INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.com
BIOMATERIALS

A substance, synthetic or natural in origin used for or suitable to use in
prostheses that come into contact...
CLASSIFICATION OF BIOMATERIALS

Autograft
Allograft
Xenograft
Alloplast

www.indiandentalacademy.com
Biological tissue implants

“Everything old is new again” rings true in the use
of biological implants in facial plastic a...
TYPES
BONE

DERMIS AND DERMAL FAT

CARTILAGE

www.indiandentalacademy.com
CARTILAGE

Most commonly used for nasal augmentation
Source for orbital reconstruction are cartilagenous nasal septum and ...
Infection and resorption of autogenous cartilage is rare
They are too flexible and do not provide adequate support for orb...
BONE

Used for mandibular reconstruction,repair of traumatic midface
defects,orthognathic and craniofacial surgery
Iliac c...
Advantages of autogenous bone are relative resistance to infection,lack of host response against
graft and lack of concern...
Endochondral – 75%
Membraneous -20%
Cortical maintain volume better than cancellous
Primary choice – calvarial bone

Princ...
www.indiandentalacademy.com
DERMAL FAT
When defects are subcutaneous

Dermal fat grafts used in mandibular ankylosis,intraoral and pharyngeal cavity
r...
What is biocompatibility?

www.indiandentalacademy.com
Causing a harmful tissue reaction like pain, swelling, necrosis that could compromise function.
Causing a systemic toxic r...
Ideal properties for generic biomaterial
Potter and ellis.biomaterials-joms-2004

Chemically inert
Biocompatible
Nonallerg...
Healing response to most biomaterials is the formation of fibroconnective tissue
scar or fibrous encapsulation

Exception!...
FACTORS LEADING TO FAILURE OF BIOMATERIALS

host

F
A
I
L
U
R
E

chemical

mechanical

Potter and ellis biomaterials for o...
Principles of alloplastic material selection and surgical placement

Tissue quality of recepient site
Emphasis on vascular...
www.indiandentalacademy.com
Alloplastic implant types

Dimethylsiloxane
Polytetrafluoroethylene
Polyethylene
Polyamides and acrylic
Titanium and gold ...
Dimethylsiloxane

Polymer from interlinking of silicon and oxygen with methyl groups
Resistant to degradation due to si-o2...
Silicone (silastic) implants for a wide variety of facial contouring procedures

www.indiandentalacademy.com
polyamides

Organopolymersderivatives of nylon
Known clinically as mesh material( supramid)
Used for orbital reconstructio...
METALS

Biocompatibility depends on surface properties and corrosion
After implantation an oxide layer quickly forms on th...
Used for skull reconstruction,repair and reconstruction of facial and skeletal injuries and
as an adjunct to oral and cran...
Vitallium fossa implant used as TMJ prosthesis which are secured to articular eminence and
lateral border of zygomatic arc...
Christensen condylar prosthesis

www.indiandentalacademy.com
Vitallium glenoid fossa implant

www.indiandentalacademy.com
Titanium

Available as pure or alloy with small amount of other metals like 6% aluminium and 4% vanadium
Highly resistant ...
Endosseous implant placed in mastoid for retension of ear prosthesis

www.indiandentalacademy.com
Acute internal orbital injury reconstruction can bo done with
precontoured titanium mesh, which is stiff enough to provide...
www.indiandentalacademy.com
Mandibular reconstruction using titanium functionally dynamic
Bridging plate system: A retrospective study of 34 cases

A ...
Unique role of osseointegration
Prosthetic reconstruction of edenjulous mandible and maxilla and single tooth
replacement,...
Comparison of custom orbital floor titanium mesh with autologous bone grafts
retained with screw fixation reported no comp...
Calcium phosphate

Capable of osteoconduction
Commercially available as hydroxyapatite
Ceramic hydroxyapetite made from cr...
Liquid and powder composite used to reconstruct traumatic frontal bone
www.indiandentalacademy.com
Porous hydroxyapatite outer defect of calvarium

Granules for partial thickness cranial
defect

www.indiandentalacademy.co...
Highly compatible ,minimal inflammatory reaction,strong mechanical bond and allows
ingrowth of host tissue providing a sca...
polytetrafluoroethylene

It is a very biocompatible group of carbon based biomaterials.
Bonding of highly reactive fluorin...
Implants as strands and cords for subdermal implantation

www.indiandentalacademy.com
Advanta ePTFE facial implants in cosmetic facial surgery

Expanded polytetrafluoroethylene implants can be used to augment...
Tendon passer through middle of upper lip

www.indiandentalacademy.com
Measurement of implant length
Plane of implant placement for facial tissues

www.indiandentalacademy.com
Passing awl in the subdermal plane to pull ePTFE implant through the incision

www.indiandentalacademy.com
www.indiandentalacademy.com
polyethylene

Differentiates from PTFE by a lack of fluorination of ethylene monomer
Comercially available as low,high and...
HDPE IS USED FOR SECONDARY RECONSTRUCTION OF INTERNAL
ORBITAL DEFECTS OR THE CORRECTION OF ENOPHTHALMOUS

www.indiandental...
polyethylene

www.indiandentalacademy.com
Use of temporal polyethylene implant after temporalis myofascial flap
transposition

The transposition of temporalis muscl...
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
cyanoacrylate

Cyanoacrylate derivatives(dermabond ,Ethicon)has been used for skin closure
5-0,6-0 skin sutures in estheti...
www.indiandentalacademy.com
ACRYLIC

Acrylic biomaterials are polymerized esters of either acrylic or methacrylic acids
Impervious,non –biodegradable ...
HTR is a composite of PMMA and PHEMA used for large full thickness defects
involving cranial,frontal,orbital where suffici...
Liquid monomer and powdered PMMA polymer which is mixed and cured for frontal cranioplasty

www.indiandentalacademy.com
polyesters

Diverse group of surgical devices that have a wide range of shapes like
suture,mesh,plates and screws and site...
Resorbable polymers

Material used in surgery as braided resorbable suture material
Non suture application is bone fixatio...
Bioresorbable poly-L/ DL-Lactide plates are reliable for repairing
Large Inferior orbital wall bony defects:

Bioresorbabl...
www.indiandentalacademy.com
The use of biodegradable plates and screws to stabilize facial fractures

Out of 291patients,59 patients were identified a...
Used in mild to moderate midface fractures resulting from low velocity injuries
and midface fractures in growing patients ...
Water bath system
www.indiandentalacademy.com
wound closure materials

Non absorbableSutures-nylon,polypopylene (tensile strength more than 60
days)
Absorbable –catgut,...
Management of alloplastic infection

When a purulent infection occurs antibiotics and drainage is not a permanant
solution...
www.indiandentalacademy.com
Role of tissue engineering in oral and maxillofacial reconstruction
Joms - 2005

Novel field that draws support from multi...
A human trial using a human tissue engineered oral mucosa was recently done

Autogenous keratinocytes were harvested from ...
Engineering scaffolds for craniofacial application

Scaffold must fit complex maxillofacial defects and be able to be stab...
Tissue engineering mandibular condyle a combination of several biomaterials.polymer on the top
For cartilage regeneration,...
In future the surgeon will be able to order a 3-D reconstruction on a
monitor in the office.with appropriate soft ware can...
Thank you
For more details please visit
www.indiandentalacademy.com

www.indiandentalacademy.com
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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Copy of biomaterials new presentation /certified fixed orthodontic courses by Indian dental academy

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. BIOMATERIALS A substance, synthetic or natural in origin used for or suitable to use in prostheses that come into contact with living tissues. www.indiandentalacademy.com
  3. 3. CLASSIFICATION OF BIOMATERIALS Autograft Allograft Xenograft Alloplast www.indiandentalacademy.com
  4. 4. Biological tissue implants “Everything old is new again” rings true in the use of biological implants in facial plastic and reconstructive surgery www.indiandentalacademy.com
  5. 5. TYPES BONE DERMIS AND DERMAL FAT CARTILAGE www.indiandentalacademy.com
  6. 6. CARTILAGE Most commonly used for nasal augmentation Source for orbital reconstruction are cartilagenous nasal septum and conchal cartilage Rib cartilage used for auricular reconstruction seventh and eigth considered as gold standard www.indiandentalacademy.com
  7. 7. Infection and resorption of autogenous cartilage is rare They are too flexible and do not provide adequate support for orbital contents in larger defects Incidence of strabismus and enophthalmous was significantly greater for cartilagenous grafts www.indiandentalacademy.com Biomaterials for orbit-2004
  8. 8. BONE Used for mandibular reconstruction,repair of traumatic midface defects,orthognathic and craniofacial surgery Iliac crest,tibia,rib and calvarium are common doner sites To correct cranial and orbital synostosis www.indiandentalacademy.com
  9. 9. Advantages of autogenous bone are relative resistance to infection,lack of host response against graft and lack of concern for late extrusion Endochondral and membraneous bone sources are used in orbital reconstruction with major donor sites being illiac crest and calvarial bone Resorption of graft volume is a concern in long terrm reconstruction www.indiandentalacademy.com
  10. 10. Endochondral – 75% Membraneous -20% Cortical maintain volume better than cancellous Primary choice – calvarial bone Principles of facial and plastic reconstrucive surgery www.indiandentalacademy.com
  11. 11. www.indiandentalacademy.com
  12. 12. DERMAL FAT When defects are subcutaneous Dermal fat grafts used in mandibular ankylosis,intraoral and pharyngeal cavity reconstruction and soft tissue deficits including hemifacial atrophy,gun shot trauma. Harvested in areas of thick skin with dermatome www.indiandentalacademy.com
  13. 13. What is biocompatibility? www.indiandentalacademy.com
  14. 14. Causing a harmful tissue reaction like pain, swelling, necrosis that could compromise function. Causing a systemic toxic reaction Having tumorogenic potential www.indiandentalacademy.com
  15. 15. Ideal properties for generic biomaterial Potter and ellis.biomaterials-joms-2004 Chemically inert Biocompatible Nonallergenic Noncarcinogenic Cost effective Sterilizable Easy handling Ability to stabilize radioopque www.indiandentalacademy.com
  16. 16. Healing response to most biomaterials is the formation of fibroconnective tissue scar or fibrous encapsulation Exception! Metallic plates for bone fixation www.indiandentalacademy.com
  17. 17. FACTORS LEADING TO FAILURE OF BIOMATERIALS host F A I L U R E chemical mechanical Potter and ellis biomaterials for orbit joms 2004 www.indiandentalacademy.com
  18. 18. Principles of alloplastic material selection and surgical placement Tissue quality of recepient site Emphasis on vascularity and soft tissue coverage Size of the implant Implant mobility Deeper the implant lesser the exposure www.indiandentalacademy.com
  19. 19. www.indiandentalacademy.com
  20. 20. Alloplastic implant types Dimethylsiloxane Polytetrafluoroethylene Polyethylene Polyamides and acrylic Titanium and gold metals Calcium phosphate and cyanocrylate adhesives www.indiandentalacademy.com
  21. 21. Dimethylsiloxane Polymer from interlinking of silicon and oxygen with methyl groups Resistant to degradation due to si-o2 Onlay implant for zygomatic,maxillary,nasal and mandibular reconstruction Advantage of easy sterilisation with out degradation High degree of chemical inertness and hydrophobic Clinical toxicity and allergy reactions exist Extensive array used in every facial site The infection rate in the orbit is 1.2% ,displacement 20% Not used in TMJ joint due to fragmentation of material- synovitis www.indiandentalacademy.com
  22. 22. Silicone (silastic) implants for a wide variety of facial contouring procedures www.indiandentalacademy.com
  23. 23. polyamides Organopolymersderivatives of nylon Known clinically as mesh material( supramid) Used for orbital reconstruction Fibosis and resorption can occur with time www.indiandentalacademy.com
  24. 24. METALS Biocompatibility depends on surface properties and corrosion After implantation an oxide layer quickly forms on the metal surface which determines its resistance to corrosion Stainless steel ,vitallium and titanium used successfully in human implantation Stainless steel has higher corrosion potential,greater amount of metal ion release and more likely to require secondary removal Vitallium forms chromic oxide layer and is more resistant to corrosion www.indiandentalacademy.com
  25. 25. Used for skull reconstruction,repair and reconstruction of facial and skeletal injuries and as an adjunct to oral and craniofacial prosthetic rehabilitation www.indiandentalacademy.com
  26. 26. Vitallium fossa implant used as TMJ prosthesis which are secured to articular eminence and lateral border of zygomatic arch with 2.0 mm screws.used with methylmethacrylate head www.indiandentalacademy.com
  27. 27. Christensen condylar prosthesis www.indiandentalacademy.com
  28. 28. Vitallium glenoid fossa implant www.indiandentalacademy.com
  29. 29. Titanium Available as pure or alloy with small amount of other metals like 6% aluminium and 4% vanadium Highly resistant to corrosion due to titanium oxide surface layer Lack of artefact on CT and MR images These properties with strength makes it best metal currently availablefor requirments in craniomaxillofacial stabilisation www.indiandentalacademy.com
  30. 30. Endosseous implant placed in mastoid for retension of ear prosthesis www.indiandentalacademy.com
  31. 31. Acute internal orbital injury reconstruction can bo done with precontoured titanium mesh, which is stiff enough to provide to bridge large defects with out losing shape.it does not resorb and provide life long support of periorbital soft tissues Use of nonresorbable alloplastic implants Joms-2004 www.indiandentalacademy.com
  32. 32. www.indiandentalacademy.com
  33. 33. Mandibular reconstruction using titanium functionally dynamic Bridging plate system: A retrospective study of 34 cases A retrospective study of 34 patients who had mandibular reconstruction using titanium dynamic bridging system for after oncological reconstruction showed satisfying functional and aesthetic results.it provides a solution for a safe and rapid mandibular reconstruction for patients with a poor prognosis or poor general condition www.indiandentalacademy.com American association of omfs Joms-2004
  34. 34. Unique role of osseointegration Prosthetic reconstruction of edenjulous mandible and maxilla and single tooth replacement,extraoral retension of facial prosthesis and hearing aids even in irradiated bone www.indiandentalacademy.com
  35. 35. Comparison of custom orbital floor titanium mesh with autologous bone grafts retained with screw fixation reported no complication when compared with placing of autologous bone grafts. 54 patients patients with titanium mesh showed excellent results with out the need for removal of implant due to infection Biomaterials for orbit Joms-2004 www.indiandentalacademy.com
  36. 36. Calcium phosphate Capable of osteoconduction Commercially available as hydroxyapatite Ceramic hydroxyapetite made from crystals Ceramic hydroxyapetite is made from crystals which are sintered at high temp in to hard nonresorbable solids used for maxillofacial reconstruction,alveolar and craniofacial augmentation Block form used as interpositonal graft in facial skeletal osteotomies Should not be used in load bearing facial areas Non ceramic used as powder-liquid mixture mixed intraoperatively and filled or contoured ti the bony defect www.indiandentalacademy.com
  37. 37. Liquid and powder composite used to reconstruct traumatic frontal bone www.indiandentalacademy.com
  38. 38. Porous hydroxyapatite outer defect of calvarium Granules for partial thickness cranial defect www.indiandentalacademy.com
  39. 39. Highly compatible ,minimal inflammatory reaction,strong mechanical bond and allows ingrowth of host tissue providing a scaffold for bone repair has limited resorption Good results for simple orbital reconstruction Limited adaptability and incompatibility with rigid fixation www.indiandentalacademy.com
  40. 40. polytetrafluoroethylene It is a very biocompatible group of carbon based biomaterials. Bonding of highly reactive fluorine to carbon creates extremely stable biomaterial which is not biodegradable PTFE in facial surgery as a skeletal augmentation material known as proplast which was either combined with graphite ( proplast I) ,alumina (proplast II) or hydroxyapatite. The fibrillar composition results in non-interconnected surface opening of pore size 10-30um which allows soft tissue ingrowth and less fibrous encapsulation and little tendency for migration. Subdermal implantation in lip,nasolabialfold ,glabella, nasaldorsum,and other subcutaneous facial defects as slings for ptotic tissues of eye lid and face and bony augmentation mid face,malar,mandibular areas www.indiandentalacademy.com
  41. 41. Implants as strands and cords for subdermal implantation www.indiandentalacademy.com
  42. 42. Advanta ePTFE facial implants in cosmetic facial surgery Expanded polytetrafluoroethylene implants can be used to augment lips,lines and wrinkles such as nasolabial folds, mentolabialfolds,glabellar lines or defects from hypoplastic scars and traumatic defects.these implants have been used successfully in subperiosteal placement or in dermal placement of the upper face American association of omfs Joms-2006 www.indiandentalacademy.com
  43. 43. Tendon passer through middle of upper lip www.indiandentalacademy.com Measurement of implant length
  44. 44. Plane of implant placement for facial tissues www.indiandentalacademy.com
  45. 45. Passing awl in the subdermal plane to pull ePTFE implant through the incision www.indiandentalacademy.com
  46. 46. www.indiandentalacademy.com
  47. 47. polyethylene Differentiates from PTFE by a lack of fluorination of ethylene monomer Comercially available as low,high and ultrahigh molecular weight PTFE Non resorbable and highly compatible HDPE has been used for facial augmentation with a variety of preformed facial,ear,orbital and cranial implants (Medpor,porex Medical) Fibrous ingrowth has clinical manifestation of stabilisation,difficulty with secondary removal and minimal settling of the implant Porous polyethylene Implant is not radiopaque www.indiandentalacademy.com
  48. 48. HDPE IS USED FOR SECONDARY RECONSTRUCTION OF INTERNAL ORBITAL DEFECTS OR THE CORRECTION OF ENOPHTHALMOUS www.indiandentalacademy.com
  49. 49. polyethylene www.indiandentalacademy.com
  50. 50. Use of temporal polyethylene implant after temporalis myofascial flap transposition The transposition of temporalis muscle results in large hollowing of temporal fossa that leaves the patient with cosmetic impairement . Use of prefabricated porous high density polyethylene temporal implant provide sufficient cosmeiic result American association of omfs Joms-2006 www.indiandentalacademy.com
  51. 51. www.indiandentalacademy.com
  52. 52. www.indiandentalacademy.com
  53. 53. www.indiandentalacademy.com
  54. 54. cyanoacrylate Cyanoacrylate derivatives(dermabond ,Ethicon)has been used for skin closure 5-0,6-0 skin sutures in esthetic facial surgery Superficial skin must be held as the adhesive is applied to prevent deposition of polymer in to the wound potentially delaying wound healing www.indiandentalacademy.com
  55. 55. www.indiandentalacademy.com
  56. 56. ACRYLIC Acrylic biomaterials are polymerized esters of either acrylic or methacrylic acids Impervious,non –biodegradable and is tolerated by development of avascular fibrous capsule Used in cranioplasty and filling full thickness cranial defects Acrylic mixtures has very low cost,intraoperative fabricationand adaptation Can be loaded with antibiotics by mixing antibiotic powder in acrylic resin www.indiandentalacademy.com PMMA used in infected cranial fractures and reconstruction
  57. 57. HTR is a composite of PMMA and PHEMA used for large full thickness defects involving cranial,frontal,orbital where sufficient autologous material available or there is sufficient morbidity with size of doner defect www.indiandentalacademy.com
  58. 58. Liquid monomer and powdered PMMA polymer which is mixed and cured for frontal cranioplasty www.indiandentalacademy.com
  59. 59. polyesters Diverse group of surgical devices that have a wide range of shapes like suture,mesh,plates and screws and sites of tissue implantation with physical properties that extend from resorbable to permanent implants www.indiandentalacademy.com
  60. 60. Resorbable polymers Material used in surgery as braided resorbable suture material Non suture application is bone fixation devices plates and screws with 82% PLA and 18% PGA (lactosorb) www.indiandentalacademy.com
  61. 61. Bioresorbable poly-L/ DL-Lactide plates are reliable for repairing Large Inferior orbital wall bony defects: Bioresorbable poly-L/DL-lactide implants are used to repair,large inferior orbital wall defects which adequately support the orbital soft tissue contents via subconjuctival approach First material in the literature to pramote bone healing along bone fragments of the inferior orbital wall www.indiandentalacademy.com Joms-2006
  62. 62. www.indiandentalacademy.com
  63. 63. The use of biodegradable plates and screws to stabilize facial fractures Out of 291patients,59 patients were identified as having received biodegradable plates( polylactide)for various fractures like Le Fort I ,II, III ,zygomatico complex,orbit,frontal sinus,mandible by ORIF. Favourable healing can be observed through the use of biodegradable PL plates and screws to stabilize selected midface fractures in patients of all ages,as well as mandible fractures in early childhood. American association of omfs Jomfs -2006 www.indiandentalacademy.com
  64. 64. Used in mild to moderate midface fractures resulting from low velocity injuries and midface fractures in growing patients were stabilised with 1.5mm or 2.0mm biodegradable plates and screws. Patients in the primary or mixed dentition presenting with mandibular fractures were all stabilised with biodegradable plates www.indiandentalacademy.com
  65. 65. Water bath system www.indiandentalacademy.com
  66. 66. wound closure materials Non absorbableSutures-nylon,polypopylene (tensile strength more than 60 days) Absorbable –catgut,polyglactin,polycolicacid,polydioxanone Staples Adhesive tapes www.indiandentalacademy.com
  67. 67. Management of alloplastic infection When a purulent infection occurs antibiotics and drainage is not a permanant solution,bacterial biofilim is impenetrable by antibiotics.drainage and removal of material is adviced Reimplantation should not be done for atleast 3-6 months to allow complete resolution of infection and inflammation in the adjacent structures Material charecteristics S .epidermidis – polymer S.aureus- metal Surface roughness, surface configuration,surface hydrophobicity www.indiandentalacademy.com
  68. 68. www.indiandentalacademy.com
  69. 69. Role of tissue engineering in oral and maxillofacial reconstruction Joms - 2005 Novel field that draws support from multiple disciplinary ,including cell culture and extracellular matrix. It offers our speciality a new opinion to supplement existing treatment for reconstruction of oral and maxillofacial complex. www.indiandentalacademy.com
  70. 70. A human trial using a human tissue engineered oral mucosa was recently done Autogenous keratinocytes were harvested from a punch biopsy 4 weeeks prior to oral surgery,placed in a serum free culture and seeded in to a human cadaveric dermal equivalent. 30 patients with precancerous lesion with this(EVPOME) graft showed 100% intake WITH CLINICAL EVIDENCE OF VASCULAR GROWTH www.indiandentalacademy.com
  71. 71. Engineering scaffolds for craniofacial application Scaffold must fit complex maxillofacial defects and be able to be stabilised.the state of art is to create the gross external shape based ion 3 dimensional (CT) images of the patient. Combination of base scaffold material is used for best results www.indiandentalacademy.com
  72. 72. Tissue engineering mandibular condyle a combination of several biomaterials.polymer on the top For cartilage regeneration, and a calcium phosphate,ceramic,hydroxyapatite on the bottom for bone formation www.indiandentalacademy.com
  73. 73. In future the surgeon will be able to order a 3-D reconstruction on a monitor in the office.with appropriate soft ware can constuct a custom made implant.the computer engineered implant would be forwaded to a work station that would fabricate the implant to the exact specification for the area of the face to be constructed www.indiandentalacademy.com
  74. 74. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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