Biomedical Engineering Reference
In-Depth Information
2
Biomaterials and Epithesis,
Our Experience in Maxillo Facial Surgery
G. Fini, L.M. Moricca, A. Leonardi,
S. Buonaccorsi and V. Pellacchia
La Sapienza/ Roma
Italy
1. Introduction
Maxillofacial prosthetics is considered in literature as ''... the art and science of anatomic,
functional and cosmetic reconstruction, by the use of non-living substitutes, of those regions
in the maxillae, mandible and face that are missing or defective...” 1. In the maxillofacial
surgery where malformative, oncologic traumatologic pathology and the plastic surgery are
treated, the maxillofacial prostheses, in selected cases, can reach a satisfactory therapeutic
result from functional, aesthetic, psychologic, and social point of views. In a delicate district,
such as the face, where a heavy deficit can determine huge psychologic and social problems,
the conventional reconstructive surgery intervenes with reconstructive techniques and with
the biomaterials insertion, often insufficient to guarantee the restoration of the harmony of
the face. When these conditions are verified, the solution resides in the osteointegration
concept and in the application of the epithesis. There are certainly some limits of application
of these prostheses, first, the ethics limits: the epithesis constitute in fact an alternative only
when the conventional reconstructive surgery cannot be applied, but inside these limits, it is
really possible to find an excellent therapeutic resource in patients who cannot undergo
surgical interventions. In literature, it is possible to find different kinds of reconstruction of
missing body parts by the application of prothesis2.The osteointegration concept was
introduced at first time by Professor Branemark in 1960 to describe the ''direct structural
and functional connection between living bone and the surface of a plant exposed to load,
understood as a not static but dynamic process3. According to his school of thought, the
technique of positioning of the implant is fundamental, to take place in the most complete
precision and to allow the initial stability of one's self. Other elements conditioning the
success of the osteointegration are the material of the implant, the form, the areas of the
application, and the patient's clinical conditions. The first titanium osteointegration implant
was positioned in 1965 in the jaw without dental elements 4;in 1977, implants were
positioned in mastoid areas for the application of an acoustic translator. In 1979,implants for
the fixation of epithesis of ears, noses, and eyes were positioned. At present, the indication
to the position of epithesis as the first choice of treatment is when the conventional
reconstructive interventions turn out to be inapplicable or ineffective. The epithesis is a
good resolution for the patient because it is not traumatic and has short-time result,
removing every psychologic physique obstacle for the inclusion in a normal social life.
