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The major problem in bone tissue engineering is the development of scaffolds which can simultaneously meet the requirements of porous structure, as well as have the ability to guide the regeneration of damaged tissue by biological fixation. Composites containing biodegradable matrix and bioactive filler are the new hope in this research field. Herein we employed a simple and facile solvent casting particulate-leaching method for producing polylactide acid/hydroxyapatite (PLA/HA) composites at room temperature. FT-IR analysis confirmed the existence of necessary functional groups associated with the PLA/HA composite, whereas energy-dispersive X-ray (EDX) spectra indicated the uniform distribution of hydroxyapatite particles in the polymer matrix. The beehive-like surface morphology of the composites revealed the presence of macropores, ranged from 300 to 400 μm, whereas the thickness of the pores was noticed to be 1–2 μm. The total porosity of the scaffolds, calculated by hydrostatic weighing, was found to be 79%. The water contact angle of pure PLA was decreased from 83.6 ± 1.91° to 62.4 ± 4.17° due to the addition of hydroxyapatite in the polymer matrix. Thus, the wettability of the polymeric biomaterial could be increased by preparing their composites with hydroxyapatite. The adhesion of multipotent mesenchymal stromal cells over the surface of PLA/HA scaffolds was 3.2 times (p = 0.03) higher than the pure PLA sample. Subcutaneous implantation in mice demonstrated a good tolerance of all tested porous scaffolds and widespread ingrowth of tissue into the implant pores. HA-containing scaffolds showed a less pronounced inflammatory response after two weeks of implantation compared to pure PLA. These observations suggest that PLA/HA composites have enormous potential for hard tissue engineering and restoring maxillofacial defects.

To investigate bone remodelling responses to mandibulectomy, a joint external and internal remodelling algorithm is developed here by incorporating patient-specific longitudinal data. The primary aim of this study is to simulate bone remodelling activity in the conjunction region with a fibula free flap (FFF) reconstruction by correlating with a 28-month clinical follow-up. The secondary goal of this study is to compare the long-term outcomes of different designs of fixation plate with specific screw positioning. The results indicated that the overall bone density decreased over time, except for the Docking Site (namely DS1, a region of interest in mandibular symphysis with the conjunction of the bone union), in which the decrease of bone density ceased later and was followed by bone apposition. A negligible influence on bone remodeling outcome was found for different screw positioning. This study is believed to be the first of its kind for computationally simulating the bone turn-over process after FFF maxillofacial reconstruction by correlating with patient-specific follow-up.

The advent of bioresorbable materials to overcome limitations and replace traditional bone-reconstruction titanium-plate systems for bone fixation, thus achieving greater efficiency and safety in medical and dental applications, has ushered in a new era in biomaterial development. Because of its bioactive osteoconductive ability and biocompatibility, the forged composite of uncalcined/unsintered hydroxyapatite and poly L-lactic acid (u-HA/PLLA) has attracted considerable interest from researchers in bone tissue engineering, as well as from clinicians, particularly for applications in maxillofacial reconstructive surgery. Thus, various in vitro studies, in vivo studies, and clinical trials have been conducted to investigate the feasibility and weaknesses of this biomaterial in oral and maxillofacial surgery. Various technical improvements have been proposed to optimize its advantages and limit its disadvantages. This narrative review presents an up-to-date, comprehensive review of u-HA/PLLA, a bioactive osteoconductive and bioresorbable bone-reconstruction and -fixation material, in the context of oral and maxillofacial surgery, notably maxillofacial trauma, orthognathic surgery, and maxillofacial reconstruction. It simultaneously introduces new trends in the development of bioresorbable materials that could used in this field. Various studies have shown the superiority of u-HA/PLLA, a third-generation bioresorbable biomaterial with high mechanical strength, biocompatibility, and bioactive osteoconductivity, compared to other bioresorbable materials. Future developments may focus on controlling its bioactivity and biodegradation rate and enhancing its mechanical strength.

The aim of this article is to identify whether bioactive glass (BG) is a valid substitute for autogenic bone grafting in maxillofacial reconstruction. PubMed, Scopus, Web of Science, and Cochrane Library databases were searched. Meta-analyses with fixed- and random-effects models were performed by using standardized mean differences (SMDs) with 95% confidence intervals (CIs). Heterogeneity was assessed by using the I² statistic. The significance of results was evaluated at P < 0.05. The BG leads to greater total bone volume retention 6 months after surgery compared with autografts (SMD = 0.796, 95% CI = 0.445–1.147, P = 8.74 × 10⁻⁶, I² = 0%). The resorption rate of BG grafts (SMD = −0.768, 95% CI = −1.360 to −0.176, P = 0.011, I² = 3.82%) was less common, while the retention of the biomaterial (SMD = 1.165, 95% CI = 0.540–1.790, P = 0.00026, I² = 0%) was higher in the experimental group. Both BG and autogenic grafts result in the formation of new bone to a similar extent. However, BG is able to provide long-term stability by maintaining the graft volume, reducing resorption, and preserving the graft scaffold, representing an effective alternative to autogenous bone grafting for a durable maxillofacial reconstruction.

Background: When surgeons operate under general anesthesia, length of surgery, not only its outcome, matters. In maxillofacial surgery we can reduce the time in reconstructive surgery by using presurgical bended plates in presurgically designed 3D models. Method: The study measured the mean time to bend the plates preoperatively on a printed three-dimensional model and the capability of the plates to adapt well on the mandible intraoperatively in cases of mandibular reconstruction after partial resection of the mandible due to pathology, such as benign aggressive tumors. Results and conclusions: The mean time to bend the plates preoperatively was 17 minutes, with rapid adaptation during surgery. This is important in minimizing the time that the wound is exposed to the environment and minimizes the trauma to the surrounding soft tissues. Multiple checks of the plate if bended at time of surgery can increase trauma to the surrounding soft tissues. The study supports the recommendation of the use of the preoperatively corrected and printed 3D models to prebend the plates pre-operatively. This step should be included as a routine workflow in elective cases, since it is not be possible in cases of emergency or urgency.  

Purpose To investigate the potential reconstruction of complex maxillofacial defects using computer-aided design 3D-printed polymeric scaffolds by defining the production process, simulating the surgical procedure, and explore the feasibility and reproducibility of the whole algorithm. Methods This a preclinical study to investigate feasibility, reproducibility and efficacy of the reconstruction algorithm proposed. It encompassed 3 phases: (1) scaffold production (CAD and 3D-printing in polylactic acid); (2) surgical simulation on cadaver heads (navigation-guided osteotomies and scaffold fixation); (3) assessment of reconstruction (bone and occlusal morphological conformance, symmetry, and mechanical stress tests). Results Six cadaver heads were dissected. Six types of defects (3 mandibular and 3 maxillary) with different degree of complexity were tested. In all case the reconstruction algorithm could be successfully completed. Bone morphological conformance was optimal while the occlusal one was slightly higher. Mechanical stress tests were good (mean value, 318.6 and 286.4 N for maxillary and mandibular defects, respectively). Conclusions Our reconstructive algorithm was feasible and reproducible in a preclinical setting. Functional and aesthetic outcomes were satisfactory independently of the complexity of the defect.

Titanium miniplates, though biocompatible, often require removal due to infections (3-18%), primarily from Staphylococcus aureus. Biofilms, which resist antibiotics, drive persistent infections. We analyzed 10 infected miniplates via SEM, revealing dense polymicrobial biofilms, especially near screw holes. These structured microbial communities underscore the need for biofilm-targeted treatments to improve outcomes.

ObjectiveThe aim of this study was to retrospectively review the midface and orbital floor fractures treated at our institution with regard to epidemiological aspects, surgical treatment options and postoperative complications and discuss this data with the current literature. Study designOne thousand five hundred and ninety-four patients with midface and orbital fractures treated at the Department of Oral, Cranio-Maxillofacial and Facial Plastic Surgery of the Goethe University Hospital in Frankfurt (Germany) between 2007 and 2017 were retrospectively reviewed. The patients were evaluated by age, gender, etiology, fracture pattern, defect size, surgical treatment and complications.ResultsThe average patient age was 46.2 (± 20.8). Most fractures (37.5%) occurred in the age between 16 and 35. Seventy-two percent of patients were male while 28% were female. The most common cause of injury was physical assault (32.0%) followed by falls (30.8%) and traffic accidents (17.0%). The average orbital wall defect size was 297.9 mm2 (± 190.8 mm2). For orbital floor reconstruction polydioxanone sheets (0.15 mm 38.3%, 0.25 mm 36.2%, 0.5 mm 2.8%) were mainly used, followed by titanium meshes (11.5%). Reconstructions with the 0.15 mm polydioxanone sheets showed the least complications (p < 0.01, r = 0.15). Eighteen percent of patients who showed persistent symptoms and post-operative complications: 12.9% suffered from persistent hypoesthesia, 4.4% suffered from post-operative diplopia and 3.9% showed intra-orbital hematoma.ConclusionResults of the clinical outcome in our patients show that 0.15 mm resorbable polydioxanone sheets leads to significantly less post-operative complications for orbital floor defects even for defects beyond the recommended 200 mm2.

Background We investigated the efficacy and safety of preoperative popliteal sciatic nerve block (PSNB) using liposomal bupivacaine (LB) to reduce perioperative opioid consumption and improve recovery quality in patients undergoing maxillofacial reconstruction with a free fibular flap. Methods A total of 74 patients were randomly allocated into two groups. The PSNB group received ultrasound guided PSNB using 133 mg of LB after anesthesia induction. In the control group, patients underwent nerve block preparation procedures without puncture or drug injection. The primary endpoint was cumulative opioid consumption during the perioperative period (from anesthesia induction to 48 h post-surgery). The secondary endpoints were the total incidence of moderate to severe pain during the 48 h postoperative period; the incidence of moderate to severe pain during different time periods after surgery; the incidence of PONV within 48 h after surgery; subjective sleep quality within 2 days after surgery; the length of post-surgical hospital stay; all-cause in-hospital mortality; and the incidence of other complications during hospitalization. Results There was no significant difference in cumulative opioid consumption between the control group (3020.0 [2163.0, 3569.5] µg of remifentanil equivalents) and the PSNB group (2856.0 [2204.0, 3771.0] µg; p  = 0.863). The incidence of moderate to severe pain at the donor site within 48 h after surgery was significantly lower in the PSNB group (3 [8.1%] of 37 patients) than in the control group (18 [48.6%] of 37 patients; p  < 0.001). The consumption of rescue opioids was significantly reduced in the PSNB group (0 [0, 50]) compared with that in the control group (50 [0, 100]; p  = 0.007). The subjective sleep quality numeric rating scale score was significantly lower in the PSNB group than in the control group (day of surgery: 6.0 [5.0, 8.0] vs. 8.0 [6.0, 9.0], p  = 0.029; postoperative day 1: 5.0 [4.0, 5.0] vs. 7.0 [5.5, 7.5], p  < 0.001; postoperative day 2: 5.0 [4.0, 5.5] vs. 6.0 [5.0, 7.5], p  = 0.001). The incidence of postoperative nausea and vomiting was significantly lower in the PSNB group (0 [0.0%]) compared with that in the control group (5 [13.5%]; p  = 0.021). There was no significant difference in the incidence of adverse events between the two groups. Conclusion Preoperative administration of PSNB by LB did not spare opioids during the intraoperative period, but significantly relieved postoperative pain at the donor site, reduced rescue opioid consumption, and improved postoperative sleep quality, without additional adverse events. Trial registration Clinicaltrials.gov. Identifier ChiCTR2400080944, 19 February 2024.

ObjectivesThe aim of this study was to propose and validate an automatic approach based on iterative closest point algorithm for virtual complement and reconstruction for maxillofacial bone defects.Materials and methodsA 3D craniomaxillofacial database of normal Chinese people including 500 skull models was established. Modified iterative closest point (ICP) algorithm was developed to complete bone defects automatically. The performances were evaluated by two approaches: (1) model experiment, virtual bony defects were created on 30 intact normal skull models not included in the database. For each defect model, the algorithm was applied to select the reference skull model from the database. 3-Dimensional and 2-dimensional comparison were conducted to evaluate the error between reference skull model with original intact model. Root mean square error (RMSE) and processing time were calculated. (2) Clinical application, the algorithm was utilized to assist reconstruction of 5 patients with maxillofacial bone defects. The symmetry of post-operative skull model was evaluated by comparing with its mirrored model.ResultsThe algorithm was tested on an CPU with 1.80 GHz and average processing time was 493.5 s. (1) Model experiment, the average root-mean-square deviation of defect area was less than 2 mm. (2) Clinical application, the RMSE of post-operative skull and its mirrored model was 1.72 mm.ConclusionIt is feasible using iterative closest point algorithm based on normal people database to automatically predict the reference data of missing maxillofacial bone.Clinical relevanceAn automated approach based on ICP algorithm and normal people database for maxillofacial bone defect reconstruction has been proposed and validated.