Page 196 - Clinical relevance of current materials for cranial implants
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Chapter 10
On the other hand, a CT follow-up protocol for autologous bone might be considered for the follow-up of the bone integrity and surveillance of early signs of resorption and loss of the protective function of the reconstruction. If resorption is detected the patient may be encouraged to wear protection or an alloplastic cranioplasty might be considered.
Materials for cranioplasties
A wide range of materials for cranioplasty with different advantages and disadvantages exists3 (Table 1). No gold standard is available for the reconstruction material. The optimal reconstruction material may vary, depending on the patient characteristics and various clinical settings.
With the current evidence, autologous bone for cranial reconstructions may be abolished for various reasons, but mainly because of its high resorption rate3. In chapter 3 we found a resorption rate of 9.1%. This number is based on the cranioplasties that were removed due to complaints of resorption (e.g. pain, cosmesis or a palpable defect). A prerequisite for autologous bone preservation is an adequate and regulated bone bank. The increased demands for quality control and the novel regulations for bone banks in hospitals hamper the application of autologous bone for cranial reconstructions in many institutes and countries. The increased expertise and evolution of 3D virtual planning software and additive manufacturing (CAD/ CAM) techniques allows the surgeon to choose for alloplastic cranial implants as a good alternative. This is especially the case in economically developed countries. On the other hand, hospitals need the equipment and expertise in terms of 3D planning software, 3D printers or CAD/CAM machines. Apart from these factors, the surgical team needs experience with the implantation of alloplastic materials and enough financial resources should be available to design and manufacture an alloplastic cranioplasty. In countries where a virtual planned and printed cranioplasty is not an option, autologous bone may be the best option for reconstruction, at least in order to protect the brain initially. For this purpose the autologous bone should be stored in a freezer or in an abdominal pocket.
Most frequently used alloplastic materials for cranioplasties are PMMA, titanium, hydroxyapatite and PEEK. Each material has its own specific characteristics (Table 1).




























































































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