1dr

. Vri

elin

ck L

uc

Titanium Membranesfor Reconstruction of Defects

dr. Vrielinck Lucdr. C. Politis, dr. S. Schepers

Department of Oral and Maxillofacial SurgeryZOL Campus St. Jan — Genk - Belgium

11/03/02

1dr

. Vri

elin

ck L

uc

• Type of Bone Defects• Titanium Membranes• Treatment Protocol• Clinical Examples• Results• Conclusions

Overview

1dr

. Vri

elin

ck L

uc

Type of Bone Defects

Results ConclusionsClinical Examples

Treatment ProtocolTitanium Membranes

1dr

. Vri

elin

ck L

uc

Results ConclusionsClinical Examples

Treatment ProtocolTitanium Membranes

Type of Bone Defects

1dr

. Vri

elin

ck L

uc

• Pure bone defects - Congenital • Cleft palate

Type of Bone Defects

1dr

. Vri

elin

ck L

uc

• Pure bone defects - Congenital • Cleft palate • Treacher Collins syndrome • Hemifacial microsomy

Type of Bone Defects

1dr

. Vri

elin

ck L

uc

• Pure bone defects - Congenital - Posttraumatic • zygomatic buttress

Type of Bone Defects

1dr

. Vri

elin

ck L

uc

• Pure bone defects - Congenital - Posttraumatic • zygomatic buttress • orbital floor

Type of Bone Defects

1dr

. Vri

elin

ck L

uc

• Pure bone defects - Congenital - Posttraumatic • zygomatic buttress • orbital floor • nasoethmoid region

Type of Bone Defects

1dr

. Vri

elin

ck L

uc

• Pure bone defects - Congenital - Posttraumatic - Postoperative • maxilla

Type of Bone Defects

1dr

. Vri

elin

ck L

uc

• Pure bone defects - Congenital - Posttraumatic - Postoperative • maxilla • mandible

Type of Bone Defects

1dr

. Vri

elin

ck L

uc

• Pure bone defects - Congenital - Posttraumatic - Postoperative • maxilla • mandible • iliac crest

Type of Bone Defects

1dr

. Vri

elin

ck L

uc

• Pure bone defects - Congenital - Posttraumatic - Postoperative • maxilla • mandible • iliac crest • skull defect after trepanantion Courtesy of Jan Haex, Maastricht

Type of Bone Defects

1dr

. Vri

elin

ck L

uc

• Pure bone defects - Congenital - Posttraumatic - Postoperative - Terminal jaw atrophy

Type of Bone Defects

1dr

. Vri

elin

ck L

uc

• Pure bone defects• Bone + soft tissue defects

Type of Bone Defects

1dr

. Vri

elin

ck L

uc

Results ConclusionsClinical Examples

Treatment Protocol

Type of Bone Defects Titanium Membranes

1dr

. Vri

elin

ck L

uc

Titanium Membranes• Hydroforming• Casting

1dr

. Vri

elin

ck L

uc

Titanium Membranes• Hydroforming - using thin titanium foils (0.2 - 0.4 mm)

1dr

. Vri

elin

ck L

uc

Titanium Membranes• Hydroforming - using thin titanium foils (0.2 - 0.4 mm) - ‘cold’ deformation under pressure (600 bar)

1dr

. Vri

elin

ck L

uc

Titanium Membranes• Hydroforming - using thin titanium foils (0.2 - 0.4 mm) - ‘cold’ deformation under pressure (600 bar) - foil is moulded around a positive cast

1dr

. Vri

elin

ck L

uc

Titanium Membranes• Hydroforming - using thin titanium foils (0.2 - 0.4 mm) - ‘cold’ deformation under pressure (600 bar) - foil is moulded around a positive cast - lateral expansion is limited by tear formation

1dr

. Vri

elin

ck L

uc

Titanium Membranes• Hydroforming - using thin titanium foils (0.2 - 0.4 mm) - ‘cold’ deformation under pressure (600 bar) - foil is moulded around a positive cast - lateral expansion is limited by tear formation - lateral compression induces folds

1dr

. Vri

elin

ck L

uc

Titanium Membranes• Hydroforming - using thin titanium foils (0.2 - 0.4 mm) - ‘cold’ deformation under pressure (600 bar) - foil is moulded around a positive cast - lateral expansion is limited by tear formation - lateral compression induces folds - industrial fabrication

1dr

. Vri

elin

ck L

uc

Titanium Membranes• Hydroforming• Casting - fabricated in dental laboratory

1dr

. Vri

elin

ck L

uc

Titanium Membranes• Hydroforming• Casting - fabricated in dental laboratory - used for complex 3D anatomic forms

1dr

. Vri

elin

ck L

uc

Titanium Membranes• Hydroforming• Casting - fabricated in dental laboratory - used for complex 3D anatomic forms - fabricated using lost wax technique

1dr

. Vri

elin

ck L

uc

Titanium Membranes• Hydroforming• Casting - fabricated in dental laboratory - used for complex 3D anatomic forms - fabricated using lost wax technique - massive titanium structures

1dr

. Vri

elin

ck L

uc

Titanium Membranes• Hydroforming• Casting - fabricated in dental laboratory - used for complex 3D anatomic forms - fabricated using lost wax technique - massive titanium structures - hollowed out structures

1dr

. Vri

elin

ck L

uc

Results ConclusionsClinical Examples

Type of Bone Defects Treatment ProtocolTitanium Membranes

1dr

. Vri

elin

ck L

uc

• CT Scan• 3D Stereolithography & Membrane Design• Membrane Fabrication• Surgery

Treatment Protocol

1dr

. Vri

elin

ck L

uc

Treatment ProtocolCT Scan

1dr

. Vri

elin

ck L

uc

Treatment ProtocolCT Scan

• Scan of the jaws (e.g. spiral tomography) - gantry tilt 0°

1dr

. Vri

elin

ck L

uc

Treatment ProtocolCT Scan

• Scan of the jaws (e.g. spiral tomography) - gantry tilt 0° - slice thickness of max 1.0 mm

1dr

. Vri

elin

ck L

uc

Treatment ProtocolCT Scan

• Scan of the jaws (e.g. spiral tomography) - gantry tilt 0° - slice thickness of max 1.0 mm• Transfer of data to PC (Mimics)

1dr

. Vri

elin

ck L

uc

Treatment ProtocolCT Scan

• Scan of the jaws (e.g. spiral tomography) - gantry tilt 0° - slice thickness of max 1.0 mm• Transfer of data to PC (Mimics)• Calculation 3D model on PC

1dr

. Vri

elin

ck L

uc

• CT Scan• 3D Stereolithography & Membrane Design• Membrane Fabrication• Surgery

Treatment Protocol

1dr

. Vri

elin

ck L

uc

Treatment Protocol3D STL & Membrane Design

• Fabrication Physical Stereolithography model (Materialise)

1dr

. Vri

elin

ck L

uc

Treatment Protocol3D STL & Membrane Design

• Fabrication Physical STL model - original image

1dr

. Vri

elin

ck L

uc

Treatment Protocol3D STL & Membrane Design

• Fabrication Physical STL model - original image - mirror image

1dr

. Vri

elin

ck L

uc

Treatment Protocol3D STL & Membrane Design

• Fabrication Physical STL model - original image - mirror image• Design of the Membrane

1dr

. Vri

elin

ck L

uc

Treatment Protocol3D STL & Membrane Design

• Fabrication Physical STL model - original image - mirror image• Design of the Membrane

1dr

. Vri

elin

ck L

uc

Treatment Protocol3D STL & Membrane Design

• Fabrication Physical STL model - original image - mirror image• Design of the Membrane

1dr

. Vri

elin

ck L

uc

Treatment Protocol3D STL & Membrane Design

• Fabrication Physical STL model - original image - mirror image• Design of the Membrane

1dr

. Vri

elin

ck L

uc

• CT Scan• 3D Stereolithography & Membrane Design• Membrane Fabrication• Surgery

Treatment Protocol

1dr

. Vri

elin

ck L

uc

Treatment ProtocolMembrane Fabrication

• initial procedures in the dental laboratory

1dr

. Vri

elin

ck L

uc

Treatment ProtocolMembrane Fabrication

• initial procedures in the dental laboratory• hydrofoil technique: positive cast needed

1dr

. Vri

elin

ck L

uc

Treatment ProtocolMembrane Fabrication

• initial procedures in the dental laboratory• hydrofoil technique: positive cast needed• casting technique: lost wax technique

1dr

. Vri

elin

ck L

uc

Treatment ProtocolMembrane Fabrication

• initial procedures in the dental laboratory• hydrofoil technique: positive cast needed• casting technique: lost wax technique• finishing the membrane

1dr

. Vri

elin

ck L

uc

• CT Scan• 3D Stereolithography & Membrane Design• Membrane Fabrication• Surgery

Treatment Protocol

1dr

. Vri

elin

ck L

uc

Treatment ProtocolSurgery

• membrane sterilised by autoclaving

1dr

. Vri

elin

ck L

uc

Treatment ProtocolSurgery

• membrane sterilised by autoclaving• general or local anesthesia

1dr

. Vri

elin

ck L

uc

Treatment ProtocolSurgery

• membrane sterilised by autoclaving• general or local anesthesia• incision and careful deperiostation

1dr

. Vri

elin

ck L

uc

Treatment ProtocolSurgery

• membrane sterilised by autoclaving• general or local anesthesia• incision and careful deperiostation• positioning the plate on top of the bone

1dr

. Vri

elin

ck L

uc

Treatment ProtocolSurgery

• membrane sterilised by autoclaving• general or local anesthesia• incision and careful deperiostation• positioning the plate• fixation and immobilisation of the plate by osteosynthesis screws

1dr

. Vri

elin

ck L

uc

Results Conclusions

Type of Bone Defects

Clinical Examples

Treatment ProtocolTitanium Membranes

1dr

. Vri

elin

ck L

uc

• Asymmetry and enoftalmy• Mandibulectomy reconstruction• Reconstruction iliac crest• Soft tissue reconstruction• Reconstruction nasoethmoid region

Clinical Examples

1dr

. Vri

elin

ck L

uc

• Asymmetry and enoftalmy

Clinical Examples

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

• Asymmetry and enoftalmy• Mandibulectomy reconstruction• Reconstruction iliac crest• Soft tissue reconstruction• Reconstruction nasoethmoid region

Clinical Examples

1dr

. Vri

elin

ck L

uc

• Mandibulectomy reconstruction

Clinical Examples

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

• Asymmetry and enoftalmy• Mandibulectomy reconstruction• Reconstruction iliac crest• Soft tissue reconstruction• Reconstruction nasoethmoid region

Clinical Examples

1dr

. Vri

elin

ck L

uc

• Reconstruction iliac crest

Clinical Examples

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

• Asymmetry and enoftalmy• Mandibulectomy reconstruction• Reconstruction iliac crest• Soft tissue reconstruction• Reconstruction nasoethmoid region

Clinical Examples

1dr

. Vri

elin

ck L

uc

• Soft tissue reconstruction

Clinical Examples

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

• Asymmetry and enoftalmy• Mandibulectomy reconstruction• Reconstruction iliac crest• Soft tissue reconstruction• Reconstruction nasoethmoid region

Clinical Examples

1dr

. Vri

elin

ck L

uc

• Reconstruction nasoethmoid region

Clinical Examples

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

1dr

. Vri

elin

ck L

uc

Conclusions

Type of Bone Defects

Clinical Examples

Treatment Protocol

Results

Titanium Membranes

1dr

. Vri

elin

ck L

uc

Treated Indications• facial asymmetry 3

Clinical Examples

1dr

. Vri

elin

ck L

uc

Treated Indications• facial asymmetry 3• maxillary defect 1

Clinical Examples

1dr

. Vri

elin

ck L

uc

Treated Indications• facial asymmetry 3• maxillary defect 1• mandibular reconstruction 2

Clinical Examples

1dr

. Vri

elin

ck L

uc

Treated Indications• facial asymmetry 3• maxillary defect 1• mandibular reconstruction 2• soft tissue reconstruction 1

Clinical Examples

1dr

. Vri

elin

ck L

uc

Treated Indications• facial asymmetry 3• maxillary defect 1• mandibular reconstruction 2• soft tissue reconstruction 1• nasoethmoid reconstruction 1

Clinical Examples

1dr

. Vri

elin

ck L

uc

Advantages of Titanium Membranes• excellent esthetic result

Clinical Examples

1dr

. Vri

elin

ck L

uc

Advantages of Titanium Membranes• excellent esthetic result• no donor site morbidity

Clinical Examples

1dr

. Vri

elin

ck L

uc

Advantages of Titanium Membranes• excellent esthetic result• no donor site morbidity• simple operation technique

Clinical Examples

1dr

. Vri

elin

ck L

uc

Advantages of Titanium Membranes• excellent esthetic result• no donor site morbidity• simple operation technique• reduced operation time

Clinical Examples

1dr

. Vri

elin

ck L

uc

Advantages of Titanium Membranes• excellent esthetic result• no donor site morbidity• simple operation technique• reduced operation time• reduced hospitalisation

Clinical Examples

1dr

. Vri

elin

ck L

uc

Advantages of Titanium Membranes• excellent esthetic result• no donor site morbidity• simple operation technique• reduced operation time• reduced hospitalisation• possible bone regeneration under the membrane (?)

Clinical Examples

1dr

. Vri

elin

ck L

uc

Type of Bone Defects

Clinical Examples Conclusions

Treatment Protocol

Results

Titanium Membranes

1dr

. Vri

elin

ck L

uc

ConclusionsWhy use titanium membranes ?

• Alternative for bone reconstruction

1dr

. Vri

elin

ck L

uc

ConclusionsWhy use titanium membranes ?

• Alternative for bone reconstruction• Can bear functional load

1dr

. Vri

elin

ck L

uc

ConclusionsWhy use titanium membranes ?

• Alternative for bone reconstruction• Can bear functional load• Very good for correction of bone asymmetries

1dr

. Vri

elin

ck L

uc

• Alternative for bone reconstruction• Can bear functional load• Very good for correction of bone asymmetries• Reduced operation time and morbidity

ConclusionsWhy use titanium membranes ?

1dr

. Vri

elin

ck L

uc