BIOMATERIALS

Maxillofacial & Skull

Implants

Brendan Boyd & Stuart Mah

 Outline Of Presentation
„ Basic Anatomy of Face and Skull
„ Reasons/Defects responsible for maxillofacial & skull surgery
„ History of Alloplastic Facial Implants
„ Brief overview of Surgical Process for implantation
„ Biomaterials Of Metal Implants
„ Biocompatibility Of Metal Implants
„ Biomaterials Of Plastic Implants
„ Biocompatibility Of Plastic Implants
„ Metal VS Plastic Implants
„ Future Advancements Of Implants

Alloplastics: Artificial implantable materials substituted for tissue

grafts; e.g., plastics, silicones, metals, textiles, etc.
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 Anatomy of Face
FRONTAL

NASAL TEMPORAL

SPHENOID

ZYGOMATIC

MAXILLA

MANDIBLE

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 Anatomy of Skull
PARIETAL FRONTAL

NASAL

ZYGOMATIC

MAXILLA

TEMPORAL MANDIBLE
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 Reasons for Needing Alloplastic Implants

„ Cosmetic reasons (ie. Plastic surgery)

„ Birth defects (ex. Cleft palate)

„ Deconstructive disease (ie. Cancer)

„ Sports or related injuries

„ Accidents (ex. Car accidents)

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 History of Alloplastic Facial Implants
„ Used for centuries in cosmetic and reconstructive surgery

„ Implants in the maxillofacial area have been used in

aesthetic and reconstructive practices to achieve symmetry
and balance

„ Early implantable materials included gold cleft palates and

ivory nasal inlays

„ Documented use of facial reconstructive surgery dates as

far back as 800 B.C.

„ Driving force for facial reconstructive surgery in late 1800’s

and early 1900’s was in fact war
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 Surgical Process for Implantations
Reconstructive software

Previous CT New CT
Scans Scans

„ CT scans used to analyze bone and cartilage deformities or

intrusions, to allow for planning of surgery

„ 3D volume reconstruction products offer complete 3D

segmentation and manipulation
• Vworks 4.0 Clinic 3D by CyberMed of Seoul

„ Combination of two technologies allows surgeons to map out and

visualize how they will perform their facial reconstructive surgery

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 Surgical Process for Implantations
Actual Surgical Process
Three methods for securing metal prosthetic devices in
human body

1. Press-fitting the device in the bone

2. Cementing them to an adjoining bone using an adhesive
3. Affixing them in place with screws

„ Generally accepted method for affixing non-metallic artificial facial

implants is using an adhesive

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 Biomaterials of Metal Implants
Properties

Metal Tensile Strength Yield Hardness Ductility Corrosion Density

(Mpa)
Mpa) Strength Resistance (g/cu. cm.)
(Mpa)
Mpa)
Titanium 500 - 600 140 Low-
Low- Medium Very High 4.5
Medium
Hardness
Titanium Alloy (with 1241 172 - 1100 Very Hard Medium Very High 4.85
Vanadium and
Aluminum)
Gold 103 210-
210-340 Medium Very, Very Very, Very High 19.32
Hardness High
Stainless Steel 800-
800-1200 350 - 800 Medium Low High 8.03
Hardness
Tungsten 432 1200-
1200-1600 Very Hard Low High 18.82
cobalt-
cobalt-chromium 600-
600-870 450 - 650 Low-
Low- Very Low Very High 8.1 – 8.8
alloys Medium
Hardness

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 Tensile Strength / Density
Metal Tensile Strength (Mpa
(Mpa)) Density
(g/cu. cm.)
Titanium 500 - 600 4.5

Titanium Alloy (with Vanadium and 1241 4.85

Aluminum)
Gold 103 19.32

„ Gold has low tensile strength

• Elongation will cause improper functioning
of facial parts
„ Among the highest Density value
• Approx. 4.5x more dense than Titanium
• Causes unbalance
• Less comfortable when implanted

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 Ductility/Corrosion
Metal Tensile Yield Hardnes Ductility Corrosion Density
Strength Strengt s Resistance (g/cu.
(Mpa)
Mpa) h (Mpa
(Mpa)) cm.)

Titanium 500 - 600 140 Low-

Low- Medium Very High 4.5
Medium
Hardness

Stainless Steel 800-

800-1200 350 - Medium Low High 8.03
800 Hardness

„ Shaping to contour of bone

• Priority towards Cosmetics / Functionality of facial parts

• Makes surgical process less difficult
• Better stability when joined with bone

„ Higher corrosion in stainless steel

• Cause pain
• Functional capacity reduced 11
 Hardness
Metal Hardness Ductility Density
(g/cu. cm.)

Titanium Low-
Low-Medium Hardness Medium 4.5

Tungsten Very Hard Low 18.82

„ Need moderately hard substance

• Less physical force applied to facial area
• Vital and sensitive parts located in facial/skull region
• Tungsten not practical for maxillofacial or skull area

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 Why Titanium?
„ Strong resistance to corrosion

„ Good candidate for long term

implants

„ Has a strong oxide layer that

renews itself

„ Ease of shaping/bending
compared to steel or cobalt-
chromium

„ Upon bending, Titanium reverts

less than Steel

„ No allergic reactions

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 Biocompatibility Of Titanium Facial Implants
„ Completely inert to human body FIGURE 1
fluids

„ Meets the following criteria of

being biocompatible
1. corrosion-resistant
2. tissue compatible
3. vital and elastic

„ Titanium implants are tolerated

for up to 13 years
• Much longer than other modern
metallic facial implants
• No inflammatory response or
large cell reactions (e.g. Figure
1)
• So far, titanium particles in
tissue have no clinical 14
significance or long-term effects
 Biocompatibility Continued

Success Rates
• Titanium plates and screws used on 54 patients with severe facial
fractures

• Included Males and Females ranging from 5 to 74 years of age

• Of these patients, only 16.7% had reoperation due to cosmetic

deformities or functional conflicts

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 Non-Metallic Implants

„ Two main types of non-metallic artificial facial implants

have been used over the past few decades:
• Silicone Rubber
• Calcium Phosphate Apatite

„ Early implants were centralized around silastic© implants

„ Silastic is a silicone rubber composite material
„ Virtually every artificial implant (non-metallic) was made of
some composite of this material
„ Material patented by Dow Corning Corporations

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Examples of artificial implants made of silastic material:
„ ears
„ burr hole covers
„ chins
„ breast implants (responsible for lawsuits)

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„ Implants are stable up to 90 days after insertion into
body (according to chart)

„ On Dow Corning website, they’re listed appropriate time

period for insertion is no more than 29 days

„ Dow Corning sued for over 6 billion dollars due to reaction

of silicon implants, mainly breast implants

„ Lawsuits ongoing due to incompatibility of implants in the

body

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Calcium Phosphate Apatite (CPA) Implant Material
„ One of the most important implantable
materials

„ Very biocompatible

„ Usually molded to form artificial ears and chins

etc., specific to the patient

„ CPA is usually made into a composite material

„ Composite material usually is a mixture of CPA

and other biomaterials, such as Hydroxyapatite

„ Bone is approximately 70% CPA, including

some Hydroxyapatite
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 Biocompatibility of Modern Non-metallic implants

„ To test biocompatibility of
Hydroxyapatite, sheets of
it were surgically
implanted onto skulls of
patients

„ Results
• No side effects were
observed
• Implant appeared to be
attached to the skull
securely
Hydroxyapatite adhered
to skull of human
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 Metal vs Non-Metallic
Implants
„ Each offers its own advantages/disadvantages
Metal Non-Metallic
„Very strong „Very flexible
„Hard, high tensile strength „Very biocompatible

„Not as biocompatible „Easily formed to make

„Can be firmly attached to natural-looking prosthetics

bone using screws or press- „Easier to manufacture
fitting „Tends to become brittle over
time in some cases
E.g. Good for plates / „Not nearly as strong
reinforcement for bones

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Future Advancements
„ Best biocompatible metal is
titanium
• Still causes fibrosis after 13
years

„ Need to find more biocompatible

metal

„ One way is to coat the metal with a

biocompatible material
• E.g. Hydroxyapatite or beta-
tricalcium phosphate (TCP)

„ Trials of coated prosthetic hips have

shown promising signs of
integration in the body 22
„ Another method to make titanium plates more
biocompatible is to roughen the metal surface

• Creates a micro-porous structure through which bone is

more likely to attach or grow

• This increases chances of osteointegration

„ Osteointegration: Bone growth directly adjacent to a metal
implant

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 References
„ Internet Resources
„ http://www.gwc.maricopa.edu/class/bio201/skull/antskul.htm
„ http://www.corrosion-doctors.org/Implants/frconten.htm
„ http://www3.interscience.wiley.com/cgi-bin/fulltext/93514148/PDFSTART
„ www.ucm.es/BUCM/compludoc/W/10508/02782391_3.htm
„ www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&
db=PubMed&list_uids=12069513&dopt=Abstract
„ www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&
db=PubMed&list_uids=16077328&dopt=Citation
„ http://www.dowcorning.com
„ http://www.lib.umich.edu/dentlib/Dental_tables/toc.html
„ http://www.auntminnie.com/index.asp?sec=ser&sub=def&pag=dis&ItemID=63867

„ Book Resources
„ “Advances In Biomedical Polymers”, Charles G. Gebelein, 1987, Plenum Press, New
York
„ “Advances in Biomaterials Volume 5”, Ducheyne, Van der Perre & Aubert, 1984,
Elsevier Science Publishers, Netherlands
„ “Biomaterials”, A.L. Bement, 1971, Battelle Seattle Research Center

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