Customised titanium implants for orofacial reconstruction

Summary

The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on customised titanium implants for orofacial reconstruction.

As part of the NICE's work programme, the current guidance was considered for review in May 2009 but did not meet the review criteria as set out in the IP process guide. The guidance below therefore remains current.

Description

The use of customised titanium orofacial implants is indicated for facial reconstruction following excision of orofacial tumours, in cases of severe orofacial trauma, and for congenital facial anomalies.

Stereoscopic lithography is used to create functional anatomic models in resin from which customised titanium implants can be produced using computer-controlled milling. In orofacial reconstruction, customised titanium implants of the mandible and maxilla (anatomical facsimiles) are made.

In the technique described by Peckitt, the oral and nasal titanium surfaces are exposed and the dentition is reconstructed using an overdenture which sits directly on the metal base. In this way, dentures can be made on the implant rather than cast from an impression and thus a one-step procedure without the need for free flaps is achieved.

Similarly, in craniofacial surgery, the use of computer aided design and stereolithography facilitates the production of complex geometric implants to replace facial features with very precise implant/bone margins (0.25mm to the border of the defect). Implants are stabilized using titanium screws. This technique has also been used in orbital reconstruction to correct bony orbital defects following tumour excisions.

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Links:

	IPG28 Exposed customised titanium implant for orofacial reconstruction: guidance	17 December 2003
	IPG28 Exposed customised titanium implant for orofacial reconstruction: understanding NICE guidance	17 December 2003
	IPG28 Mewnblaniadau titaniwm gweladwy wedi'u saernïo ar gyfer adlunio'r wyneb: deall canllawiau NICE	12 May 2009
	IPG28 Exposed customised titanium implant for orofacial reconstruction: distribution list	17 December 2003
	Consent - procedures for which the benefits and risks are uncertain	27 November 2003
	Interventional procedures consultation document - customised titanium implants in orofacial reconstruction	05 August 2003
	Overview of customised titanium implants in orofacial reconstruction	05 August 2003