Patient-specific Polyetheretherketone Research Articles

Surface modification of PEEK implants for craniofacial reconstruction and aesthetic augmentation-fiction or reality?

Facial implantology, a crucial facet of plastic and reconstructive surgery, focuses on optimizing implant materials for facial augmentation and reconstruction. This manuscript explores the use of Polyetheretherketone (PEEK) implants in craniofacial surgery, highlighting the challenges and advancements in this field. While PEEK offers mechanical resilience, durability, and compatibility with imaging modalities, its biologically inert nature hinders integration with the host tissue, which may lead to complications. In this systematic review, our aim was to assess the current state of knowledge regarding the clinical evaluation of Polyetheretherketone (PEEK) implants in facial implantology, with a focus on craniofacial augmentation and reconstruction in human studies. Additionally, we explore and discuss surface and structural modifications that may enhance bioreactivity and reduce complications in PEEK implants. A systematic review identified 32 articles detailing the use of PEEK Patient-Specific Implants (PSIs) in 194 patients for both reconstructive and aesthetic purposes. Complications, including infections and implant failures, were reported in 18% of cases, suggesting the need for improved implant materials. The discussion delves into the limitations of PEEK, prompting the exploration of surface and structural modifications to enhance its bioreactivity. Strategies, such as hydroxyapatite coating, titanium coating, and porous structures show promise in improving osseointegration and reducing complications. However, the literature review did not reveal reports of coated or modified PEEK in facial reconstructive or aesthetic surgery. In conclusion, although PEEK implants have been successfully used in craniofacial reconstruction, their biological inertness poses challenges. Surface modifications, particularly hydroxyapatite coatings, provide opportunities to promote osseointegration. Future research should focus on prospective long-term studies, especially in craniofacial surgery, to investigate the stability of uncoated PEEK implants and the potential benefits of surface modifications in clinical applications. Patient-specific PEEK implants hold promise for achieving durable craniofacial reconstruction and augmentation.

Custom CAD/CAM Peek Implants for Complex Orbitocranial Reconstruction: Our Experience with 15 Patients

Bone defects within the cranio-orbital complex present unique challenges in terms of surgical planning and reconstruction. This article presents a novel approach using PEEK material and advanced surgical technologies to address these challenges. A retrospective analysis of 15 patients who underwent craniofacial reconstruction using patient-specific polyetheretherketone (PEEK) implants between 2016 and 2021 was carried out. Comprehensive preoperative planning was performed, utilizing advanced imaging techniques and specialized software for virtual surgical planning. Patient-specific PEEK PSIs were designed and manufactured based on the preoperative plan. Intraoperative navigation was used to guide the surgical procedure, enabling precise osteotomy and optimal implant placement. This article describes the step-by-step process and the tools utilized in each phase. The etiologies were as follows: meningioma in seven cases, benign lesions in five cases, malignant tumors in two cases, and trauma sequelae in one case. In all cases, 3D-printed PEEK implants were utilized to achieve precise reconstruction. No major complications were described. In one case, an implant replacement was needed with successful outcomes. Our study demonstrates the feasibility and effectiveness of using PEEK patient-specific implants for personalized craniofacial reconstruction. The combination of advanced imaging, virtual planning, and CAD-CAM technology contributes to improved surgical outcomes in terms of oncologic margin control, functional restoration, and aesthetic results.

Patient-Specific Facial Implants in Polyetheretherketone and Their Stability: A Preliminary Study.

Polyetheretherketone (PEEK) is a synthetic material with many favorable characteristics; PEEK implants are increasingly used for a variety of applications ranging from cranioplasty to orthopedic surgery and facial implants. This study is a retrospective review of patients who underwent PEEK implant placement in our department over the last 5 years. Polyetheretherketone computer-aided design and manufacture facial implants were designed from high-resolution computed tomography (CT) scans of each patient. The implants placed were onlay implants used for facial rehabilitation purposes to correct malformative and posttraumatic malformations. Twenty-eight consecutive patients (11 males and 17 females) underwent PEEK implant positioning between January 2015 and December 2020. Common indications were anterior plagiocephaly, hemifacial microsomia, and residual facial imbalance after orthognathic surgery. No complications of implant breakdown, exposure, infection, or displacement were noticed during the follow-up period. During routine controls on 3 patients, we requested a craniomaxillofacial CT scan for reasons unrelated to the implanted prostheses. The CT scans were all high resolution (<1-mm slices). The CT images indicated that bone was starting to form around the implant in all 3 patients as well as in the penetrating holes that were planned in the implants. In our experience, computer-designed, patient-specific PEEK onlay implants are a valid option for the treatment of malformative and posttraumatic malformations. This is, to the best of our knowledge, the first clinical report on bone reaction to PEEK implantation in the maxillofacial field. Moreover, based on the signs of bone regrowth that we observed in CT controls we can presume that the design of this type of prosthesis can probably take advantage of some technical stratagems not yet codified and fully exploited. Despite our preliminary favorable results, further multicentric and comparative studies are necessary to evaluate outcomes and better understand the behavior of this promising material and thus optimize its use in craniomaxillofacial surgery.

Design, Analysis, and 3D Printing of a Patient-Specific Polyetheretherketone Implant for the Reconstruction of Zygomatic Deformities.

The reconstruction of craniomaxillofacial deformities, especially zygomatic bone repair, can be exigent due to the complex anatomical structure and the sensitivity of the crucial organs involved. The need to reconstruct the zygomatic bone in the most precise way is of crucial importance for enhancing the patient outcomes and health care-related quality of life (HRQL). Autogenous bone grafts, despite being the gold standard, do not match bone forms, have limited donor sites and bone volume, and can induce substantial surgical site morbidity, which may lead to adverse outcomes. The goal of this study is to provide an integrated approach that includes various processes, from patient scanning to implant manufacture, for the restoration of zygomatic bone abnormalities utilizing Polyetheretherketone (PEEK) material, while retaining adequate aesthetic and facial symmetry. This study takes an integrated approach, including computer-aided implant design using the mirror reconstruction technique, investigating the biomechanical behavior of the implant under loading conditions, and carrying out a fitting accuracy analysis of the PEEK implant fabricated using state-of-the-art additive manufacturing technology. The findings of the biomechanical analysis results reveal the largest stress of approximately 0.89 MPa, which is relatively low in contrast to the material's yield strength and tensile strength. A high degree of sturdiness in the implant design is provided by the maximum value of strain and deformation, which is also relatively low at roughly 2.2 × 10-4 and 14 µm. This emphasizes the implant's capability for load resistance and safety under heavy loading. The 3D-printed PEEK implant observed a maximum deviation of 0.4810 mm in the outside direction, suggesting that the aesthetic result or the fitting precision is adequate. The 3D-printed PEEK implant has the potential to supplant the zygoma bone in cases of severe zygomatic reconstructive deformities, while improving the fit, stability, and strength of the implant.

Would augmentation genioplasty using patient-specific PEEK (Polyether Ether Ketone) implant meet patient’s expectations?

Introduction: Patient-specific implants become very valuable in restoring facial contours, including the chin area. Evaluation of patient satisfaction with the esthetic results should be a primary concern. Aim of study: To evaluate the success of augmentation genioplasty using patient-specific PEEK (Polyether Ether Ketone) implant in meeting patient’s expectations. Methods: Seven patients were enrolled in this study. They were all having deficient chin that was managed by augmentation genioplasty using patient-specific PEEK implant. Preoperative clinical evaluation was performed for all patients. With the help of MIMICS and 3-MATIC soft wares, diagnosis, virtual planning and final implant design were done. Finally, STL file was sent for milling using PEEK material. Under GA, PSI was inserted through an intra-oral vestibular approach and fixed to the underlying bone using mini-screws. Patient expectations were evaluated by Face-Q questionnaire. Result: The study was conducted on 7 cases, 3(42.9%) of which were males and 4(57.1%) were females. The mean age of the cases was (22.00±1.29) years. All patients showed high degree of contentment with the procedure. Conclusions: Patient-specific PEEK implant can be used for chin augmentation with good esthetic results close to that of patients’ expectations.

The Use of the Three-Dimensional Printed Polyether Ether Ketone Implant in Secondary Craniosynostosis Revision.

Skull deformities may be seen in patients years after craniosynostosis correction. These deformities cause psychosocial distress in affected patients. In this series, the authors describe the use of patient specific polyether ether ketone (PEEK) implants for correction of skull deformities after cranial vault remodeling for craniosynostosis. A chart review was conducted for 3 revision procedures performed by 1 plastic surgeon in collaboration with 1 neurosurgeon, both affiliated with Northwell Health. Preoperative computed tomography scans were used to design three-dimensional (3D) printed PEEK implants manufactured by KLS Martin. Implants were used to correct frontal and orbital asymmetry and skull deformities in each patient. Outcomes were assessed at 1 week, 1 month, and 3 months post-operation. Two males and 1 female, ages 13, 17, and 19, underwent revision cranioplasty or orbital rim reconstruction using a custom, single piece 3D printed PEEK implant. All 3 patients underwent cranial vault remodeling in infancy; 1 was treated for coronal craniosynostosis and 2 were treated for metopic craniosynostosis. Revision cranioplasty operative times were 90, 105, and 147 minutes, with estimated blood loss of 45 mL, 75 mL, and 150 mL, respectively. One patient went home on post op day 1 and 2 patients went home on post op day 2. All patients had an immediate improvement in structural integrity and cranial contour, and all patients were pleased with their aesthetic results. Custom 3D printed PEEK implants offer a single piece solution in revision cranioplasty surgery to correct skull deformities after cranial vault remodeling for craniosynostosis.

Patient-specific PEEK implants for immediate restoration of temporal fossa after maxillary reconstruction with temporalis muscle flap.

BackgroundTemporal hollowing is a common complication following the rotation of the temporalis muscle that leaves the patient with a cosmetic impairment. Several alloplastic materials have been used to reconstruct the donor site; however, these implants need meticulous adaptation to conform the periphery of the defect and restore the contour of the temporal area. The aim of this study was to assess the use of patient-specific polyetheretherketone (PEEK) temporal implants to prevent temporal hollowing following the use of full temporalis muscle flap for large maxillary defects reconstruction.MethodsThis was a prospective study conducted on eight patients with major maxillary defects indicating the need of reconstruction with full temporalis muscle flap or any lesion indicating major maxillary resection and immediate reconstruction with total temporalis muscle flap. For each patient, a patient-specific PEEK implant was fabricated using virtual planning and milled from PEEK blocks. In the surgical theater, the temporalis muscle was exposed, elevated, and transferred to the maxilla. After the temporalis muscle transfer, PEEK implants were fixed in place to prevent temporal hollowing.ResultsThe surgical procedures were uneventful for all patients. The esthetic result was satisfactory with no post-operative complications except in one patient where seroma occurred after 2 weeks and resolved after serial aspiration.ConclusionPatient-specific PEEK implant appears to facilitate the surgical procedures eliminate several meticulous steps that are mainly based on the surgeon’s experience.Trial registrationClinical trials registration: NCT05240963.

Assessment of Customized Alveolar Bone Augmentation Using Titanium Scaffolds vs Polyetheretherketone (PEEK) Scaffolds: A Comparative Study Based on 3D Printing Technology.

Customized alveolar bone augmentation provides sufficient and precisely regenerated bone tissue for subsequent dental implant placement. Although some clinical cases have confirmed the successful use of the patient-specific polyetheretherketone (PEEK) scaffolds, the biomechanical property and osteogenic performance of the patient-specific PEEK scaffolds remain unclear. The objectives of this study were (1) to evaluate the space maintenance capacity and osteogenic performance of the patient-specific PEEK scaffolds for customized alveolar bone augmentation and (2) to compare the biomechanical properties of three-dimensionally printed titanium scaffolds and PEEK scaffolds. Both titanium scaffolds and PEEK scaffolds were designed and manufactured via additive manufacturing technology combined with computer-aided design (CAD). In three-point bending tests, the bending strength of the PEEK scaffold was about 1/3 that of the titanium scaffold. Accordingly, the equivalent strain value of the internal bone graft beneath the PEEK scaffold was about 3 times that beneath the titanium scaffold in finite element analysis, but the maximum deformations of both scaffolds were less than 0.05 mm. Meanwhile, in in vivo experiments, it is demonstrated that both scaffolds have similar space maintenance capacity and bone ingrowth efficiency. In conclusion, patient-specific PEEK scaffolds showed significantly lower biomechanical strength but comparable space maintenance and osteogenic properties to the titanium counterpart. Compared with traditional guided bone regeneration (GBR) surgery, both patient-specific PEEK and titanium scaffolds can achieve excellent osteogenic space maintenance ability. This study provides a preliminary basis for the clinical translation of the nonmetallic barrier membrane in customized alveolar bone augmentation.

Accurate reconstruction of bone defects in orbital–maxillary–zygomatic (OMZ) complex with polyetheretherketone (PEEK)

The aim of this study was to evaluate the safety and efficacy of using patient-specific polyetheretherketone (PEEK) for the reconstruction of patients with defects in orbital-maxillary-zygomatic (OMZ) complex. This study included 12 patients who underwent primary/delayed reconstruction of defects in OMZ complex by using patient-specific PEEK implants. Postoperative appearance (facial and orbital symmetry) and function were assessed after 6 months. Ophthalmologic examinations including globe position, exophthalmos, and orbital volume measurement were also performed. A comparative analysis of the treatment outcomes between pre- and postoperation was performed, and a value of P < 0.05 was considered as significant. All patients underwent planned surgical procedure successfully. No obvious complications occurred. Facial symmetry and globe position were improved after surgery and the postoperative esthetic assessment was rated as excellent. The postoperative evaluation revealed that exophthalmos was 15.91±1.80mm, vertical position difference of eyeball 15.91±1.80mm, and orbital volume 15.91±1.80mm, respectively. There was a statistically significant difference in the mean values of exophthalmos, vertical position difference, and orbital volume among pre- and postoperation conditions, whereas there was no statistically significant difference between the reconstructed side and the unaffected side after surgery. With the aid of virtual surgical planning and individual custom-made surgical guides, patient-specific PEEK implantation can successfully reconstruct the complicated 3D structure of OMZ complex and shows excellent biocompatibility and clinical outcomes.

Quantitative Assessment of Point-of-Care 3D-Printed Patient-Specific Polyetheretherketone (PEEK) Cranial Implants.

Recent advancements in medical imaging, virtual surgical planning (VSP), and three-dimensional (3D) printing have potentially changed how today’s craniomaxillofacial surgeons use patient information for customized treatments. Over the years, polyetheretherketone (PEEK) has emerged as the biomaterial of choice to reconstruct craniofacial defects. With advancements in additive manufacturing (AM) systems, prospects for the point-of-care (POC) 3D printing of PEEK patient-specific implants (PSIs) have emerged. Consequently, investigating the clinical reliability of POC-manufactured PEEK implants has become a necessary endeavor. Therefore, this paper aims to provide a quantitative assessment of POC-manufactured, 3D-printed PEEK PSIs for cranial reconstruction through characterization of the geometrical, morphological, and biomechanical aspects of the in-hospital 3D-printed PEEK cranial implants. The study results revealed that the printed customized cranial implants had high dimensional accuracy and repeatability, displaying clinically acceptable morphologic similarity concerning fit and contours continuity. From a biomechanical standpoint, it was noticed that the tested implants had variable peak load values with discrete fracture patterns and failed at a mean (SD) peak load of 798.38 ± 211.45 N. In conclusion, the results of this preclinical study are in line with cranial implant expectations; however, specific attributes have scope for further improvements.

Defect reconstruction in oral squamous cell carcinoma patient using novel patient-specific polyether ether ketone implant: Report of a case

Oral squamous cell cancer comprises of one-third of carcinomas of the maxillofacial region. The principle of treatment involves the resection of the lesion with safe surgical margins. However, the rehabilitation of resected soft and hard tissues remains a challenging aspect for the maxillofacial surgeons. In the past few years, the alternatives for maxillofacial rehabilitation have been transmogrified. The profoundness of functional and esthetic significance of the face has led to evolving concepts in the field of reconstruction. With the emerging trends and search for a better reconstruction modality, a novel, biocompatible, and nonmetallic material that is polyether ether ketone (PEEK) was introduced that has shown to have good success rates in the past few years. However, its utility in the reconstruction of mandibular segmental defect is yet to be studied extensively. This case presents our success in reconstructing a mandibular segmental defect in an operated case of oral squamous cell carcinoma using a patient-specific PEEK implant with a follow-up period of 2 years.

Risk Factors for Postoperative Inflammatory Complications After Maxillofacial Reconstruction Using Polyether-Ether-Ketone Implants

Polyether-ether-ketone (PEEK) implants are increasingly used for the reconstruction of craniomaxillofacial deformities, but limited data exist on their limitations or risk factors for complications associated with their use. The purpose of the present study was to identify risk factors for postoperative inflammatory complications (POICs) after the use of PEEK implants in craniomaxillofacial reconstruction. A retrospective cohort study was conducted, incorporating all patients treated with patient-specific PEEK implants at the authors' institution from August 1, 2012 to June 30, 2019. The outcome variable was the presence of POICs. The potential predictor variables were demographic, medical, anatomic, and treatment related. Statistical analysis was performed using Fisher exact tests, t tests, and multivariable logistic regression analysis where appropriate. The 32 patients included in the study were composed of 68.8% men; mean age was 40.6years. The PEEK implant was placed adjacent to the paranasal sinuses in 56.3% of patients. The indication for use was malar depression in 50.0%, orbital dystopia in 46.9%, forehead or skull defects in 21.9%, and mandibular contour deformities in 6.2%; 8 patients had more than 1 indication. The overall rate of POICs was 28.1%. Of the POICs, 66.7% were managed with incision and drainage, revision surgery, or removal and 33.3% were managed with outpatient wound care or antibiotics. Tobacco use, the presence of an intraoral incision, and the presence of multiple incisions were all associated with POICs. On multivariable analysis, tobacco use approached significance (odds ratio, 17.3 [95% confidence interval, 0.98 to 306.7]) and multiple incisions (odds ratio, 6.9 [95% confidence interval, 1.5 to 32.3]) had a statistically significant association with the occurrence of complications. The present study identified several variables potentially associated with complications after the use of PEEK implants in maxillofacial reconstruction. Consideration should be given in the preoperative evaluation when a smoker is identified and when multiple incisions are planned.

Biomechanical comparison of titanium miniplates versus a variety of CAD/CAM plates in mandibular reconstruction

Titanium plate fixation of free flaps in mandibular reconstruction involves complications such as osseous non-union or imaging artefacts. Interosteotomy movement (IOM) is known to affect bone healing. This study aimed to compare IOM and mechanical integrity of four different fixation systems in a mandible reconstruction model. Two polyurethane (PU) fibula segments were fixed in right-sided defects of PU mandibles. Laser-melted patient-specific titanium plates were fixed with non-locking-screws (Ti-NL) or locking-screws (Ti-L). The third group consisted of locking-screws for patient-specific polyetheretherketone (PEEK-L) plates. The last group used titanium miniplates and monocortical screw fixation (Ti-MP). All models were loaded unilaterally via cyclic dynamic loading with increasing loads to simulate mastication. IOM was registered using a 3D optical tracking system. PEEK-L showed highest vertical displacement (p=0.010), lowest stiffness (p=0.004) and highest IOM (p=0.001). All specimen in PEEK-L demonstrated abnormal bending (n=5) or plate fracture (n=1). Vertical displacement or stiffness did not differ between any of Ti-MP, Ti-L and Ti-NL. IOM in Ti-MP was higher than in Ti-L and Ti-NL (p=0.001). Mechanical integrity of all titanium plates complies with established standards. In this model, the screw system did not influence IOM. In the tested composition and shape, PEEK plates do not seem to guarantee sufficient mechanical integrity for a use in mandibular reconstruction. Thus modifications are needed. Future clinical studies are needed to clarify optimal IOM after mandible reconstruction.

Assessment of 3-dimensional bone augmentation of severely atrophied maxillary alveolar ridges using patient-specific poly ether-ether ketone (PEEK) sheets.

This study aimed to analyze the effectiveness of virtually designed polyether-ether ketone (PEEK) sheets to delineate and maintains the three-dimensional patient's maxillary alveolar ridge. Fourteen patients (34 implants) with severely atrophied anterior maxillary alveolar ridges underwent rehabilitation using custom-made CAD/CAM PEEK sheets acting as a containment system for interpositional mix of particulate autogenous and xenogeneic bone graft, fixed by mono-cortical screws. Radiographic Assessment included measurements of linear changes in the vertical and horizontal dimensions on cross-sectional cuts of computed tomography (CBCT) using special software. Wound healing was uneventful for all the patients except one patient that showed wound break down 2 weeks postoperatively, which did not affect the outcome of the procedure. CBCT scans were interpreted to compare the quantity of both vertical and horizontal bone preoperatively and 6 months postoperatively. Statistical analyses demonstrated a significant difference between the results of both time intervals, with a mean vertical and horizontal bone gain was 3.47 mm(±1.46) and 3.42 (±1.1) with a P-value of (.0001). The customized sheets were removed 6 months postoperative with the successful placement of dental implants. The virtual planning of three-dimensional maxillary alveolar ridge augmentation utilizing patient-specific PEEK sheets deemed successful to restore the deficient ridge and to accommodate suitable size dental implants.

The use of patient specific polyetheretherketone implants for reconstruction of maxillofacial deformities

PurposeThe aim of this study was to evaluate polyetheretherketone (PEEK) as a patient-specific implant (PSI) material in maxillofacial reconstructive surgery. Materials and methodsThe retrospective study included a cohort of 24 patients who underwent maxillofacial surgery using PEEK PSIs. Each patient underwent preoperative multislice computed tomography (CT) with 0° tilt of gantry. Based on the CT scan, the PEEK PSIs were planned and manufactured using three-dimensional (3D) modeling and computer-aided design/computer-aided manufacturing (CAD/CAM) techniques. All procedures were performed under general anesthesia. Implants were placed intraorally, extraorally or through subciliary, transconjuctival or coronal incisions. ResultsIn 22 of 24 cases, the PEEK PSI fit well without adjustments. Although the fit to the surrounding bone was perfect in almost all of the cases, the outer contour of the PSI was modified in nine cases before fixation. However, intraoperative implant modification did not affect the infection rate. In two cases, postoperative wound dehiscence and infection needed additional treatment and healed without removal of the implants. ConclusionThe follow-up data in this study showed good outcomes with reliable results for PSI made of PEEK in the maxillofacial region.

Primary reconstruction of resected proximal mandibular segments: a novel protocol using patient-specific poly ether-ether ketone (peek) condylar replicas

Purpose: This study aims to evaluate the efficiency of computer-aided design and computer-aided manufacturing(CAD/CAM), mirror-imaged Polyetheretherketone (PEEK) assembly that aimed to duplicate both of the exactanatomic position and the configuration of the resected mandibular condyle, post segmental proximal tumor resection.Methods: Five patients were included in the study; diagnosed for mandibular ramus locally aggressive tumors, involving or markedly jeopardizing the mandibular condyles. All of the patients were subjected to a fully guided reconstructive protocol that implements guided resection, guided alignment of a pre-bent reconstruction plate, secured to a (CAD/CAM) fabricated, mirror-imaged (PEEK), looking forward to duplicating both of the anatomic location and the configuration of the amputated mandibular ramus and condyle.Results: Clinical evaluation revealed acceptable recovery of the maximal mouth opening and limited postoperativemalocclusion and mandibular deviation. The computed radiographic superimposition between the virtual plane and the oneweek postoperative C.T. revealed decreased linear condyle displacement in both the mediolateral and anteroposterior directions versus an increased linear vertical displacement and decreased axial angular rotation versus increased sagittal angular rotation. The replication between the virtually planned condylar location and that surgically duplicated was judged as good to excellent among all the cases.Conclusion: The novel simulation and allocation of the customized (PEEK) assembly represents a simple and efficientmodality to reconstruct both of the lost condylar position and configuration. However, the anterior extension of the resected proximal mandibular segment deemed determinant to the success of the identical surgical execution of the virtual preplanned arrangement.

Correction of facial deformity with bespoke patient-specific polyetheretherketone implant: in-house manufacturing to virtual planning and navigational technology

Correction of facial deformity with bespoke patient-specific polyetheretherketone implant: in-house manufacturing to virtual planning and navigational technology

Outcome in patient-specific PEEK cranioplasty: A two-center cohort study of 40 implants.

The best material choice for cranioplasty following craniectomy remains a subject to discussion. Complication rates after cranioplasty tend to be high. Computer-assisted 3-dimensional modelling of polyetheretherketone (PEEK) was recently introduced for cranial reconstruction. The aim of this study was to evaluate patient- and surgery-related characteristics and risk factors that predispose patients to cranioplasty complications. This retrospective study included a total of 40 cranial PEEK implants in 38 patients, performed at two reference centers in the Netherlands from 2011 to 2014. Complications were registered and patient- and surgery-related data were carefully analysed. The overall complication rate of PEEK cranioplasty was 28%. Complications included infection (13 %), postoperative haematoma (10 %), cerebrospinal fluid leak (2.5 %) and wound-related problems (2.5 %). All postoperative infections required removal of the implant. Nonetheless removed implants could be successfully re-used after re-sterilization. Although overall complication rates after PEEK cranioplasty remain high, outcomes are satisfactory, as our results compare favourably to recent literature reports on cranial vault reconstruction.

Patient-specific polyetheretherketone implants for repair of craniofacial defects.

Large cranial defects represent reconstructive challenges. Polyetheretherketone (PEEK) implants are preoperatively tailored to the exact size of the defect and exhibit an excellent combination of strength, durability, and environmental resistance. This study presents our experience with patient-specific PEEK implants with computer modeling. A retrospective chart review was conducted on all patients who underwent cranioplasty treated by a PEEK implant between 2007 and 2012. Analysis of the preoperative and perioperative data as well as outcome analysis was performed. A total of 11 patients were included. Mean age was 46 years. The indication for cranioplasty was bone flap infection and subsequent removal in 8 patients, traumatic bone loss in 2 patients, and acquired defect due to cancer resection in 1 patient. The mean time to PEEK cranioplasty since the patient's last operation was 16 months. The mean defect size was 74 cm(2). The mean surgical blood loss was 124 mL. The mean length of stay was 3 days. Complications included 1 postoperative bleeding that required reoperation, but the PEEK implant was successfully salvaged. The mean time to follow-up was 6 months. Use of patient-specific PEEK implants is a good alternative for alloplastic cranioplasty. It is associated with low morbidity as reported in our series, with additional advantages including strength, stiffness, durability, and inertness. It would be beneficial to assess the longer-term outcomes; however, it appears at first glance that PEEK implants show great promise in calvarial reconstruction.

Computer-Designed PEEK Implants

Polyetheretherketone (PEEK) is a synthetic material that was used initially in spine and hip surgery. It has the properties of being biocompatible, resistant to thermal and ionizing radiation, and resembles cortical bone biomechanically. These favorable characteristics have led to the increasing use of PEEK implants for calvarial defects which remain a significant reconstructive challenge. This study is a retrospective review of patients who underwent PEEK cranioplasty by a single surgeon. PEEK implants were fashioned from high-resolution CT scans of each patient and sterilized preoperatively before cranioplasty was performed using standard techniques. The mean follow-up period was 7 months (range 1-22). Twelve consecutive patients (75% males; mean age = 43, range 16-67) underwent PEEK cranioplasty between January 2011 and December 2012 after a mean time interval of 10 months (range 3-40) following initial craniectomy. The mean defect size was 11 × 8 cm (range 7 × 6 to 14 × 8 cm) and no additional contouring of PEEK implants was necessary intraoperatively. The scalp was closed primarily in all patients, and no complications of implant breakdown, wound infection, or cerebrospinal fluid leak were appreciated during follow-up. Computer-designed, patient-specific PEEK implants for cranioplasties are a viable alternative when autologous bone grafts are unavailable or unsuitable. Such prefabrication reduces operative times through minimal to no intraoperative adjustments. Although initial results are promising, longer-term follow-up and further comparative studies including randomized control trials to evaluate outcomes between different alloplastic materials for cranioplasty are necessary.