jawsurgeryforums.com
General Category => General Chat => Topic started by: overbiter on August 24, 2015, 10:26:58 AM
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(http://3dprintingindustry.com/wp-content/uploads/2015/05/3D-printed-ct-bone.jpg)
3D printed bone implants are now available to patients in europe, thanks to dutch company Xilloc Medical. These implants are patient specific and are created from CT scans, then printed out using a 3D printer. The implants are made from bio compatible materials that turn into real bone once implanted. Implants can be created to augment jaws, zygomas and brows, or pretty much any part of the cranial anatomy. See this article for more information.
http://3dprintingindustry.com/2015/05/18/move-over-titanium-3d-printed-bone-implants-are-here/ (http://3dprintingindustry.com/2015/05/18/move-over-titanium-3d-printed-bone-implants-are-here/)
Here's the website
http://www.xilloc.com/ct-bone/ (http://www.xilloc.com/ct-bone/)
Example implants
http://www.xilloc.com/products_services/patient-specific-implants/examples/ (http://www.xilloc.com/products_services/patient-specific-implants/examples/)
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The manufacturing of CT-Bone involves printing the designed implant using calcium phosphate, the primary constituent of natural bone. The advantage is that when this is implanted, the patient’s existing bone fuses with it just as it would with natural bone and unifies in a few months. It’s a bone-like implant that allows bone to grow naturally into it.
So it's not really bone, just something resembling human bones more then solid silicon i guess. Must be expensive?
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So it's not really bone, just something resembling human bones more then solid silicon i guess. Must be expensive?
It's a bio compatible material that the human body eventually converts into bone. It integrates with the body, blood vessels grow through its porous texture, new bone cells grow within it. It becomes indistinguishable from other bone over time.
I'm not sure how expensive it would be to get an implant made. I suppose that they probably aren't even doing it for purely cosmetic purposes yet anyway. It will be available for that purpose soon though, because of the advantages it offers.
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Wow sounds cool. Hopefully it comes out in the next 2-3 years.
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i sent them an email. Let's see if they reply
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sounds like the material is HA
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sounds like the material is HA
They specifically mention that CT-Bone is different from HA. It's not very informative to call it calcium phosphate since that's just the name of a family of minerals (which HA is also a part of).
Relevant quote:
Unlike other 3D printed ceramics (like Hydroxyapatite or Beta-TCP), CT-Bone® does not require a thermal process (sintering) to increase mechanical strength and therefore also displays better bony fusion (sintering increases crystallinity which adversely affects biodegradability).
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sounds like the material is HA
The difference between CT-bone and HA is that it has degradability. A patients body can break this stuff down and remould it. Which means that it can be fully integrated into the body and become a part of the living skeleton.
HA cannot be broken down. The sintering process, required to increase its mechanical strength, creates a crystalline molecular structure. Adding HA to bones is a bit like slapping some glass on them. Bloods vessels and bone cells cannot grow into it, it's an inert material, it will never become a part of the patients biology. Surgeons only use it because it has the ability to bind to bone, that doesn't mean it will ever become bone. HA behaves like any other artificial material when applied, in that it never becomes a part of the body's biology. It is synthetic. Bones might look like they are 'fixed' by it, but in fact that is an illusion. Bones 'fixed' by HA can never heal, they lose that potential because of the lack of degradability. That is why HA is bad.
CT-bone implants are not like other implants, in that they become a part of the patients biology. Once inside the body they transform into natural bone. The implants are colonised by a patients own cells. It's like having a bone graft, only better because the implants are created by a 3D printer.
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i sent them an email. Let's see if they reply
Great, keep us updated.
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Yeah I will totally get sinn to use this on me if it's available. Please keep us updated!!!
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what the ho ho? let's get more info?
who's the c*nt who negged my karma. f**k off and eat s**t. I'm like a BOSS of the jawsurgeryforums! I made you nigga! I made you!!!
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I'm going to ask about this at my next appointment.
I'm thinking about jaw (angle of) implants and I like the sound of these...
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i got one brief reply from them regarding the accessibility for patients who needs CT-Bone for cosmetic purposes only. Apparently this group of patients are their main target group and they hope to release the product in early 2016 in Europe and apply for FDA clearence in the US at the same time.
I returned a more spesific email with questions regarding estimated costs, surgeons capable of inserting these implants, long-term effects on facial bones and tissue etc but never got any reply back...
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Ain't no maxillofacial surgery in the motherf**kin hood.
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thanks for the update skippy
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Is there any way to create a vascularized graft with this? Like the way they do with a fibular free flap or ALT graft? I had an anterior maxillectomy and this would be so much better than having bone taken from my leg.
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i got one brief reply from them regarding the accessibility for patients who needs CT-Bone for cosmetic purposes only. Apparently this group of patients are their main target group and they hope to release the product in early 2016 in Europe and apply for FDA clearence in the US at the same time.
Interesting, this is exactly what I was hoping to hear. Good work skippy. Now let's just hope that surgeons update their methodology to include this new technique, and don't drag their feet like anchors in the way these guys usually do.
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Is there any way to create a vascularized graft with this? Like the way they do with a fibular free flap or ALT graft? I had an anterior maxillectomy and this would be so much better than having bone taken from my leg.
I think blood vessels just colonise the implant after it is put inside the body. Maybe there are ways to help this process with stem cells etc. A patient specific implant made with CT-Bone could work well for someone like you. Try emailing the company to see what they say.
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This sounds a little too good to be true, are other cosmetic surgeons taking an interest?
Surely this can't be all natural, it's still an implant after all. Will it migrate, is it susceptible to infection and will it truly be indistinguishable from real bone?
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This sounds a little too good to be true, are other cosmetic surgeons taking an interest?
Surely this can't be all natural, it's still an implant after all. Will it migrate, is it susceptible to infection and will it truly be indistinguishable from real bone?
It's 2015 mate, we're not living in the dark ages anymore. Take your smart phone out of your pocket, have a good look at it, and thank god you're living in the modern age.
The implant won't migrate because it fuses with the adjacent bone. It becomes real bone over time.
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It's 2015 mate, we're not living in the dark ages anymore. Take your smart phone out of your pocket, have a good look at it, and thank god you're living in the modern age.
The implant won't migrate because it fuses with the adjacent bone. It becomes real bone over time.
YEAH! OVERBITER IS MY NEW FAVORITE PERSON ON THIS BLOG!!! Except for my fiancee 27f.
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i got one brief reply from them regarding the accessibility for patients who needs CT-Bone for cosmetic purposes only. Apparently this group of patients are their main target group and they hope to release the product in early 2016 in Europe and apply for FDA clearence in the US at the same time.
I returned a more spesific email with questions regarding estimated costs, surgeons capable of inserting these implants, long-term effects on facial bones and tissue etc but never got any reply back...
That usually means 'will be released somewhere in 2020 or later'. It will be there, just not in 2016.
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FWIW, multiple surgeons have told me that HA paste vascularises eventually and becomes "like your own bone".
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Sweet! See, I'm so glad I'm planning on waiting until 40s-50s to address that problem. By then, there will be lots of data on patients with this but I'm guessing it's gonna be good. Real good. Game changer here! Then not only will correct my deficiencies but I'll also get to dial back age somewhat, turning me from looking 60 at 50 back to 40. And reversing all the age related risk factors for having flat cheeks at the same time. f**k cost, you don't get a new face but you can always private label new items at Amazon.
Anyone know how they are fixated? Why do we need plates and screws for everything? I'll have them try and remove my hardware while they're in there. Supposedly biodegradable silk hardware should be available starting in 2020, stronger than titanium, none of the issues with existing products, and ability to deliver healing compounds to the site like BMPs. News is a few years old here, not sure why it's taking so long.
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It's 2015 mate, we're not living in the dark ages anymore. Take your smart phone out of your pocket, have a good look at it, and thank god you're living in the modern age.
The implant won't migrate because it fuses with the adjacent bone. It becomes real bone over time.
Ah.... I do not think it becomes "real" bone. The most that is claimed is that it vascularizes. That is hugely different from real bone. In order to become real bone, the implant would have to be re-absorbed. Otherwise, there is no room for real bone.
It does appear that at the margins where it is in contact with real bone that the real bone will infiltrate the junctions.
Regards, George
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Ah.... I do not think it becomes "real" bone. The most that is claimed is that it vascularizes. That is hugely different from real bone. In order to become real bone, the implant would have to be re-absorbed. Otherwise, there is no room for real bone.
It does appear that at the margins where it is in contact with real bone that the real bone will infiltrate the junctions.
Regards, George
"Typical bone augmentation implants are made from alloplastic materials (like PEEK or titanium) or the patient’s own bone is cut and repositioned. CT-Bone® is a bone-like implant that can be 3D printed and is converted to real bone by the patient."
http://www.xilloc.com/ct-bone/ (http://www.xilloc.com/ct-bone/)
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"Typical bone augmentation implants are made from alloplastic materials (like PEEK or titanium) or the patient’s own bone is cut and repositioned. CT-Bone® is a bone-like implant that can be 3D printed and is converted to real bone by the patient."
http://www.xilloc.com/ct-bone/ (http://www.xilloc.com/ct-bone/)
"As Maikel Beerens, CEO at Xilloc, said, “3D Printing of CT-Bone allows us to help even more patients with a tailor-made solution. After taking a CT-scan of the patient, a patient-specific implant is designed by our biomedical engineers in collaboration with the surgeon. This design perfectly fits on the anatomy of the patient, ensuring good bone-to-implant contact and facilitating bony in-growth.”
The material is artificially made, yet integrates with the body just as natural bone would. 3D printing it means that it can be customized to the individual patient and controlled to exhibit the same porosity as natural bone. "
That really does not sound like anybody is actually claiming that the implant will end up being re-absorbed and replaced with real bone. The fact that it is also not supposed to be structural - - tends to support that notion. "... good bone -to-implant contact " also does not suggest that the implant becomes bone. It would REALLY be nice if it did transform itself into natural bone.
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"As Maikel Beerens, CEO at Xilloc, said, “3D Printing of CT-Bone allows us to help even more patients with a tailor-made solution. After taking a CT-scan of the patient, a patient-specific implant is designed by our biomedical engineers in collaboration with the surgeon. This design perfectly fits on the anatomy of the patient, ensuring good bone-to-implant contact and facilitating bony in-growth.”
The material is artificially made, yet integrates with the body just as natural bone would. 3D printing it means that it can be customized to the individual patient and controlled to exhibit the same porosity as natural bone. "
That really does not sound like anybody is actually claiming that the implant will end up being re-absorbed and replaced with real bone. The fact that it is also not supposed to be structural - - tends to support that notion. "... good bone -to-implant contact " also does not suggest that the implant becomes bone. It would REALLY be nice if it did transform itself into natural bone.
Like I said, it's a bit too good to be true. However custom implants with less complications is always good news. What would be the benefits of using this new technique over say silicon anyway?
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well silicone is s**t. i assume this would be like halfway between ha paste and medpor, the advantage here is essentially that the implant could take shape into a mold and would bind or fuse to your bone, your blood cells and stuff would grow into the implant just like they do with medpor. I mean this sounds alright, i'd certainly do it if it was available cause you could at least get a very exact approximation of a true bone graft that was moldable.
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They finally replied to my old email i sent them;
One of the major drawbacks of solid silicon implants are bone erosion and long term risk of inflammation and implant rejection, what kind of improvement could we really expect from CT-Bone regarding this?
Inflammation and rejection is always a risk when implanting something. Even when they use the patients own bone, infection or rejection can happen. CT-Bone is a more bone like material, whereas silicon is really a foreign material, so I guess our odds are better.
How realistic is your early 2016 EU- release? Should we start getting our hopes up just yet?
We are still on schedule for an early 2016 EU-release.
Would these implants be more surgically challenging to place then ordinary silicon implants? If so, will it be problematic to seek out surgeons capable of installing them?
If anything, it should be easier; we make the implants custom-made, so they should fit perfectly on the bone. Silicon implants are never adopted to the shape of the bone by my knowing. Although I can imagine that because silicon is flexible it can be squeezed through a certain incision, whereas CT-Bone is solid and the incision should be large enough. No squeezing possible. Still I think there is a different purpose: CT-Bone aims to create skeletal symmetry, whereas silicon is used more to achieve soft-tissue symmetry. They will probably co-exist.
What price bracket will CT-Bone be located in? New technology is always more expensive, how affordable will CT-bone be compared to custom -made solid silicon implants?
I don’t know yet what custom-silicon implants cost. Ballpark figure: I expect facial CT-Bone implants to be between 4.000 and 10.000 €. Is that affordable in your opinion? Maybe I should ask your audience what they would be willing to pay.
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Nice thanks for the reply. I think 10k euro is fine as long as the results are good and not fake looking.
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I think the real question is what those prices mean. I'm betting that's just the price of the implants themselves, before any surgeons get involved.
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So, calcium phosphate. What's the difference with hydroxyapatite exactly? The implants are pre-shaped, well yes, but why would they be "replaced by bone" as claimed, whereas that is by far not a given when using for example hydroxyapatite? A lot of claims made by the company selling the stuff, hope they can seriously back it up with some proper studies. Me thinks this would be worldwide front page news if they could.
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So, calcium phosphate. What's the difference with hydroxyapatite exactly? The implants are pre-shaped, well yes, but why would they be "replaced by bone" as claimed, whereas that is by far not a given when using for example hydroxyapatite? A lot of claims made by the company selling the stuff, hope they can seriously back it up with some proper studies. Me thinks this would be worldwide front page/Nature.com news if they could.
Osteo:
Your skepticism is well founded. If you read the details in the literature - - the matrix is not replaced by real bone. It does allow some infiltration at the attachment points.
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Osteo:
Your skepticism is well founded. If you read the details in the literature - - the matrix is not replaced by real bone. It does allow some infiltration at the attachment points.
So does HA paste.
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So does HA paste.
Yes... agree. There is supposed to be infiltration at the mating surface.
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newsflash medpor allows extensive blood vessel ingrowth and it stays f**king medpor.
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newsflash medpor allows extensive blood vessel ingrowth and it stays f**king medpor.
Quoted for truth.
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Osteo:
Your skepticism is well founded. If you read the details in the literature - - the matrix is not replaced by real bone. It does allow some infiltration at the attachment points.
I'm not sure what source material you are reading, but if you did a bit more background research you would realise you are wrong. Here is an article about the company that makes CT-Bone, Next 21
http://3dprint.com/37745/bone-and-tissue-bioprinting/ (http://3dprint.com/37745/bone-and-tissue-bioprinting/)
In the article the lead researcher specifically states that this technique is useful to treat children born with deformities. Why would anyone Implant a material that fuses with a childs bone (and therefore cannot be removed) but does not remould as a child grows. Think about it, don't be ignorant.
"Takato is the head of the Division of Tissue Engineering at Tokyo University Hospital and says he believes this technology will also offer hope to children born with bone or cartilage deformities. He says the process of using synthetic implants is currently inadequate as the rate of a child’s growth outstrips the usefulness of the implants over time."
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I'm not sure what source material you are reading, but if you did a bit more background research you would realise you are wrong. Here is an article about the company that makes CT-Bone, Next 21
http://3dprint.com/37745/bone-and-tissue-bioprinting/ (http://3dprint.com/37745/bone-and-tissue-bioprinting/)
In the article the lead researcher specifically states that this technique is useful to treat children born with deformities. Why would anyone Implant a material that fuses with a childs bone (and therefore cannot be removed) but does not remould as a child grows. Think about it, don't be ignorant.
"Takato is the head of the Division of Tissue Engineering at Tokyo University Hospital and says he believes this technology will also offer hope to children born with bone or cartilage deformities. He says the process of using synthetic implants is currently inadequate as the rate of a child’s growth outstrips the usefulness of the implants over time."
What is proposed in the article you point to is, as yet, just a possible/maybe still to be approved project - - which appears to be an interesting further possible advance on the CT Bone Next 21 calcium phosphate process.
But the discussion was about the existing Next 21 calcium phosphate implants - - not some further possible / maybe / sometime development. I think it remains true that the calcium phosphate implants allow infiltration at the attachment surfaces - - but do not grow native bone in the matrix.
But new research may enhance that sometime further down the road with the different biological components (such as stem cells) that are planned to be added to the 3D printing process - - sometime in the future.
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What is proposed in the article you point to is, as yet, just a possible/maybe still to be approved project - - which appears to be an interesting further possible advance on the CT Bone Next 21 calcium phosphate process.
But the discussion was about the existing Next 21 calcium phosphate implants - - not some further possible / maybe / sometime development. I think it remains true that the calcium phosphate implants allow infiltration at the attachment surfaces - - but do not grow native bone in the matrix.
But new research may enhance that sometime further down the road with the different biological components (such as stem cells) that are planned to be added to the 3D printing process - - sometime in the future.
Where are you getting your facts from buddy? Just point me to the literature that is backing up your claims and I will believe you. You stated that somewhere in the small print it said that CT-Bone is non resorbable. Just show me where it says that and set me straight. I want to see it, if it is true. If that claim of yours was made up on the other hand, then back down gracefully, and don't make s**t up in the future.
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Ha paste is widely used for paediatric craniofacial defects.
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Where are you getting your facts from buddy? Just point me to the literature that is backing up your claims and I will believe you. You stated that somewhere in the small print it said that CT-Bone is non resorbable. Just show me where it says that and set me straight. I want to see it, if it is true. If that claim of yours was made up on the other hand, then back down gracefully, and don't make s**t up in the future.
Overbiter,
Your response is pretty hostile in tone. Is that really necessary ?
The problem I have, is what I see in the following:
"The manufacturing of CT-Bone involves printing the designed implant using calcium phosphate, the primary constituent of natural bone. The advantage is that when this is implanted, the patient’s existing bone fuses with it just as it would with natural bone and unifies in a few months. It’s a bone-like implant that allows bone to grow naturally into it.
As Maikel Beerens, CEO at Xilloc, said, “3D Printing of CT-Bone allows us to help even more patients with a tailor-made solution. After taking a CT-scan of the patient, a patient-specific implant is designed by our biomedical engineers in collaboration with the surgeon. This design perfectly fits on the anatomy of the patient, ensuring good bone-to-implant contact and facilitating bony in-growth.” "
That is NOT a direct claim that the calcium phosphate is absorbed. It is not a direct claim that the calcium phosphate is replaced by new bone growth.
The best that can be said is that the CT-bone fits well to the mating surface (due to the digital 3D printing - - not the material ) and that facilitates intimate contact with the bone and that facilitates bony "in-growht".
Nor is that a claim that the calcium phosphate is replaced with natural bone.
Is it possible that at some point that we could have a complete bony infiltration that over time functions like real bone: Meaning that there will be an integral blood supply through a new periosteum layer and there will be internal bone marrow which is making new blood cells and which new bone could repair itself if fractured like natural bone repairs itself ? Yes. I suppose all of that is possible.
But at this point, that is still a long way in the future.
All of that is my opinion, based on my reading of the literature and the basic biology involved.
Regards
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Yeah Bobbit is right.
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Overbiter,
Your response is pretty hostile in tone. Is that really necessary ?
The problem I have, is what I see in the following:
"The manufacturing of CT-Bone involves printing the designed implant using calcium phosphate, the primary constituent of natural bone. The advantage is that when this is implanted, the patient’s existing bone fuses with it just as it would with natural bone and unifies in a few months. It’s a bone-like implant that allows bone to grow naturally into it.
As Maikel Beerens, CEO at Xilloc, said, “3D Printing of CT-Bone allows us to help even more patients with a tailor-made solution. After taking a CT-scan of the patient, a patient-specific implant is designed by our biomedical engineers in collaboration with the surgeon. This design perfectly fits on the anatomy of the patient, ensuring good bone-to-implant contact and facilitating bony in-growth.” "
That is NOT a direct claim that the calcium phosphate is absorbed. It is not a direct claim that the calcium phosphate is replaced by new bone growth.
The best that can be said is that the CT-bone fits well to the mating surface (due to the digital 3D printing - - not the material ) and that facilitates intimate contact with the bone and that facilitates bony "in-growht".
Nor is that a claim that the calcium phosphate is replaced with natural bone.
Is it possible that at some point that we could have a complete bony infiltration that over time functions like real bone: Meaning that there will be an integral blood supply through a new periosteum layer and there will be internal bone marrow which is making new blood cells and which new bone could repair itself if fractured like natural bone repairs itself ? Yes. I suppose all of that is possible.
But at this point, that is still a long way in the future.
All of that is my opinion, based on my reading of the literature and the basic biology involved.
Regards
I'm not hostile. It's just that there are a lot of lookism.net people on this forum making claims, but then not backing them up with evidence. All I'm saying is that CT-Bone as a material is resorbable. Bone cells can colonise its structure and it can eventually become like living bone. If this isn't true, then why would surgeons consider making implants for children out of it?
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I'm not hostile. It's just that there are a lot of lookism.net people on this forum making claims, but then not backing them up with evidence. All I'm saying is that CT-Bone as a material is resorbable. Bone cells can colonise its structure and it can eventually become like living bone. If this isn't true, then why would surgeons consider making implants for children out of it?
This stuff sounds just like HA paste. And doctors do routinely use HA paste in paediatric craniofacial surgery. I've been told by doctors that "it become part of you". How genuine that claim is, I don't know. Fully replaced with your own bone? Or do they make the claim purely off the fact that there is vascularisation and the ingrowth at the boundary between HA paste and your skull? No idea.
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Not all HA is the same. It comes in block or granular form, resorbable and non-resorbable, and in different sizes. Looks like it still needs a few screws to attach it to the skeleton and resorbable sutures. It's pretty good but bony ingrowth is still going to take a few months. What's significant about this product is that it's pretty much at market. However, if you can hold out 3 more years then epibone will be ready with a vascularized graft. We'll have to see in pricing. Hopefully Tetranite will appear about the same time so fixation will disappear too. Allow a few more years for them to refine the technologies and because you don't want to be the first one to have experimental technology in you but yeah in 5-10 years, bony augmentations looks real good!
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This stuff sounds just like HA paste. And doctors do routinely use HA paste in paediatric craniofacial surgery. I've been told by doctors that "it become part of you". How genuine that claim is, I don't know. Fully replaced with your own bone? Or do they make the claim purely off the fact that there is vascularisation and the ingrowth at the boundary between HA paste and your skull? No idea.
I keep telling people this is not HA paste, but what the hell, think what you want. Just don't misinform people.
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However, if you can hold out 3 more years then epibone will be ready with a vascularized graft.
The Epibone product doesn't use 3D printing. They use a graft taken from an animal, then seed it with the patients own cells. The implant is shaped on a machine that looks like a lathe, only it is more primitive. It just chisels the bone, it doesn't turn it. Epibone is in the dark ages compared to a 3D printed custom implant. Anyway the implants that could be fashioned using that technology would be tiny, and hardly worth implanting in my opinion.
Xilloc's implants could be improved by seeding them with stem cells. I'm sure they will do this in future, however they do not need to do this to make their product work. So many people on this forum don't understand how good their technology is, and don't understand the relevance of it. I almost regret starting this thread. It's just pearls before swine.
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I keep telling people this is not HA paste, but what the hell, think what you want. Just don't misinform people.
It's not a paste, but it's still just HA at the end of the day. They are not a "miracle material" company, they are just a 3D printing company. They will print you an implant out of anything you want.
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It's not a paste, but it's still just HA at the end of the day. They are not a "miracle material" company, they are just a 3D printing company. They will print you an implant out of anything you want.
They didn't even invent the material. I never said they did. It was invented by Next21 a Japanese company. Xilloc are not about the material.
HA is in general not resorbable. CT-Bone is resorbable, that is the difference, as I have been trying to point out. Technologically speaking it is pretty miraculous as it is light years ahead of anything that has been used before. Maybe you think a 3D printed CT-Bone implant (which is resorbable) is equivalent to a surgeon spreading crystallised HA paste on someones bones on the operating table, but you are dead wrong. A perfectly shaped implant beats useless HA paste hands down. There is no argument. To try to argue the point is foolish in the extreme.
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If the cost is cheap enough and it is strong enough, I wonder whether it can be used in the osteotomies too? Surgeon designing cuts using 3d planning now anyway, would it be a stretch to ask Xilloc to print structural grafts for these locations too? Then you just need a binder to hold it in place while bone heals.
I agree with @overbiter, a perfectly shaped implant is just a revolution in this domain. There are other companies which do this already, of course, but not with a resorbable scaffold to my knowledge. I get the impression the "perfectly shaped" is still a work in progress, though, given the difficulty with soft tissue modeling.
@overbiter How did you glean that info about epibone? I had trouble finding out much about it. Why do you say "dark ages"? Do you mean in terms of how mature the product is? The big gain I see is that you don't have to wait for bone to form after implantation in the body. That's less time for infection, greater guarantee of resorption, reduced risk of rejection, etc I just don't know how they stimulate the bone segments to grow into each other and wonder how the vascular systems connect. My speculative mental model has always been that blood vessels grow in clots and then bone forms around it. Once the bone is already formed, well I don't see how that works or at least not well. But living bone with cells from your own body seems like a good thing.
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how they put the nerves through those implants ?
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If the cost is cheap enough and it is strong enough, I wonder whether it can be used in the osteotomies too? Surgeon designing cuts using 3d planning now anyway, would it be a stretch to ask Xilloc to print structural grafts for these locations too? Then you just need a binder to hold it in place while bone heals.
Maybe, but I don't think implants would be required for most osteotomies. What surgeons really need is a way to keep the bleeding under control, so that the post surgery hematoma doesn't grow too large. That way the bone callous that forms will be more aesthetically shaped, and patients won't have jawline deformities. Perhaps someone can invent a scaffold to soak up the blood, and that dissolves after a few days. Then the bone can heal in the correct shape.
@overbiter How did you glean that info about epibone? I had trouble finding out much about it. Why do you say "dark ages"? Do you mean in terms of how mature the product is? The big gain I see is that you don't have to wait for bone to form after implantation in the body. That's less time for infection, greater guarantee of resorption, reduced risk of rejection, etc I just don't know how they stimulate the bone segments to grow into each other and wonder how the vascular systems connect. My speculative mental model has always been that blood vessels grow in clots and then bone forms around it. Once the bone is already formed, well I don't see how that works or at least not well. But living bone with cells from your own body seems like a good thing.
I watched the video on their website. It seems like they are just cutting animal bone to make a graft, stripping the animal cells, and then adding stem cells from a patient. This technology is in the dark ages compared to Xilloc because they are basically just carving up tiny pieces of bone, and not creating perfectly shaped implants that can be of any size required. They seem to be many years away from creating anything implantable in a patient. To be honest, I very much doubt whether they will ever produce a commercial product because 3D printed scaffolds seeded with stem cells will be available soon. Epibone will be dead on arrival.
I've alway thought that because the body can remould bones, that new vascular systems can just grow through them as required. I don't have any medical training though, so I have no idea if this is true. It would be interesting to find out from a doctor.
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how they put the nerves through those implants ?
Xilloc create openings in their implants for blood vessels and nerves. The surgeons utilise those spaces.
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Nice thanks for the reply. I think 10k euro is fine as long as the results are good and not fake looking.
Wow you really aren't hurting for money if you consider 10k for a 3D printed calcium block "fine".
10k in total, surgical expenses included would be understandable since it's new tech.
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Wow you really aren't hurting for money if you consider 10k for a 3D printed calcium block "fine".
10k in total, surgical expenses included would be understandable since it's new tech.
It's not just a calcium block. There's a lot of technology and expertise that goes into creating the implants. Xilloc need to make money as well.
It seems like surgery using these implants could be pricey, but if paying more money up front means you get the right result it is worth it imo. Think about all the people who had malar osteotomies and weren't pleased with the results. That is all money down the drain.
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did you ask the company which doctors they are working with on this? if they plan the fda. process for 2016, they will have had to already select 2 accredited us doctors to work with. you can probably get a discount if you sign up now.
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It's not just a calcium block. There's a lot of technology and expertise that goes into creating the implants. Xilloc need to make money as well.
It seems like surgery using these implants could be pricey, but if paying more money up front means you get the right result it is worth it imo. Think about all the people who had malar osteotomies and weren't pleased with the results. That is all money down the drain.
Do you think using CT-bone on the zygomatic bone could give good results seeing how this implant technology supposedly acts with the surrounding tissue? Silicon implants, especially placed on the zygomatic arch looks like s**t which i think is caused by the surrounding muscles and tissue not being able to "settle" with the implant. Thoughts on this?
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Do you think using CT-bone on the zygomatic bone could give good results seeing how this implant technology supposedly acts with the surrounding tissue? Silicon implants, especially placed on the zygomatic arch looks like s**t which i think is caused by the surrounding muscles and tissue not being able to "settle" with the implant. Thoughts on this?
This is what I'd like to know. My choice is between a modified le fort III and some kind of implant.
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Thinking about this logically, osteotomies seem like the best option becaude there is so much going on in the face. First there's bones, arteries, veins, muscle and fascia and layers of the skin. Implanting a foreign substance will usually look worse because it isn't compatible with all these layers. Not to mention developing some auto immune response to a foreign substance. Also how would you facial muscles relact with this stuff in your face? Seems like the lesser option between the two. Even with the limits of bone movements. Unless you have some huge deficiency then I guess implants are the best choice.
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Thinking about this logically, osteotomies seem like the best option becaude there is so much going on in the face. First there's bones, arteries, veins, muscle and fascia and layers of the skin. Implanting a foreign substance will usually look worse because it isn't compatible with all these layers. Not to mention developing some auto immune response to a foreign substance. Also how would you facial muscles relact with this stuff in your face? Seems like the lesser option between the two. Even with the limits of bone movements. Unless you have some huge deficiency then I guess implants are the best choice.
The claim of CT bone is that it's replaced by natural bone overtime. If that's true then it should be better than an osteotomy.
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The claim of CT bone is that it's replaced by natural bone overtime. If that's true then it should be better than an osteotomy.
Finally, someone understands. Thank you.
No osteotomy can mimic an implant like this, because of the inherent problems associated with just cutting and moving bone. A 3D printed implant is perfectly shaped to achieve the most aesthetic result. Moving bone around is primitive compared to this technique.
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Yes CT bone seems like the future but say you problem is malar zygomatic area. Where you master muscles attach. How would you implant cone there? On top of the muscle? Underneath? I don't really understand this part.
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just curious, can this CT bone implant be used to augment the brow bone and orbital rims? I have terrible bug eyes that I need to fix.
Yes but I personally think a modified Lefort iii like earl had done provides a much more natural result. I am in the process of researching how I can improve the area around my eyes as well, my orbitals and cheeks are quite weak unfortunately.
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why is lefort 3 more natural if the article claims that this implant is converted to bone after time? won't that make this result just as natural?
lefort 3 is scary and I would like to avoid it all costs
I meant that the result looks more natural but since it is your bone rather than a foreign object I'd say it also holds true in a more general sense as well.
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Finally, someone understands. Thank you.
No osteotomy can mimic an implant like this, because of the inherent problems associated with just cutting and moving bone. A 3D printed implant is perfectly shaped to achieve the most aesthetic result. Moving bone around is primitive compared to this technique.
Here's a revoltuionary idea since you guys are already now projecting surgery results based on this. How about actually contacting the company and reporting back about when this purported technology will be available, which surgeons use it and how realistic it is in achieving the results we want. Overbiter, since you're it's main proponent I nominate you. I find all this discussion just in the realm of science fiction right now, since from I can see, the tech isn't even available yet.
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Here's a revoltuionary idea since you guys are already now projecting surgery results based on this. How about actually contacting the company and reporting back about when this purported technology will be available, which surgeons use it and how realistic it is in achieving the results we want. Overbiter, since you're it's main proponent I nominate you. I find all this discussion just in the realm of science fiction right now, since from I can see, the tech isn't even available yet.
The implants aren't available yet, but they will be in 2016. Someone on this thread already got a reply from them about that. I've emailed them with some more questions. Hopefully they will message me back. If they do I'll post the replies here.
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Such an interesting thread, thank you for starting it.
For the sake of information, here's the link to the european company website
http://www.xilloc.com/ct-bone/
and a synthetic article about it
http://3dprintingindustry.com/2015/05/18/move-over-titanium-3d-printed-bone-implants-are-here/
Even more interesting is their policy directed towards patients directly rather than just surgeons and hospitals, but I guess it has to do with the whole 3-D custom design thing.
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In my research, there are many disadvantages to modified LeFort 3 which is why it's done so infrequently. Requires a separate surgery, limits to movements, difficulty predicting movements, visibility and migration of hardware over time, general surgical risk, incomplete ossification, fistulas, ridges and unnatural contour. The main reason the industry moved to augmentations is that the results are better. Augmentations, of course, suck. CT-bone looks considerably better but, still, I'd wait until you're older just so you can at least offset some age related changes. Plus, gives technology time to mature.
However, it's unclear to me if this product is replaced by bone. If the scaffold remains in place, then it's possible for it to separate later with facial bone changes and that's not good. There's screws too, of course, maybe those can be biodegradable. Overall, it looks very promising though.
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I sent them a question and asked if it can be used for cosmetic augmentation, this is reply:
"We do make custom facial augmentation implants, but only for reconstruction after trauma or surgery, i.e. when there is a medical need.
Unfortunately we don't make augmentation implants purely for cosmetic reasons.
Kind regards,
Erik
Erik Boelen, MSc, PhD
Chief Operations Officer"
:(
this have to be in regards to current implants made of titanium or PEEK because the same guy wrote me this:
"Actually, the main indication for CT-Bone is cosmetic; it is aimed at augmenting non load-bearing facial skeletal structures, like augmentation of the mandible and the zygoma." refering to my question if it would be available for purely cosmetic purposes
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That's pretty f**ked up you guys got two contradicting responses from that dude!??
Anyway, you need to ask the company which doctors they've partnered with using these implants for cosmetic usages. Or it's just not actually available yet. Is it being used in clinical practice and which doctors are using it?
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Erik Boelen seems to be full off s**t, he recommended me a PEEK implant for cosmetic augmentation (PEEK is s**t btw).
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Erik Boelen seems to be full off s**t, he recommended me a PEEK implant for cosmetic augmentation (PEEK is s**t btw).
How so?
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Just sent a new email and keep you updated
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Reconstructive purposes
Surgery to fill or cover a skeletal defect, either traumatic, congenital or idiopathic. Commonly out of “medical neccessity”.
Aesthetic purposes
Surgery to enhance the physical appearance of a patient. Can be either reconstructive (neccessity) or cosmetic (patient’s choice).
Directly quoting their website (from the "indication" section) , guess it's pretty much self explanatory...
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I sent them a question and asked if it can be used for cosmetic augmentation, this is reply:
"We do make custom facial augmentation implants, but only for reconstruction after trauma or surgery, i.e. when there is a medical need.
Unfortunately we don't make augmentation implants purely for cosmetic reasons.
Kind regards,
Erik
Well then I fit the bill for custom implants because after Lazlo analyzed my pictures and told me how much s**t I am lacking I was pretty damn "TRAUMATIZED" and in need of "reconstruction". Im so ugly that its depressing which is also a medical condition. Where do I sign up for these "medically needed" implants????????
Erik Boelen, MSc, PhD
Chief Operations Officer"
:(
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Sounds like it's just bulls**t.
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ugly mofo (sure you're being harsh on yourself,but whatever), maybe he was referring to "extensive facial implants", saying it would be tricky to do it for cosmetic purpose, but maybe for smaller areas, such as jaw angles or chin, it would be ok...don't know actually
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It seems like maybe they are only offering this procedure to patients with trauma or congenital defects at the moment. They've changed their information a bit on this link http://www.xilloc.com/ct-bone/ (http://www.xilloc.com/ct-bone/).
They are saying this now "Patients requiring skeletal augmentation, for example those with facial asymmetry resulting from either trauma or congenital defects, would be helped best with a bony implant made to match their anatomy". I don't see what their problem is. What difference does it make if someone is ugly because of a congenital defect, or because they just have weak bone structure? Why do they have to be so sniffy and decide whether someone is really ugly enough to warrant this surgery? I think they are ignoring a huge market if they go down this route.
On another note, the link above proves what I have been saying all along. CT-Bone does fuse with a patients bone and become like real bone. Click the "Comparison: Hydroxyapatite vs CT-Bone" hypertext link and see this.
"Further histological investigations showed that in the hydroxyapatite, bone-like tissue was only found in some micropores close to the surface. In CT-Bone®, large bone-like tissues penetrated into the macropores, containing activated osteoclasts, fibroblasts and even blood vessels. In addition, bone marrow formation was observed containing erythroblasts and megakaryocytes."
24 weeks post-op
(http://www.xilloc.com/wp-content/uploads/2015/05/HA-vs-CT-Bone-postop-24w.jpg)
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okay, f**kin'A!!!!
Now we're getting somewhere. So next one of you needs to ask them which surgeon they've worked with for "congenital defects" which basically f**king means ugly okay?
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Porous ha blocks have been around for at least 25 years. The big difference here is these are 3d printed.
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It seems like maybe they are only offering this procedure to patients with trauma or congenital defects at the moment. They've changed their information a bit on this link http://www.xilloc.com/ct-bone/ (http://www.xilloc.com/ct-bone/).
They are saying this now "Patients requiring skeletal augmentation, for example those with facial asymmetry resulting from either trauma or congenital defects, would be helped best with a bony implant made to match their anatomy". I don't see what their problem is. What difference does it make if someone is ugly because of a congenital defect, or because they just have weak bone structure? Why do they have to be so sniffy and decide whether someone is really ugly enough to warrant this surgery? I think they are ignoring a huge market if they go down this route.
On another note, the link above proves what I have been saying all along. CT-Bone does fuse with a patients bone and become like real bone. Click the "Comparison: Hydroxyapatite vs CT-Bone" hypertext link and see this.
"Further histological investigations showed that in the hydroxyapatite, bone-like tissue was only found in some micropores close to the surface. In CT-Bone®, large bone-like tissues penetrated into the macropores, containing activated osteoclasts, fibroblasts and even blood vessels. In addition, bone marrow formation was observed containing erythroblasts and megakaryocytes."
Now that's just mean or something, why would they do that?
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Porous ha blocks have been around for at least 25 years. The big difference here is these are 3d printed.
When they 3D print is it possible to have it so the outerpart is following the natural contours of hte pre-existing bone, so that really it's exactly like an osteotomy? Basically to be like an extension of existing bone.
Perhaps that seems dumb, however most implants I see are completely smooth and create weird, unnatural results.
My other concern would be how precision this can be with regard to predicting the necessary implant relative to soft-tissue movements. Whereas an osteotomy has the surgeon there able to precisely judge the movements and whether there ought to be an impromptu additional mm here or there.
P.S. Here is something I was sent by them. Honestly, it's concerning as f**k that THREE YEARS POST-OP the soft-tissue and implant are still changing. Is this s**t ever stable?
(http://i.imgur.com/ZCRZ8nW.png)
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^
looks impressive to me, soft tissue seems to be slowly but continuously improving in symmetry, meaning the implant really interact with the soft tissue and does what it's intended to do. Must be impossible to remove though
seeing how good your communication with them is, could you get them to confirm if this is gonna be available for pure cosmetic purposes or not?
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When they 3D print is it possible to have it so the outerpart is following the natural contours of hte pre-existing bone, so that really it's exactly like an osteotomy? Basically to be like an extension of existing bone.
Perhaps that seems dumb, however most implants I see are completely smooth and create weird, unnatural results.
My other concern would be how precision this can be with regard to predicting the necessary implant relative to soft-tissue movements. Whereas an osteotomy has the surgeon there able to precisely judge the movements and whether there ought to be an impromptu additional mm here or there.
P.S. Here is something I was sent by them. Honestly, it's concerning as f**k that THREE YEARS POST-OP the soft-tissue and implant are still changing. Is this s**t ever stable?
(http://i.imgur.com/ZCRZ8nW.png)
The pictures are a bit artifactual. The contrast has been "turned up" before the last image was included in the set of images. And notice the very careful choice of words - - it doesn't say the implant is replaced by new bone. Only that the implant "unifies" with the old bone. That happens at the boundary between the new implant and the native bone.
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The pictures are a bit artifactual. The contrast has been "turned up" before the last image was included in the set of images. And notice the very careful choice of words - - it doesn't say the implant is replaced by new bone. Only that the implant "unifies" with the old bone. That happens at the boundary between the new implant and the native bone.
totally, these pics are bulls**t, see the shot scale is different in each one.
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How good would the results be if CT bone was used to augment the brow ridge and lateral orbital rims? If its like an osteotomy then this might be the best thing since sliced bread. Hope for better eye structure?
yeah cause like anyone here could answer that question! ::)
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haha true.
idk I just f**king want better eyes already!! :( :(
me too bud, I have similar problems.
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Any guesses what happens to this thing with facial decline? Face skeleton doesn't change quickly but it does change and substantially over time. I predict losses of contact with protrusions. For that matter, the way bone replaces itself I still think the implant could migrate. Then there's the general issues of HA becoming infected or causing a foreign body reaction. There's sadly no substitute for good as new :(
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I think every maxfax will be able to order this, they just won't sell to plastic surgeons
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I think every maxfax will be able to order this, they just won't sell to plastic surgeons
Why would they not sell to plastic surgeons ?
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Somehow I'm still skeptical.
I believe that the muscles which stretch the face from cheekbone to mouth, and cheekbone to jaw are attached to the actual cheekbones. Moving the bone in an osteotomy changes the shape of the actual muscle and how it holds the soft tissue on the face. OTOH, it seems like the only these implants or any others would do is augment the bone but leave the muscles and their points of attachment where they are, possibly resulting in sub-par results in terms of soft tissue position, which is very important in terms of facial contour.
I don't quite have a complete working knowledge of this, so please correct me if I'm wrong.
Here's a pic to show what I mean:
one reason why implants will never work.
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Has anyone emailed dr yaremchuck on his opinion of these implants and if he plans on using them
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Has anyone emailed dr yaremchuck on his opinion of these implants and if he plans on using them
why would you care? aren't you done with midface?
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Why would they not sell to plastic surgeons ?
Because they say they will not
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i emailed dr. y. he thinks they will be brittle and wont turn into bone
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i emailed dr. y. he thinks they will be brittle and wont turn into bone
Lol me too, he answered yesterday. Probably saw both of us asking the same thing.
I got a reply from company:
Currently we are working to prepare and set-up our CT-Bone production facility. Somehow these things always take longer than expected, so I hope we can start producing CT- Bone implants in Q2.
CT-Bone is indicated for use as a bone augmentation implant; to augment a patient's bone structure in order to achieve symmetry on a skeletal level. This should not be confused with soft-tissue cosmetic implants, which are used to augment soft-tissues.
Our initial focus will be on CMF surgeons, but indeed there is a lot of interest coming also from plastic, orthopedic and neuro-surgeons.
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Update.
The company Xilloc is having problems getting the production of the implants ready. Apparently they need additional machinery and set up cleanroom production. As of today they don't have the economical means to sort it out, so they're planning for a crowfounding campaign in hopes of being able to launch CT-BONE. Their chief operation officer fears it will take a bit longer then 2016. Price range for CT-BONE implants are still estimated between 4,000-8,000 EUR.
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Thanks a lot for this update, I was wondering what happened
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Seems like the company have added more info on their website:
A pre-clinical study clearly shows the difference between an implant from Hydroxyapatite and an implant from CT-Bone. The CT-Bone implant really fuses with the original bone. Clinical studies confirm excellent bony fusion (results available upon request).
Further histological investigations showed that in the hydroxyapatite, bone-like tissue was only found in some micropores close to the surface. In CT-Bone, large bone-like tissues penetrated into the macropores, containing activated osteoclasts, fibroblasts and even blood vessels. In addition, bone marrow formation was observed containing erythroblasts and megakaryocytes.
(http://www.xilloc.com/wp-content/uploads/2015/05/HA-vs-CT-Bone-postop.jpg)
Post-op (Hydroxyapatite left, CT-bone right).
(http://www.xilloc.com/wp-content/uploads/2015/05/HA-vs-CT-Bone-postop-24w.jpg)
24 weeks post-op.
Regarding implant resorption:
CT-Bone is biodegradable by the patient’s osteoclasts and after 3 months CT-Bone will be fused with the patient’s bone and will remodel in the osteo-cycle. CT-Bone does not loose shape/volume over time and therefore should not be confused with a bioresorbable material that will be resorption over time.
(http://www.xilloc.com/wp-content/uploads/2015/05/CT-Bone-volume-768x498.png)
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I emailed the founder who had communicated with me previously about what happens if you were hit or somehow the implant cracked or broke? Would you need a new operation or would it heal like natural bone? He never replied.
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I emailed the founder who had communicated with me previously about what happens if you were hit or somehow the implant cracked or broke? Would you need a new operation or would it heal like natural bone? He never replied.
Good question!!!
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He never replied.
Because it would (maybe) get infected.
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I emailed the founder who had communicated with me previously about what happens if you were hit or somehow the implant cracked or broke? Would you need a new operation or would it heal like natural bone? He never replied.
Maybe they're too busy replying?
Due to overwhelming interest in CT-Bone, we are unfortunately unable to answer everybody personally. However if you contact us we will add you to our mailing list and you will receive email updates about the availability of CT-Bone.
Or maybe they don't want to admit what that one study discovered? f**k knows.
Either way, that's not a deal breaker for me, the implant is the closest thing to real bone we're going to get for a long time so i'm ready to compromise.
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boyo, I am at that point already kinda too so I empathize.
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What's described is pretty incredible. Based on that, well it depends on how long you've had the implant. If it hadn't had time to fully integrate, then you'd probably have a dislodged foreign body that never resorbs. It might need to be surgically removed. They're claiming that it fully converts into bone, though unclear whether it will look the same on both sides when that happens. Definitely worth keeping an eye on!
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Any updates on this?
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Any updates on this?
Nope just forget about it. It's just a brittle HA concept and it just crumbles and can get seriously f**ked up as an onlay graft. We already have ha blocks for interbone positions. This has no aesthetic advantage. And we're no where close to printing real bone. Check back in 10 years.
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Nope just forget about it. It's just a brittle HA concept and it just crumbles and can get seriously f**ked up as an onlay graft. We already have ha blocks for interbone positions. This has no aesthetic advantage. And we're no where close to printing real bone. Check back in 10 years.
Israel has regrown partial bone successfully in a patient, but no word on applying that for cosmetic purposes:
https://www.calcalistech.com/ctech/articles/0,7340,L-3727870,00.html
Two weeks ago, Bonus announced the successful injection of its bone graft in the jawbones of 11 people, in a separate clinical trial that started September 2016. Over several months, the graft created new bone growth in all eleven participants.
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As cool as that sounds, I'm not optimistic that it'd help us. It's one thing to replace missing bone through injections like that in a bony gap, where there's (presumably cancellous) bone on several sides from prior injury and another to try and augment the same way on top of corticol bone. You never know though. I guess a lot of injections and you could get a small amount of volume added. Too much and the soft tissue envelope becomes a problem since it's attached to the existing bone.
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IDK. Keep in mind they are using the stem cells found in fat to seed a bony type scaffold on to which to grow the bone and then they need to put it in a bio-reactor to mimic the bio-dynamics within the body. As I see it, the take home message is that there is a likelihood that getting fat grafts will have some stem cells in them to jump start a process of some of them turning into bone.
So that or implants where the bone cells grow into the pores.
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Did you change your username? Well, let's hope you are right! A friend of mine recently had a piece of his femur rebuilt that way. It's all infected now but I think it'll clear up and look good in the end. They also added bone marrow aspirate.
I didn't see anything about the bioreactor. What's that for? I thought it's just to mimic the conditions in the body.
These days my bags don't bother me too much. My thinning hair bothers me more. How have we not solved this problem yet??
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Check out my old thread!
http://jawsurgeryforums.com/index.php?topic=6395.msg53116#msg53116
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Did you change your username?
What was his username before?
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I won't say the username here but I note his title is "global moderator" and there's only one that I know of here.
Didn't see that link before. Thanks for reminding me! Yes it looks more promising now. We need a way to separate the soft tissue from the bone still though. I guess it should be as effective as fillers but I think there's only a few pockets where they put them now. I don't know that much about them tbh.
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Did you change your username? Well, let's hope you are right! A friend of mine recently had a piece of his femur rebuilt that way. It's all infected now but I think it'll clear up and look good in the end. They also added bone marrow aspirate.
I didn't see anything about the bioreactor. What's that for? I thought it's just to mimic the conditions in the body.
These days my bags don't bother me too much. My thinning hair bothers me more. How have we not solved this problem yet??
No change from start point. I assist GJ. Bioreactor was reference to another thread about generating bone from fat stem cells. If your generating bone from stem cells in VITRO, a bioreactor is needed. Yes. To mimic conditions in the body.
ETA: Moderator function differs from Administration.