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      Reconstruction of bony facial contour deficiencies with polymethylmethacrylate implants: case report

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          Abstract

          Facial trauma can be considered one of the most serious aggressions found in the medical centers due to the emotional consequences and the possibility of deformity. In craniofacial surgery, the use of autologous bone is still the first choice for reconstructing bony defects or irregularities. When there is a shortage of donor bone or a patient refuses an intracranial operation, alloplastic materials such as polymethylmethacrylate (PMMA) can be used. The PMMA prosthesis can be pre-fabricated, bringing advantages such as reduction of surgical time, easy technical handling and good esthetic results. This paper describes the procedures for rehabilitating a patient with PMMA implants in the region of the face, recovering the facial contours and esthetics of the patient.

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          Clinical outcome in cranioplasty: critical review in long-term follow-up.

          Andrea Moreira, Vincent DiNick, Khaled Barakat … (2003)
          Various materials have been proposed for cranial reconstruction. Bone autograft and alloplasts such as polymethylmethacrylate (PMMA) and hydroxyapatite (HA) cement are most commonly used at the present time. Patients submitted for cranioplasty were evaluated. The prognostic factors influencing the results and the outcome were analyzed. Three hundred twelve patients who had 449 procedures performed by a single surgeon to reconstruct a calvarial deformity between 1981 and 2001 were studied. Post-tumor resection deformity was the main reason for cranioplasty (32.4%). Bone graft was the material of choice (69.5%). The main surgical site was the frontal bone (53.2%). Complications were observed in 23.6% of cases and were responsible for the least satisfactory results (P > 0.001), with infection and material exposure being the most critical complications. The eventual outcome was considered good in 91.8% of cases. The use of HA cement was associated with the worst results (P > 0.001). Bone grafts showed a high grade of partial resorption and required further surgery for correction. Multiple surgical procedures were correlated with a high rate of complications and an unsatisfactory outcome. Bone graft and PMMA are still the best materials in calvarial reconstruction. Even though HA cement is an osteoconductive material, it seems to induce what appears to be an immunoguided delayed inflammatory reaction that leads to thinning of the skin and exposure of the material, making secondary repair difficult. Before deciding which reconstructive option to use, a careful evaluation of the patient in terms of diagnosis, number of previous surgeries, and surgical site should be undertaken. If this is adopted, good results and a satisfactory outcome can be achieved on long-term follow-up.
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            Biomaterials in craniofacial reconstruction.

            Arun Gosain, Jun Cho (2004)
            Biomaterials have become an integral component of craniofacial reconstruction. Their increasing ease of use, long "shelf-life," and safety enables them to be used effectively and play an important role in reducing operating times. There are various biomaterials currently available and specific usages have been characterized well in the literature. This article reviews different biomaterials that can be used in craniofacial reconstruction,including autogenous bone, methyl methacrylate and hard tissue replacement,hydroxyapatite, porous polyethylene, bioactive glass, and demineralized bone.
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              Cranioplasty using acrylic material: a new technical procedure.

              Luigi Chiarini, Sabina Figurelli, Giuseppe Pollastri … (2004)
              Today, cranioplasty is performed using different procedures. Numerous materials may be used to reconstruct the cranial vault including autologous bone and different types of synthetic resins. When plastic materials are used, the main requirement for an effective cranioplasty is the preoperative shaping of the implant to fit the bony defect precisely. In this paper, experience with a new method for cranioplasty using an acrylic cranial implant is presented. In this new technical procedure an acrylic implant, precisely shaped to the defect, is fabricated preoperatively using CT data. The study consists of 15 cases in whom cranioplasty was performed using this method. In all these, reconstruction was at least 3 months after the initial operation that lead to the cranial bony defect. No major complications occurred and the final functional and aesthetic results were good in all cases. The acrylic implant manufacture does not require the use of complex computer interface software or high-tech equipment, but involves simple, cheap, repeatable processes.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Appl Oral Sci
                Journal ID (iso-abbrev): J Appl Oral Sci
                Title: Journal of Applied Oral Science
                Publisher: Faculdade de Odontologia de Bauru da Universidade de São Paulo
                ISSN (Print): 1678-7757
                ISSN (Electronic): 1678-7765
                Publication date (Print and electronic): Jul-Aug 2011
                Publication date (Print): Jul-Aug 2011
                Volume: 19
                Issue: 4
                Pages: 426-430
                Affiliations
                [1 ] DDS, Assistant Professor, Department of Oral Surgery, School of Dentistry, University of Alfenas, Alfenas, MG, Brazil.
                [2 ] DDS, PhD, Assistant Professor, Department of Pediatric Dentistry, Orthodontics and Community Health, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil.
                [3 ] DDS, MSc, PhD student, Department of Pediatric Dentistry, Orthodontics and Community Health, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil.
                [4 ] DDS, PhD, Full Professor, Department of Pediatric Dentistry, Orthodontics and Community Health, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil.
                Author notes
                Corresponding address: Prof. Dr. Ruy Cesar Camargo Abdo - Faculdade de Odontologia de Bauru - USP - Departamento de Odontopediatria, Ortodontia e Saúde Coletiva - Disciplina de Odontopediatria - Alameda Dr. Octávio Pinheiro Brisolla, 9-75 - Bauru, São Paulo - 17012-901 - Brasil - Phone: 55 14 32358218 e-mail: marchini@ 123456usp.br
                Article
                DOI: 10.1590/S1678-77572011000400021
                PMC ID: 4223797
                PubMed ID: 21952926
                SO-VID: 4b53a399-e2eb-47a6-ad7e-b37d17aaaa1c
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 25 March 2010
                Date revision received : 30 May 2010
                Date accepted : 26 October 2010
                Categories
                Subject: Case Reports

                Keywords: polymethylmethacrylate,craniofacial abnormalities,prostheses and implants,facial injuries
                Data availability:
                Keywords: polymethylmethacrylate, craniofacial abnormalities, prostheses and implants, facial injuries

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