Auto-graft vs 3D printed implant in reconstruction of frontal bone region

Relevance. Fibrous dysplasia is a pathological condition characterized by the substitution of normal bone with fibrous tissue. The progression of this disorder generally stabilizes with increasing age. Clinically, it may manifest as painless swelling and facial asymmetry. Radiographic examination reveals well-defined margins, intramedullary expansion, maintenance of a smooth cortical contour, and ground-glass appearance. Histologically, the condition is distinguished by the presence of fibrous tissue replacing bone, along with irregularly arranged and randomly oriented bony trabeculae. Current treatment approaches frequently involve surgical intervention utilizing custom-fabricated polyether ether ketone (PEEK) implants or autogenous bone grafts, such as calvarial grafts. Materials and Methods. In the Department of Maxillofacial Surgery of the Russian Children’s Clinical Hospital (RCCH) - a branch of the Federal State Autonomous Educational Institution of Higher Education Russian National Research Medical University named after. N.I. Pirogov of the Ministry of Health of the Russian Federation of Moscow, 65 patients, from 2016 to 2023, were treated for histologically confirmed fibrous dysplasia in the frontal bone. Among them, 2 patients (7 years old girl, and 17 years old boy) were treated with 3D implants made from PEEK, and 2 patients (6 years old boy, and 9 years old girl) were treated with calvarial graft. Results and Discussion. The application of 3D implants has effectively enforce the primary stability of the reconstructed area. The lesion was successfully addressed, achieving an optimal aesthetic outcome characterized by a combination of strength, lightweight properties, and biocompatibility, without any observed complications or failures. Notably, recurrences have been recognized in patients who underwent treatment with calvarial grafts over five years after the operation. Conclusion. PEEK is a thermoplastic polymer characterized by its non-absorbable and nonporous properties, which allows for intraoperative modifications and provides optimal imaging characteristics in the postoperative period. On the other hand, it has been observed that auto-grafts may exhibit a higher risk of failure compared to custom-fabricated implants.