Socket Reconstruction Research Articles

Consensus of the Amapá society of implantodontics on the criteria for choosing a bone graft.

A bone graft may be used in a variety of clinically practiced implant surgeries, namely, guided bone regeneration, extraction socket preservation or reconstruction, ridge augmentation, and sinus membrane elevation. The bone graft is of various types depending on the material, for instance, autogenous bone graft, allograft, xenograft, alloplastic graft, and autogenous bone graft with demineralized dentin matrix, which may be used alone or with other materials. Bioactive agents that promote bone formation, such as recombinant human bone morphogenetic protein-2 (rhBMP-2), have been shown to exhibit a clinically beneficial effect on bone regeneration. Here, we intend to present surgical guidelines for bone grafts and criteria for selection of bone graft materials by referring to evidence-based studies and recent lectures on the subject of ‘bone grafts for implant dentistry’ at the Amapá society of implantodontics, 2020.

<p>Primary Dermis Fat Grafting for Socket Reconstruction: Retrospective Comparison of Electrocoagulation versus Scalpel Dissection for Epidermis Removal</p>

PurposeTo evaluate outcomes of the use of electrocoagulation for epidermis removal in dermis fat grafting (DFG) compared to the conventional scalpel dissection in patients who underwent primary anophthalmic socket reconstruction.DesignRetrospective, observational, and comparative study.MethodsA retrospective review was performed on patients who underwent primary DFG for socket reconstruction between 2017 and 2019 at tertiary teaching hospitals. Patients with previous orbital surgery, previous radiotherapy to the periocular region, any medical condition that affects healing, cicatrizing ocular surface disease or heavy smokers were excluded. Patients with complete documentation of preoperative and postoperative data only were included. Patients were divided into two groups; group A: epidermis removal by the traditional scalpel dissection and group B: epidermis removal using low power setting electrocoagulation. The main outcome was the timing of complete epithelialization of the dermis layer. Other outcomes included implant motility, prosthesis fitting, patient’s satisfaction, and any complications.ResultsA total of 27 patients met the study criteria, and the mean follow-up period was 24.81 months. There were no differences between both groups regarding preoperative characteristics. The mean duration of complete epithelialization of the DFG implant was 9.15 ± 2.94 weeks in group A compared to 22.29 ± 4.43 weeks in group B (p value <0.001). Dermal ulceration was noticed in 9 patients (64.3%) in group B compared to none in group A (p value =0.001). Dermal ulceration was significantly associated with long conjunctival healing period (p value <0.001). Volume loss was more common in group B while graft hirsutism and granuloma were more evident in group A. Final prosthesis fitting was possible in all included patients.ConclusionEpidermis removal using the electrocoagulation is related to much more delayed epithelialization of the dermis with a higher rate of dermal ulceration compared to the scalpel dissection technique. However, there was no significant difference between both groups regarding the final prosthesis fitting or the overall patient satisfaction.

Conical Biosilicate Implant for Volume Augmentation in Anophthalmic Sockets.

The ideal implant for anophthalmic socket reconstruction has yet to be developed. Biosilicate, a highly bioactive glass-ceramic, has been used in the composition of conical implants, which were initially tested in rabbit orbits with excellent results. However, the use of this material and the conical shape of the implants require further study in the human anophthalmic socket. Thus, we propose the use of a new conical implant composed of Biosilicate for orbital volume augmentation in anophthalmic sockets. This prospective, randomized study included 45 patients receiving conical implants composed of either Biosilicate or polymethylmethacrylate (control). Patients were evaluated clinically before and 7, 30, 60, 120, and 180 days after implantation. Systemic evaluations, laboratory tests, and computed tomography of the orbits were performed preoperatively and 180 days postoperatively. Both groups had good outcomes with no significant infectious or inflammatory processes. Only 1 patient, in the Biosilicate group, had early implant extrusion. Laboratory tests were normal in both groups. Computed tomography scans showed that the implants in both groups were well positioned. The new conical implant composed of Biosilicate was successfully used for anophthalmic socket reconstruction. This implant may provide a good alternative to the only conical implant currently available on the market, which is composed of porous polyethylene.

Optimizing parameters in surface reconstruction of transtibial prosthetic socket using central composite design coupled with fuzzy logic-based model

In this paper, a fuzzy logic-based artificial intelligence technique is delineated to optimize surface reconstruction parameters, initiating from raw point cloud data using contactless scanning of transtibial prosthetic socket. The prosthetic socket having a free-form surface is considered for reconstruction of an accurate and complete digital model, which is further crucial for subsequent design, analysis and production. The input factors considered for the socket surface reconstruction includes number of points, filtering, triangle counts and smoothing level. The experimental trials are performed using face-centered central composite design, and further experimental data are used to establish Mamdani fuzzy logic model to predict the surface standard deviation and required space in computer memory as the response parameters. The confirmation experiment results reveal that the fuzzy model shows good agreement of 96.53% with the experimental measured value. Based on the results, it is proved that established fuzzy model can be used for predicting the surface reconstruction parameters to improve the final accuracy of the transtibial prosthetic socket model. The results concluded that the fuzzy logic provides commendable results; in addition, it successfully predicts the effect of different parameters considered for surface reconstruction on surface accuracy and computer file size.

Reconstruction of the Orbit and Anophthalmic Socket Using the Dermis Fat Graft: A Major Review.

To perform a comprehensive review of dermis fat graft (DFG) in socket reconstruction and illustrate the technical nuances and outcomes using a retrospective case review. A literature search of 143 texts was reviewed. A retrospective case series of 34 patients following primary or secondary DFG after enucleation at a single institution (2009-2019) was performed. Clinical outcomes were statistically analyzed. Variables investigated included age, sex, race, surgical indication, muscle reattachment, complications, motility, eyelid position, prosthesis fit, and need for additional surgery. The history of DFG, use in socket reconstruction, primary and secondary indications, and surgical techniques are described. Thirty-two adults and 2 pediatric cases of DFG were reviewed; 18.75% indications were primary and 81.25% were secondary. Good eyelid position was observed in 83.3% of patients with primary DFG versus 37.5% with secondary DFG (p = 0.07). Postoperative complications occurred in 58.8% of patients, were typically mild, and resolved with minimal or no intervention. No statistically significant differences were found between occurrence of any particular complication in primary versus secondary DFG placement (p = 0.36) or between primary and secondary DFG placement and the need for additional surgery (p = 1.0). Among the 67.7% patients who had implant exposure or extrusion as an indication for DFG, 39.1% required additional surgery within 2 years. Advanced age was not associated with higher complication rates (p = 0.12). DFG is an excellent option for socket reconstruction, particularly in cases involving pediatric patients, complicated orbits, history of multiple previous surgeries, and inflamed, contracted, or scarred sockets.

Persistent fetal vasculature with colobomatous cystic optic disc in a microphthalmic eye: A clinicopathological case report

Aim: To present a rare clinico-pathological case of persistent fetal vasculature with colobomatous cystic optic disc in a micro-ophthalmic eye. Method: A case report. Results: An 8 year boy presented to the tertiary eye care center was diagnosed as micro-ophthalmos, microcornea, inferior iris coloboma with suspected retinochoroidal coloboma in right eye (OD). Ultrasound B scan of OD was done which confirmed the above findings along with the presence of membranous echoes attached to the disc. On MRI of right orbit, retinal detachment with colobomatous cyst in the posterior aspect of the eyeball was present. OD was enucleated with parenteral consent and silicon ball and socket reconstruction was done. We thereafter examined the enucleated eyeball grossly as well as by histopathological examination. Herein, we present the pathological features of a case of persistent fetal vasculature (PFV) supported by gross and microscopic examination with a special emphasis on the presence of colobomatous cystic optic disc in a micro-ophthalmic eye. Conclusion: This is one of the rare associations of PFV making this original report a unique one.

Dermis-fat graft for contracted socket reconstruction in an indigenous black population, Southwestern Nigeria

The purpose of this case series is to report the indications for dermis-fat grafting and the outcome of treatment in orbital soft tissue contraction among patients in a tertiary center. It is a retrospective, consecutive, interventional case series where all patients with orbital soft tissue contraction who had dermis-fat grafting were studied. All nine patients in our series underwent secondary dermis-fat grafting for orbital soft tissue reconstruction. The major cause for contracted socket was surgical eye removal following trauma. Eight of nine patients had no orbital implants inserted at the time of primary eye removal and eight patients have had failed orbital reconstructive procedures. Satisfactory cosmetic results were reported in all patients post-operatively. Dermis-fat grafting for contracted socket reconstruction was found to give satisfactory cosmetic results in our studied population.

The Modified IVAN Technique: Hard and Soft Tissue Augmentation at Extraction for Delayed Implant Placement.

Failure of a natural tooth may not permit placement of an implant at the time of extraction due to insufficiency in available bone to house the implant. Reconstruction of the extraction socket frequently involves both hard and soft tissue augmentation to provide a site that can house the implant and ridge contours that mimic the adjacent natural anatomy. The modified IVAN technique achieves those goals and may be used in both delayed and immediate placement situations. A case will be presented showing use of the mIVAN technique with a delayed implant placement and long-term follow-up demonstrating hard and soft tissue maintenance.

Reconstruction of Contracted Eye Socket With Autogenic Dermal Sphere Connected to Epidermis

Because of the deficiency of blood circulation and soft tissue, reconstruction of the eye socket for severe conjunctival sac stenosis in anophthalmic patients is very difficult. In this article, the authors report an innovative technique for conducting a 1-stage operation to reconstruct the contracted eye socket with an autogenic dermal sphere connected to the epidermis (ADSE). Five patients, each having a single severely contracted eye socket and conjunctival sac, were included in this study. An ADSE was transplanted into the contracted eye socket and conjunctival sac. After the operation, several observation indexes were evaluated, such as the survival and stability of implanted autologous tissue, the improvement of the contracted eye socket, and the degree of patients' satisfaction with their appearance. All of the implanted epidermal and dermal tissues survived well after 6 months' observation. Although somewhat absorbed, the transplanted dermal ball was plump in the eye socket, and the epithelial tissues merged well with the residual conjunctival epithelium. Moreover, the transplanted epidermis assumed a mucosal appearance in 4 of 5 patients. After reconstruction of the eye socket, the size of the conjunctival sac and depth of the eye socket were corrected sufficiently for patients to wear an ocular prosthesis. The implantation of an ADSE can reconstruct a severely contracted eye socket in anophthalmic patients. Because of the high survival rate and limited absorption ratio, this 1-stage operation satisfied both patients and their ophthalmologists.

Hard palate-dermis fat composite graft for reconstruction of contracted anophthalmic socket

ABSTRACT Purpose: To describe a novel technique of using a hard palate-dermis fat composite graft (HPDFG) for reconstruction of a contracted anophthalmic socket. Methods: Retrospective, noncomparative, interventional case series of four patients who underwent HPDFG placement by one surgeon between 2010 and 2017. Results: Six harvested HPDFGs were placed in four patients with contracted anophthalmic sockets. A harvested hard palate graft (HPG) and a dermis fat graft (DFG) were adjoined with sutures to form a composite graft. All adhesions and symblephara between the eyelid and the anterior surface of the anophthalmic socket were lysed. The HPG component was attached to the tarsal margin to vertically lengthen the eyelid. The free edge of the DFG was sutured to the cut edge of the bulbar conjunctiva to simultaneously expand the anterior conjunctival surface area and fornix volume. The line of union between the two grafts formed the apex of the new fornix. Four HPDFG were used to reconstruct both the upper and lower lid fornices in two severely contracted sockets. Three patients received post-operative 5-fluorouracil (5-FU) injections. Three patients underwent additional revisions with buccal mucous membrane graft, amniotic membrane graft, full-thickness skin graft, pedicle flap, and dermal fillers. All four patients achieved excellent cosmesis and comfortable prosthesis fit. Conclusions: Composite HPDFG is an effective method of reconstructing a contracted anophthalmic socket by restoring volume, lengthening the posterior lamella, and expanding the fornix to allow for successful prosthesis retention. Adjunctive use of 5-FU injections can delay post-operative cicatrization.

Use of Amniotic Membrane for Covering Large Oral Mucosal Defects during Socket Reconstruction Procedures.

Use of Amniotic Membrane for Covering Large Oral Mucosal Defects during Socket Reconstruction Procedures.

Computer-Assisted Volumetric Analysis and Quantitatively Anophthalmic Orbit Reconstruction With Dorsalis Pedis Flap and Bone Graft.

Current approaches to orbit reconstruction are based on the assumption of facial symmetry and surgeons' experiences, and the reconstructed orbits are not precise. Through computer-assisted volumetric quantitative analysis, the volume of the bony orbit, and the volume of the soft tissues in both the anophthalmic orbit and the contralateral orbit are calculated in 39 anophthalmic patients. The rib graft is used for orbit reconstruction; the dosalis pedis flap and lipo-injection were used for soft tissue reconstruction and skin socket reconstruction. The size and the shape of the rib graft and soft tissues were designed according to the volumetric analysis. The size and the shape of the skin socket were designed according to measurement during surgery. Asymmetry eye sockets with adequate size were created in the 37 patients. Two patients presented with a poor asymmetry with the contralateral orbit, and got gradual extrusion of the eye prosthesis 4 months after operation, which was because of necrosis of the flaps. The flaps were remedied by frontal island flap and skin grafting. Further surgeries, such as lipoinjection, lid surgery, and canthoplasty, were applied to improve the surgical results. The eye prostheses fitted well in all of the reconstructed sockets using this technique. Our studies suggest that the computer-assisted volumetric analysis technique combined with quantitative bone graft and dorsalis pedis flap transfer, ± lipoinjection proved to be an accurate method and a quality assurance for optimization of bony orbit, soft tissue and skin socket reconstruction, and promised a successful postoperative outcome for patients' functional and esthetic appearance.

Dermis-fat graft for anophthalmic socket reconstruction: indications and outcomes.

To evaluate the outcomes of dermis-fat graft procedure for orbital volume replacement in anophthalmic socket. A retrospective chart review was performed studying all dermis-fat graft surgeries done at King Khlaed Eye Specialist Hospital in the last 10-year period. Sixty-two anophthalmic socket carriers underwent dermis-fat graft during the study period. Data were collected on characteristics of the patients, postoperative complications, cosmesis, and functional results such as the ability to hold an external prosthesis. Mean age of the patients included in the study was 34.2 ± 9.7 years. There were 38.7% of patients with grade 3 anophthalmic socket, 64.5% of patients had an acquired anophthalmic socket, and dermis-fat graft was performed as a secondary procedure in 61.3% of patients. Postoperative complications included lagophthalmos (22.6%), graft necrosis (17.7%), pyogenic granuloma (12.9%), decreased graft size (12.9%), malpositioned lids (3.2%), and volume deficiency (3.2%). The prosthesis was held in place in 49 patients (79%) preoperatively and in 55 patients (88.7%) postoperatively. Dermis-fat graft is an excellent option for congenital or acquired as well as primary or secondary anophthalmic sockets, with or without contraction. The outcomes are favorable, and complications are rare.

Postoperative Complications of Dermis-Fat Autografts in the Anophthalmic Socket

ABSTRACTReconstruction of the anophthalmic socket allows the use of an ocular prosthesis and rehabilitation of facial appearance. Dermis-fat grafting is one option in volume augmentation of the anophthalmic socket and presents unique benefits, including increased surface area within the socket and the ability to grow with pediatric patients. Postoperative complications of this procedure are relatively common. Minor complications, such as graft hirsutism, keratinization, and conjunctival cysts or granulomas, are managed easily by observation or simple intervention. Major complications, such as graft atrophy, infection, or ulceration, may prevent good prosthesis fit and may require return to the operating room.

Immediate Dentoalveolar Restoration Technique (IDR). Autograft characterization and a case report

Case report We present a case of implant rehabilitation using the immediate dentoalveolar restoration (IDR) technique where the bone walls are reconstructed by a bone graft harvested from the maxillary tuberosity. In addition, we performed cellular and molecular evaluations of osteoblastic cells harvested from maxillary tuberosity as: cell proliferation, alkaline phosphatase activity, extracellular matrix mineralization and gene expression of osteoblastic markers. Three maxillary tuberosities were reconstructed using microtomography and qualitative-quantitative analyses were performed. Clinical and tomographic evidences showed that IDR is a feasible technique that allows in only one session the full reconstruction of alveolar socket, placement of dental implant and provisionalization. Cell proliferation increased over time and cell displayed alkaline phosphatase (ALP) activity, extracellular mineralized matrix and gene expression of all evaluated bone markers (ALP, RUNX2, bone sialoprotein, osteopontin, osteocalcin and distal-less homeobox 5), ratifying the osteogenic potential of the tuberosity cells. Micro-CT analysis showed the maxillary tuberosity as a highly porous structure surrounded by a thin cortical that resembles a mechanical barrier. These cellular, molecular and tomographic features indicate that the maxillary tuberosity is a source of osteoblastic cells and acts as a natural scaffold, supporting the excellent functional and aesthetic results of IDR technique.

Autologous fat transfer with SEFFI (superficial enhanced fluid fat injection) technique in periocular reconstruction

ABSTRACTPurpose: To evaluate the aesthetic and functional outcomes of autologous fat transfer using the SEFFI (superficial enhanced fluid fat injection) technique for reconstruction of the periocular area.Methods: Autologous fat injections prepared with the 0.5 mL and 0.8 mL SEFFI technique were used in four patients for periocular rehabilitation.Results: Case 1 (C1): A patient with left-sided progressive facial hemiatrophy underwent ipsilateral volumizing with 0.8 SEFFI in the superior, temporal, and inferior periorbital areas, and 0.5 SEFFI in both eyelids. C2: A 21-year-old female with a post trauma frontal scar, left ptosis, and lower eyelid retraction was treated with 0.5 SEFFI applied in the scar area associated with an upper eyelid conjunctivomullerectomy and resection of the lower eyelid retractors. C3: A patient with previous left-eye evisceration and orbital floor and medial wall fractures underwent socket reconstruction with buccal mucosal graft in the lower fornix and 0.5 SEFFI injections in both superior and inferior eyelids. SEFFI was also applied in the intraorbital space for correction of the enophthalmos. C4: A patient with lower lid retraction post blepharoplasty was treated with 0.8 SEFFI injections in lower eyelids and malar areas, complemented with a bilateral lateral cantopexy.Conclusions: Autologous fat transfer with SEFFI technique is an effective and safe procedure in cases of periocular rehabilitation.

Amniotic membrane transplantation: Current indications in a tertiary eye hospital of eastern Nepal.

Amniotic membrane has unique properties that can be helpful to treat different ocular surface diseases. To report our experience with 100% glycerol preserved amniotic membrane at 4°C and fresh amniotic membrane transplantation (AMT) with and without limbal graft for ocular surface reconstruction. Retrospective case study of 211 eyes of 211 patients was conducted at Biratnagar Eye Hospital from June 2008 to March 2014. The cases were evaluated in terms of demographic parameters, preoperative diagnosis and the type of surgery performed. The most common indication for surgery was Pterygium (90 eyes, 42.65%), followed by symblepharon (57 eyes, 27.01%), chemical injury (35 eyes, 16.58%), socket reconstruction (9 eyes, 4.26%), shield ulcer (6 eyes, 2.84%), PED (4 eyes, 1.89%), Steven Jonson's syndrome (5 eyes, 2.36%), dry Eye (2 eyes, 0.94%), Corneal Degeneration (2 eyes, 0.94%), bullous keratopathy (1 eye, 0.47%). The mean age was 28.12 ±17.2 years (age range 3-78 years). More men (161, 76.30%) underwent surgery than women (50 eyes, 23.69%). Symblepharon (24 eyes, 36.36%) was the major cause of surgery in pediatric group. The mean follow-up was 7 months (range 2-36, months). Resurgery was needed in (18 eyes, 8.53%) of which symblepharon (7eyes, 39%) was the major cause. AMT was done in 189 (89.57%) eyes and AMT with conjunctival limbal graft was done in 22(10.42 %) cases. Infectious, inflammatory, or allergic reactions were not encountered in any patient. All patient experienced increased ocular comfort with anatomical restoration of corneal and conjunctival surfaces. AMT alone or in combination with limbal graft aids in ocular surface reconstruction.

Single-stage socket reconstruction with vascularised temporalis muscle flap following total orbital exenteration: Description of 3 surgical approaches

ABSTRACTWe describe the techniques and outcome of three different approaches to transfer the posterior 2/3rd temporalis muscle pedicle flap for orbital socket reconstruction following total orbital exenteration. A retrospective interventional series of 9 patients operated between February of 2000 and 2006. We describe three different techniques, namely supraorbital, transorbital and transorbitectomy approach. All patients were followed for minimum of 3 years and muscle trophism with periorbital contour was clinically studied for outcome. There were 6 males and 3 females with a mean age of 42 years. Three patients each underwent the three mentioned approaches of socket reconstruction following total orbital exenteration performed mainly for oculo-adenexal malignancies with orbital extension (77.78%). Intraoperative, tumor-free histopathological margins were ensured. Postoperatively, bulky lateral orbital rim was noticed in all 3 patients of supraorbital approach, while progressive temporalis flap atrophy was noticed in all with transorbital approach over a period of 6 months. No such complications were observed in transorbitectomy approach and reasonably good periorbital cosmetic appearance with optimum preservation of muscle trophism was obtained. The mean follow-up period was 7 years. Temporalis muscle flap provides adequate orbital volume restoration in an exenterated socket. It also helps in better skin graft uptake, socket health and appearance. The transorbitectomy approach appeared as a reliable one stage surgical technique with reasonably acceptable anatomical and cosmetic outcome over a long-term follow-up. The choice of posterior portion of temporalis muscle as a flap offers satisfactory temporal fossa appearance.

Integrated versus non-integrated orbital implants for treating anophthalmic sockets.

Anophthalmia is the absence of one or both eyes, and it can be congenital (i.e. a birth defect) or acquired later in life. There are two main types of orbital implant: integrated, whereby the implant receives a blood supply from the body that allows for the integration of the prosthesis within the tissue; and non-integrated, where the implant remains separate. Despite the remarkable progress in anophthalmic socket reconstruction and in the development of various types of implants, there are still uncertainties about the real roles of integrated (hydroxyapatite (HA), porous polyethylene (PP), composites) and non-integrated (polymethylmethacrylate (PMMA)/acrylic and silicone) orbital implants in anophthalmic socket treatment. To assess the effects of integrated versus non-integrated orbital implants for treating anophthalmic sockets. We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 7), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to August 2016), Embase (January 1980 to August 2016), Latin American and Caribbean Health Sciences Literature Database (LILACS) (1982 to August 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 8 August 2016. Randomised controlled trials (RCTs) and quasi-RCTs of integrated and non-integrated orbital implants for treating anophthalmic sockets. Two authors independently selected relevant trials, assessed methodological quality and extracted data. We included three studies with a total of 284 participants (250 included in analysis). The studies were conducted in India, Iran and the Netherlands. The three studies were clinically heterogenous, comparing different materials and using different surgical techniques. None of the included studies used a peg (i.e. a fixing pin used to connect the implant to the prosthesis). In general the trials were poorly reported, and we judged them to be at unclear risk of bias.One trial compared HA using traditional enucleation versus alloplastic implantation using evisceration (N = 100). This trial was probably not masked. The second trial compared PP with scleral cap enucleation versus PMMA with either myoconjunctival or traditional enucleation (N = 150). Although participants were not masked, outcome assessors were. The last trial compared HA and acrylic using the enucleation technique (N = 34) but did not report comparative effectiveness data.In the trial comparing HA versus alloplastic implantation, there was no evidence of any difference between the two groups with respect to the proportion of successful procedures at one year (risk ratio (RR) 1.02, 95% confidence interval (CI) 0.95 to 1.09, N = 100, low-certainty evidence). People receiving HA had slightly worse horizontal implant mobility compared to the alloplastic group (mean difference (MD) -3.35 mm, 95% CI -4.08 to -2.62, very low-certainty evidence) and slightly worse vertical implant motility (MD -2.76 mm, 95% CI -3.45 to -2.07, very low-certainty evidence). As different techniques were used - enucleation versus evisceration - it is not clear whether these differences in implant motility can be attributed solely to the type of material. Investigators did not report adverse events.In the trial comparing PP versus PMMA, there was no evidence of any difference between the two groups with respect to the proportion of successful procedures at one year (RR 0.92, 95% CI 0.84 to 1.01, N = 150, low-certainty evidence). There was very low-certainty evidence of a difference in horizontal implant motility depending on whether PP was compared to PMMA with traditional enucleation (MD 1.96 mm, 95% CI 1.01 to 2.91) or PMMA with myoconjunctival enucleation (-0.57 mm, 95% CI -1.63 to 0.49). Similarly, for vertical implant motility, there was very low-certainty evidence of a difference in the comparison of PP to PMMA traditional (MD 3.12 mm 95% CI 2.36 to 3.88) but no evidence of a difference when comparing PP to PMMA myoconjunctival (MD -0.20 mm 95% CI -1.28 to 0.88). Four people in the PP group (total N = 50) experienced adverse events (i.e. exposures) compared to 6/100 in the PMMA groups (RR 17.82, 95% CI 0.98 to 324.67, N = 150, very low-certainty evidence).None of the studies reported socket sphere size, cosmetic effect or quality of life measures. Current very low-certainty evidence from three small published randomised controlled trials did not provide sufficient evidence to assess the effect of integrated and non-integrated material orbital implants for treating anophthalmic sockets. This review underlines the need to conduct further well-designed trials in this field.

Periumbilical fat auto-graft associated to a porous orbital implant for socket reconstruction after enucleation

ABSTRACTHaving to remove the sclera, fat and the optic nerve in patients undergoing an enucleation, translates in a larger volume that needs to be replaced to achieve good motility and aesthetic results. Using a 20 or 22 mm implant can only partially replace the removed volume. We report the results of our enucleation technique, which includes the use of a porous orbital implant combined with a primary fat graft to replace a higher percentage of the removed volume to achieve a better cosmetic outcome and to avoid implant related complications in high risk patients. Prospective, non-randomized study of enucleated patients for whom porous orbital implantation was performed with anterior placement of a fat auto-graft. The development of implant extrusion or exposure was recorded as well as the presence of conjunctival wound dehiscence and infection. Orbital volume was clinically and radiologically evaluated as well. Twenty-eight patients were included, with a postop follow-up of at least 6 months (6-79 months). No cases of migration or extrusion were found. One case of a large exposure resolved completely. All MRI demonstrated proper implant-graft integration and vascularisation. The aesthetic result and the symmetry were very adequate, with Hertel differences of less than 2 mm in all cases and good motility range. The fat graft is well tolerated, showing low incidence of implant-related complications whilst maintaining good volume and motility.