Why do most implant results suck?

[Lord-of-the-Cartilage]

Medpor implants are meant to be carved unless you're talking strictly customs. Dr's like medpor because of the (scar??) tissue ingrowth, less chance of rotation or movement long term, can be shaped during surgery, and (falsely) it doesn't cause bone resorption or have a significantly lower infection rate vs silicone.

Interesting, I meant that they must see an advantage of using PEEK over medpor. I don't know anything about PEEK apart from the fact that it also causes resorption of the underlying bone.

[Lestat]

Interesting, I meant that they must see an advantage of using PEEK over medpor. I don't know anything about PEEK apart from the fact that it also causes resorption of the underlying bone.

Maybe because Peek can be 3d printed. 3d printing is the future.

"In our article, we described a series of patients whose reconstruction included the use of PEEK PSIs. After a follow-up period of 16 to 20 months, none of the patients experienced implant-related complications such as infection, extrusion, or malposition, while all improved with respect to aesthetics or function."

- Nice result btw:

http://medcad.net/wp-content/uploads/2015/07/PEEK_case_study.pdf



https://cmf.stryker.com/products/peek-customized-implant

http://www.mkprecision.com/why-peek-implants/

[Lord-of-the-Cartilage]

Maybe because Peek can be 3d printed. 3d printing is the future.

Ah yes that must be it, the only problem with 3D printing is that when the surgeon puts the implant in they may think that the amount of augmentation was misjudged, I mean what looked good on the computer didn't turn out to be enough to normalize the defect or desired result.

[Lefortitude]

Medpor implants are meant to be carved unless you're talking strictly customs. Dr's like medpor because of the (scar??) tissue ingrowth, less chance of rotation or movement long term, can be shaped during surgery, and (falsely) it doesn't cause bone resorption or have a significantly lower infection rate vs silicone.

Recent reports have shown that the bone resorption observed in the past were caused by surgeons who used the fiberous ingrowth or musculature (i.e masseter muscle) to hold the implant in place (as opposed to screwing them in).  As such, micro movements from facial animation over time lead to friction between the surface of the implant and the bone, causing the resorption cited in previous literature. 

Surgeons who are prudent nowadays with medpor implants always use titanium screws, and have reported that bone resorption is no longer an issue

ALSO @Lestat that PEEK result is amazing, but the sample size is quite small.  i worry that since it hasnt been observed long term on a large scale that we dont really know as much as we do about medpor or silastic which have been used for decades

i could be wrong, ofcorse

[Lestat]

Recent reports have shown that the bone resorption observed in the past were caused by surgeons who used the fiberous ingrowth or musculature (i.e masseter muscle) to hold the implant in place (as opposed to screwing them in).  As such, micro movements from facial animation over time lead to friction between the surface of the implant and the bone, causing the resorption cited in previous literature. 

Surgeons who are prudent nowadays with medpor implants always use titanium screws, and have reported that bone resorption is no longer an issue

+1

(A world class surgeon confirmed me that in a personal consultation).

[ppsk]

It can only boil down to the shape and material, silicone will always look like putty, medpore gives great results if the shape is right. I have never seen PEEK but I know that is what Zurich University uses now, they previously used medpor so they must see some advantage to it.

you mentioned university, something I do not understand as ive encountered quite a few maxfacs with excellent CVs who are now staffed at universities.... do universities take on elective/private patients? or are they only doing studies?

[Lord-of-the-Cartilage]

you mentioned university, something I do not understand as ive encountered quite a few maxfacs with excellent CVs who are now staffed at universities.... do universities take on elective/private patients? or are they only doing studies?

I was told that in Zurich university you can go as a private patient for facial implants, but I've never asked the university myself so can't confirm if that is true.

[Lefortitude]

You do realise those are essentially similar figures to silicone infection rates? (1-3% from memory)

It also depends where the implant is positioned; the closer to the sinus cavities the greater the chance of infection (~10% from memory)

Infection rates shouldn't be a deciding factor between the two, it's so close. They are both low single digit percentages for most cases.

That's not true. There are three components to the bone resorption issue:

1. Implant not being held sufficiently in place
2. Implant not exactly matching anterior surface of bone contour
3. Biological response to foreign body being pressed against bone in combination with facial musculature

So even if you had an implant held in place with loads of screws (1) and it was 3D printed to exactly match (2), you could still have (3). Eppley states (3) happens regardless of screws or not.

Thanks for the information! From my understanding the medpor implants are heated during the surgery, causing them to become malleable after which they are pressed against the bone such that they form to the anterior contour.

Most importantly i think is the vascularization and ingrowth into medpor implants.  This is because during the dissection, surgeons scrape the bone surface clear of the overlying soft tissue.  this soft tissue is responsible for bringing bloodflow to the bone surface, without which, resorption is more likely to occur.  This is usually only an issue in older patients and patients who have had say multiple osteotomies like ZSO or chin wing or had several revisions to their implant where the soft tissue is repeatedly being dissected, resulting in scar tissue with impaired vascular capabilities. 

[Lord-of-the-Cartilage]

It also depends where the implant is positioned; the closer to the sinus cavities the greater the chance of infection (~10% from memory)

Great I have a damn medpor implant on my nose bridge, I will probably go to someone to replace it with cartilage.

I am the Lord of the cartilage said he.

[Lestat]

I am the Lord of the cartilage said he.

Hi! Who are you? The Lord of cartilage? I am Lestat! I have never seen you before, you seem to be an old member!

I would not use cartilage. I think the risk of resorption is very high.

[Lord-of-the-Cartilage]

Noo Lestat it's MrFox I just changed my screen name from Tightrope to this, yes I hate that cartilage resorbs.

[Lestat]

Noo Lestat it's MrFox I just changed my screen name from Tightrope to this, yes I hate that cartilage resorbs.

Yes OF COURSE I knew but you are not really Mr.Fox.  I wish he could return, he is my friend!

[Lord-of-the-Cartilage]

Yeah I know, MrFox is nice, I don't like Lord of the Cartilage... he keeps telling me to get more cartilage. 

[Lestat]

Tell him my life would be perfect if cartilage would not resorb!

[Lord-of-the-Cartilage]

Tell him my life would be perfect if cartilage would not resorb!

Same, have you noticed any resorption? I am sure mine have shrunk to some degree.
One night I had to sleep on this stupid concrete thing and lay on the side of my face and now that cheekbone looks less good I think.

What do you think is the best implant material that is available at the moment?