Patientenspezifische Implantate in der Mund-, Kiefer- und Gesichtschirurgie

Zusammenfassung

Die Verwendung von patientenspezifischen Implantaten zur Rekonstruktion von Defekten des Schädels und der Kiefer hat sich in den letzten Jahren als Standard in der Mund-, Kiefer- und Gesichtschirurgie etabliert. Anfänglich wurden die zum Einsatz kommenden Implantate intraoperativ direkt an die Defektsituation angepasst. Mit dem Fortschritt in der 3-dimensionalen Bildgebung und im Zuge der zunehmenden Digitalisierung wurden zunächst patientenspezifische 3-D-gedruckte Biomodelle zur direkten Anpassung konfektionierter Implantate im Operationssaal verwendet. Heute kommen vermehrt Implantate zum Einsatz, die im Rahmen eines computerassistierten Designprozesses (CAD) und einer anschließenden computerassistierten Herstellung (CAM) vollständig digital geplant werden. Anfangs war die Verwendung dieser CAD/CAM-gefertigten Implantate auf Defekte mit einfachen Geometrien, wie die Rekonstruktion des Schädeldachs, beschränkt. Durch Fortschritte in der digitalen Planung und der digital gestützten Herstellung können CAD/CAM-gefertigte patientenspezifische Implantate heute auch zur Versorgung komplexer Defektsituationen im präventiven und funktionalisierten Design verwendet werden. Neben der Orbitarekonstruktion und der alloplastischen Rekonstruktion des Unterkiefers kommen individualisierte Implantate auch zur komplexen dentalen Rehabilitation und funktionellen Wiederherstellung der Kiefergelenke zum Einsatz.

Abstract

The use of patient-specific implants for reconstruction of osseus craniofacial defects has become a standard in oral and maxillofacial surgery in recent years. Initially the implants used were intraoperatively adapted directly to the defect situation. With progress in 3-dimensional imaging and increasing digitization patient-specific 3-D printed bio-models were used for adaptation of these implants in the operating room. By now the implants used are increasingly manufactured in the completely digital process of computer assisted design (CAD) and subsequent computer-assisted manufacturing (CAM). In the beginning these CAD/CAM-manufactured implants were used for reconstructing defects of simple geometry such as calvaria-reconstruction only. With advances in the digital planning and digitally supported production CAD/CAM-manufactured patient-specific implants can now be used for treatment of complex defect situations in preventive and functionalized design. In addition to the orbital reconstruction and the alloplastic reconstruction of the mandible customized implants also come to use in complex dental rehabilitation and functional restoration of the temporomandibular joint.

Schlüsselwörter

patientenspezifische Implantate - rekonstruktive Chirurgie - CAD/CAM

Key words

patient-specific implants - reconstructive surgery - CAD/CAM

Publication History

Article published online:
17 March 2021

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