Abstract:In Ecuador, intraoperative fabrication of polymethylmethacrylate (PMMA) craniofacial-implants is the norm when small sizes and simple geometry implants are required; this method has high infection risk, is inaccurate and unaesthetic. In this work we present a process for preoperative fabrication of craniofacial-implants using PMMA. For this study, a tomographic image of the head of a subject with a parietotemporal defect was used, the defect was then reconstructed using Blender® and Autodesk-Inventor® to generate a model of the implant. A 3D-printed model was used to fabricate a silicon-rubber mold; finally the implant was produced by casting. PMMA was also altered with Hy-droxyapatite/Carboxymethyl-cellulose (Hap/CMC) in order to im-prove its bioactivity. VERO-cells were then used to test proliferation and adhesion on different combinations of PMMA/Hap/CMC. Results showed that probes altered with 5%-Vol Hap and 10%-Vol CMC had significantly better cell-growth when compared to unal-tered-PMMA (Tukey HSD); in contrast, materials altered solely with carboxymethylcellulose showed cell-growth inhibitions/death. Overall, this manufacture approach showed highly aesthetic and functional outcomes when the final implant was compared against the 3D-printed skull defect, which renders this method as a viable option for the fabrication of PMMA implants meant to replace missing bone-flaps. Likewise, in vitro tests with Vero-cells suggest an improvement of implant-bioactivity with the addition of 5%-Vol hydroxyapatite and 10%-Vol CMC. |