Biomaterials for craniofacial reconstruction

Biomaterials for reconstruction of bony defects of the skull comprise of osteosynthetic materials applied after osteotomies or traumatic fractures and materials to fill bony defects which result from malformations, traumata or tumor resections. Other applications concern functional augmentations for dental implants or asthetic augmentations in the region of the face. For ostheosynthesis, mini- and microplates from titanium alloys provide major advantages concerning biocompatibility, stability and individual fitting to the implant bed. The necessity of removal of asymptomatic plates and screws after fracture healing is still a controversial issue. Risks and costs of secondary surgery for removal face a low rate of complications (due to corrosion products) when the materials remains in situ. Resorbable osteosynthesis systems have similar mechanical stability and are especially useful in the growing skull. The huge variety of biomaterials for reconstruction of bony defects makes it difficult to decide which material is adequate for which indication and for which site. The optimal biomaterial that meets every requirement (e. g. biocompatibility, stability, intraoperative fitting, product safety, low costs etc.) does not exist. The different material types are (autogenous) bone and many alloplastics such as metals (mainly titanium), ceramics, plastics and composites. Future developments aim to improve physical and biological properties, especially concerning surface interactions. To date, tissue engineered bone is far from routine clinical application.