rounded orbital implant to reconstruct the full length of the orbital foor with an inverted snow-shovel-design at the posterior ledge. Furthermore, implementing the info of a two-step surgery (ablation and reconstruction) into only one implant allows for a later implant-to-implant relationship in selected cases, or even creates complete line extensions that permit the combination of a functionalized implant with a conventional implant. Together with design improvements of implants - that helped to cut down typical pitfalls of reconstructive procedures - and technological progress in additive manufacturing these ideas of individualization and functionalization pushed the quality of reconstructive CMF surgery to higher grounds and smoothed the way to produce new types and generations of custom-made implants.
Different indications are demonstrated to clarify the advantage of the evolutionary process of functionalized implants in the field of:
1 | Tumor related reconstructive surgery
2 | Primary and secondary orbital reconstructive surgery
3 | Dental rehabilitation with implant borne restorations
For the mandible: Instead of using drill guides, resection templates, positioning devices and the mandibular implant itself, nowadays it is possible to use one device only that allows to fulfill all above mentioned purposes.
For the orbit: The insertion control with or without navigation with a metric info and the ability to implement trajectory-based navigational control, including design advances to overcorrect by intension or saving the orbital environment, this has taken the level of orbital surgery towards a complete quality control through digital workflow.
By using individual patient-specific solutions as a one piece implant with a patient-specific fit towards midfacial or mandibular bony structures far away from the entry side of the implant poles into the oral cavity, a functionally stable, outpatient driven single step reconstruction in extended cases of tissue loss and reconstructive needs in craniomaxillofacial reconstruction is now made possible.
