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Titanium Membranesfor Reconstruction of Defects
dr. Vrielinck Lucdr. C. Politis, dr. S. Schepers
Department of Oral and Maxillofacial SurgeryZOL Campus St. Jan — Genk - Belgium
11/03/02
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• Type of Bone Defects• Titanium Membranes• Treatment Protocol• Clinical Examples• Results• Conclusions
Overview
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Type of Bone Defects
Results ConclusionsClinical Examples
Treatment ProtocolTitanium Membranes
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Results ConclusionsClinical Examples
Treatment ProtocolTitanium Membranes
Type of Bone Defects
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• Pure bone defects - Congenital • Cleft palate
Type of Bone Defects
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• Pure bone defects - Congenital • Cleft palate • Treacher Collins syndrome • Hemifacial microsomy
Type of Bone Defects
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• Pure bone defects - Congenital - Posttraumatic • zygomatic buttress
Type of Bone Defects
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• Pure bone defects - Congenital - Posttraumatic • zygomatic buttress • orbital floor
Type of Bone Defects
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• Pure bone defects - Congenital - Posttraumatic • zygomatic buttress • orbital floor • nasoethmoid region
Type of Bone Defects
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• Pure bone defects - Congenital - Posttraumatic - Postoperative • maxilla
Type of Bone Defects
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• Pure bone defects - Congenital - Posttraumatic - Postoperative • maxilla • mandible
Type of Bone Defects
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• Pure bone defects - Congenital - Posttraumatic - Postoperative • maxilla • mandible • iliac crest
Type of Bone Defects
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• Pure bone defects - Congenital - Posttraumatic - Postoperative • maxilla • mandible • iliac crest • skull defect after trepanantion Courtesy of Jan Haex, Maastricht
Type of Bone Defects
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• Pure bone defects - Congenital - Posttraumatic - Postoperative - Terminal jaw atrophy
Type of Bone Defects
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• Pure bone defects• Bone + soft tissue defects
Type of Bone Defects
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Results ConclusionsClinical Examples
Treatment Protocol
Type of Bone Defects Titanium Membranes
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Titanium Membranes• Hydroforming• Casting
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Titanium Membranes• Hydroforming - using thin titanium foils (0.2 - 0.4 mm)
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Titanium Membranes• Hydroforming - using thin titanium foils (0.2 - 0.4 mm) - ‘cold’ deformation under pressure (600 bar)
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Titanium Membranes• Hydroforming - using thin titanium foils (0.2 - 0.4 mm) - ‘cold’ deformation under pressure (600 bar) - foil is moulded around a positive cast
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Titanium Membranes• Hydroforming - using thin titanium foils (0.2 - 0.4 mm) - ‘cold’ deformation under pressure (600 bar) - foil is moulded around a positive cast - lateral expansion is limited by tear formation
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Titanium Membranes• Hydroforming - using thin titanium foils (0.2 - 0.4 mm) - ‘cold’ deformation under pressure (600 bar) - foil is moulded around a positive cast - lateral expansion is limited by tear formation - lateral compression induces folds
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Titanium Membranes• Hydroforming - using thin titanium foils (0.2 - 0.4 mm) - ‘cold’ deformation under pressure (600 bar) - foil is moulded around a positive cast - lateral expansion is limited by tear formation - lateral compression induces folds - industrial fabrication
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Titanium Membranes• Hydroforming• Casting - fabricated in dental laboratory
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Titanium Membranes• Hydroforming• Casting - fabricated in dental laboratory - used for complex 3D anatomic forms
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Titanium Membranes• Hydroforming• Casting - fabricated in dental laboratory - used for complex 3D anatomic forms - fabricated using lost wax technique
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Titanium Membranes• Hydroforming• Casting - fabricated in dental laboratory - used for complex 3D anatomic forms - fabricated using lost wax technique - massive titanium structures
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Titanium Membranes• Hydroforming• Casting - fabricated in dental laboratory - used for complex 3D anatomic forms - fabricated using lost wax technique - massive titanium structures - hollowed out structures
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Results ConclusionsClinical Examples
Type of Bone Defects Treatment ProtocolTitanium Membranes
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• CT Scan• 3D Stereolithography & Membrane Design• Membrane Fabrication• Surgery
Treatment Protocol
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Treatment ProtocolCT Scan
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Treatment ProtocolCT Scan
• Scan of the jaws (e.g. spiral tomography) - gantry tilt 0°
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Treatment ProtocolCT Scan
• Scan of the jaws (e.g. spiral tomography) - gantry tilt 0° - slice thickness of max 1.0 mm
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Treatment ProtocolCT Scan
• Scan of the jaws (e.g. spiral tomography) - gantry tilt 0° - slice thickness of max 1.0 mm• Transfer of data to PC (Mimics)
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Treatment ProtocolCT Scan
• Scan of the jaws (e.g. spiral tomography) - gantry tilt 0° - slice thickness of max 1.0 mm• Transfer of data to PC (Mimics)• Calculation 3D model on PC
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• CT Scan• 3D Stereolithography & Membrane Design• Membrane Fabrication• Surgery
Treatment Protocol
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Treatment Protocol3D STL & Membrane Design
• Fabrication Physical Stereolithography model (Materialise)
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Treatment Protocol3D STL & Membrane Design
• Fabrication Physical STL model - original image
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Treatment Protocol3D STL & Membrane Design
• Fabrication Physical STL model - original image - mirror image
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Treatment Protocol3D STL & Membrane Design
• Fabrication Physical STL model - original image - mirror image• Design of the Membrane
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Treatment Protocol3D STL & Membrane Design
• Fabrication Physical STL model - original image - mirror image• Design of the Membrane
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Treatment Protocol3D STL & Membrane Design
• Fabrication Physical STL model - original image - mirror image• Design of the Membrane
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Treatment Protocol3D STL & Membrane Design
• Fabrication Physical STL model - original image - mirror image• Design of the Membrane
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• CT Scan• 3D Stereolithography & Membrane Design• Membrane Fabrication• Surgery
Treatment Protocol
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Treatment ProtocolMembrane Fabrication
• initial procedures in the dental laboratory
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Treatment ProtocolMembrane Fabrication
• initial procedures in the dental laboratory• hydrofoil technique: positive cast needed
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Treatment ProtocolMembrane Fabrication
• initial procedures in the dental laboratory• hydrofoil technique: positive cast needed• casting technique: lost wax technique
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Treatment ProtocolMembrane Fabrication
• initial procedures in the dental laboratory• hydrofoil technique: positive cast needed• casting technique: lost wax technique• finishing the membrane
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• CT Scan• 3D Stereolithography & Membrane Design• Membrane Fabrication• Surgery
Treatment Protocol
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Treatment ProtocolSurgery
• membrane sterilised by autoclaving
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Treatment ProtocolSurgery
• membrane sterilised by autoclaving• general or local anesthesia
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Treatment ProtocolSurgery
• membrane sterilised by autoclaving• general or local anesthesia• incision and careful deperiostation
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Treatment ProtocolSurgery
• membrane sterilised by autoclaving• general or local anesthesia• incision and careful deperiostation• positioning the plate on top of the bone
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Treatment ProtocolSurgery
• membrane sterilised by autoclaving• general or local anesthesia• incision and careful deperiostation• positioning the plate• fixation and immobilisation of the plate by osteosynthesis screws
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Results Conclusions
Type of Bone Defects
Clinical Examples
Treatment ProtocolTitanium Membranes
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• Asymmetry and enoftalmy• Mandibulectomy reconstruction• Reconstruction iliac crest• Soft tissue reconstruction• Reconstruction nasoethmoid region
Clinical Examples
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• Asymmetry and enoftalmy
Clinical Examples
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• Asymmetry and enoftalmy• Mandibulectomy reconstruction• Reconstruction iliac crest• Soft tissue reconstruction• Reconstruction nasoethmoid region
Clinical Examples
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• Mandibulectomy reconstruction
Clinical Examples
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• Asymmetry and enoftalmy• Mandibulectomy reconstruction• Reconstruction iliac crest• Soft tissue reconstruction• Reconstruction nasoethmoid region
Clinical Examples
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• Reconstruction iliac crest
Clinical Examples
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• Asymmetry and enoftalmy• Mandibulectomy reconstruction• Reconstruction iliac crest• Soft tissue reconstruction• Reconstruction nasoethmoid region
Clinical Examples
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• Soft tissue reconstruction
Clinical Examples
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• Asymmetry and enoftalmy• Mandibulectomy reconstruction• Reconstruction iliac crest• Soft tissue reconstruction• Reconstruction nasoethmoid region
Clinical Examples
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• Reconstruction nasoethmoid region
Clinical Examples
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Conclusions
Type of Bone Defects
Clinical Examples
Treatment Protocol
Results
Titanium Membranes
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Treated Indications• facial asymmetry 3
Clinical Examples
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Treated Indications• facial asymmetry 3• maxillary defect 1
Clinical Examples
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Treated Indications• facial asymmetry 3• maxillary defect 1• mandibular reconstruction 2
Clinical Examples
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Treated Indications• facial asymmetry 3• maxillary defect 1• mandibular reconstruction 2• soft tissue reconstruction 1
Clinical Examples
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Treated Indications• facial asymmetry 3• maxillary defect 1• mandibular reconstruction 2• soft tissue reconstruction 1• nasoethmoid reconstruction 1
Clinical Examples
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Advantages of Titanium Membranes• excellent esthetic result
Clinical Examples
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Advantages of Titanium Membranes• excellent esthetic result• no donor site morbidity
Clinical Examples
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Advantages of Titanium Membranes• excellent esthetic result• no donor site morbidity• simple operation technique
Clinical Examples
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Advantages of Titanium Membranes• excellent esthetic result• no donor site morbidity• simple operation technique• reduced operation time
Clinical Examples
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Advantages of Titanium Membranes• excellent esthetic result• no donor site morbidity• simple operation technique• reduced operation time• reduced hospitalisation
Clinical Examples
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Advantages of Titanium Membranes• excellent esthetic result• no donor site morbidity• simple operation technique• reduced operation time• reduced hospitalisation• possible bone regeneration under the membrane (?)
Clinical Examples
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Type of Bone Defects
Clinical Examples Conclusions
Treatment Protocol
Results
Titanium Membranes
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ConclusionsWhy use titanium membranes ?
• Alternative for bone reconstruction
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ConclusionsWhy use titanium membranes ?
• Alternative for bone reconstruction• Can bear functional load
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ConclusionsWhy use titanium membranes ?
• Alternative for bone reconstruction• Can bear functional load• Very good for correction of bone asymmetries
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• Alternative for bone reconstruction• Can bear functional load• Very good for correction of bone asymmetries• Reduced operation time and morbidity
ConclusionsWhy use titanium membranes ?
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