Computer-guided frontal bone defect reconstruction using customized three dimensional PEEK-PSI

Purpose : Cranio-facial trauma with Frontal bone defects develops a frustrating facial deformity with a resultant obvious bad appearance. Conventional frontal defect reconstruction often develops an asymmetric facial contour due to the lack of ultimate accuracy. This study aimed to utilize the computer guided 3D planning, designing and printing technology to reconstruct frontal bone defects using Poly-ether-ether-ketone (PEEK) material to reach a more precise prosthesis for better frontal bone contour and esthetics.
Patients and methods: A total of six patients suffering from Frontal bone defects were included in this study from the department of oral and maxillofacial surgery, faculty of Dentistry, Cairo University. All the patients were subjected to clinical and CT radiographic examination to assess the extent of the defect and its implications. The computer software was used to manipulate the CT data to create a skull template and an anatomically precise prosthesis through “mirroring” using the sound contra-lateral skull as a reference. The prosthetic part was 3D printed with PEEK-patient specific implant (PSI) material and was adapted and fixed in place through either coronal incision, in four patients, or the pre-existing frontal scars, in two patients. After a 12 months follow-up, clinical inspection and palpation was performed. Postoperative CT imaging was done to validate the accuracy of the implanted PEEK-PSI part in relation to the preoperative computerized plan.
Results: A male predominance in all cases with a mean age of 46 years was found with a dominating etiology of motor vehicle accidents (MVA). The surgeries in all cases proceeded uneventful. Surgical site healing was normal without any signs of infection. The anatomic frontal contour and facial esthetics were admirable. The CT scan revealed the precise adaptation of the prosthesis in place without any pathology. Preoperative virtual plan fell precisely in place when compared with the post-surgical CT images after the prosthesis fixation. Conclusion: Computer guided 3D designing and printing of the prosthesis in frontal defect reconstruction was highly beneficial; higher accuracy and less obtained surgical errors due to the perfect fit of the prosthesis, along with the resultant reduction of the surgical time was documented. The integration of computer programs in surgery planning and custom prosthesis designing in defect reconstruction is highly advisable due to its great benefits and accuracy.