| Objectives:In this study,individualized 3D printed PEEK implants were used to reconstruct the maxilla for patients with depressed paranasal regions.Individualized 3D printed PEEK implants combined with vascularized free fibular flap were used to reconstruct the mandible for patients with extensive mandibular defects.This study amis to observe the safety and the aesthetic effect of its clinical application,and to provide a novel strategy for aesthetic reconstruction of the jaw with insufficient autologous bone volume in the donor area.Methods:A retrospective analysis of 19 cases of oral and maxillofacial surgery at Southern Medical University from December 2019 to March 2022 using 3D printed PEEK implants for aesthetic reconstruction of the jaws was performed,they were divided into two groups:maxilla group and mandible group.In the maxilla group,17 patients with skeletal class III mandibular protrusion and mild maxillary hypoplasia were treated with 3D printed PEEK implants.The mandible group consisted of 2 patients with extensive mandibular defects(defect range>10 cm)caused by resection of benign tumors of the mandible,3D printed PEEK implants combined with vascularized fibula for simultaneous or staged reconstruction of mandibular defects were applied to accommodate mandibular length and height.All patients were selected strictly according to the inclusion and exclusion criteria.CBCT and 3D MD scans were performed before the operation,and according to the anatomic characteristics of different patients and their clinical requirements,the shape and guide plate design of the individual implants were carried out.At the same time,the mechanical properties of the implants were analyzed by the biological finite element analysis to ensure the strength of the implants,the 1:1 peek implants were produced by 3D printing technology.With a digital guidance,the precise aesthetic reconstruction of the maxillary paranasal depression was performed,and the mandibular reconstruction combined with vascularized free fibular flap was performed in both length and height.Six-month follow up and collection of data were conducted to evaluate the safety of 3D printed PEEK implants and to objectively evaluate the aesthetic reconstruction of the jaws.Results:A total of 19 individuals were enrolled in this study,including 17 subjects in the maxilla group and 2 subjects in the mandible group,with age ranging from 20 to 40 years old and an average age of 28 years old.Follow-up were conducted in all patients with an average period of 15.4 ± 8.7 months.The follow-up period was longer than 6 months in 14 cases,including 12 in the maxilla group and 2 in the mandible group.No inflammation or other complications were observed in the maxilla group.All wounds were healing by primary intention.According to 12 patients who finished the FACE-Q satisfaction questionnaire,none of them expressed unsatisfactory result.Excellent outcome was achieved in 3 patients(25%),good outcome was achieved in 8 patients(67%)and average outcome was achieved in one patients(8%).The soft and hard tissues of 12 patients were evaluated with CBCT 6 months after the operation.The depression in the paranasal area was improved compared with that before operation(P<0.001),and the nasolabial fold severity score(WSRS-NLF)decreased from 1.3 to 0.6(P<0.001)after operation.The nasolabial angle increased from 87.1°to 99.3°(P=0.046).The root means square error of implants position between 7 days and 6 months postoperatively was 0.5 ± 0.1 mm.One case in the mandibular group had postoperative wound healing by primary intention.The facial symmetry,the ratio of 1/3 of the middle face to 1/3 of the lower face,and the aesthetic index of the aesthetic plane were all improved,and the occlusal function was restored.One case developed a postoperative infection(fistula formation due to intraoral incision dehiscence caused by contraction of the peroneal myofascial flap),and the facial profile was well maintained after a second surgery to remove the 3D-printed PEEK.Conclusions:1.The individualized PEEK model was constructed by digital technology,and the PEEK implants were made by 3D printing technology.3D printed PEEK implants can effectively reshape the aesthetics of the maxillary paranasal region in patients with depressed paranasal regions,and 3D printed PEEK implants can restore the contour of the mandible in patients with extensive(>10 cm)mandibular defects,to make up for the height deficiency of fibula transplantation in repairing extensive mandibular defects,to achieve the aesthetic restoration of the jaw;2.The 3D printed PEEK implants are easy to manufacture and light in weight,which can satisfy different bone defects.The method of implantation is simple and accurate;3.The 3D printed PEEK implants preliminarily show good biocompatibility and are safe and reliable for the aesthetic reconstruction of the jaw,which is worthy of further investigation. |
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