About implants | Dr. Andreishchev

виды имлпнтатов

Силикон - зло!

About implants

Manufacturing of individual implants or individualization is a reliable tool in the planning of the surgery, and opportunities for creating implants are great.

In my practice I use the following combination:

A computerized tomography (CT) scan – computer modeling of an expected result – stereolithography – an adaption of a standard implant on the bone surface – surgery.

The scheme clearly localizes the cause of deformation and in case of planning the surgery with these data we will achieve a stable aesthetical result.

Types

Standard, made based on the average anatomical parameters of the face.
Individual. The same standard implants adapted to the anatomy of the facial skeleton based on the stereolithographic model.
Individual, made based on the data of computer modeling by milling or by pressing according to the computerized tomography (CT) scan of a particular patient.

In my practice I use the MEDPOR (USA) or Ekoflon (Russia) implants, there are small differences between them. The choice depends on the initial situation: if there were no injuries or primary surgeries, then I use MEDPOR. If there were injuries, fractures, asymmetry and other tricks, then the implant is made individually, and it will be Ekoflon.

Medpor

The implant made of porous polyethylene. For many years it is the option I choose the most in my practice as it is porous and quite solid, biologically inert. The manufacturer offers a variety of implants for different zones, of diverse design, in a few projection options. This greatly facilitates the surgeon’s life: the implant from the general line is suitable.

MEDPOR is quite solid that allows clearly setting up on the skin surface and reliably fixing by the micro-screw. The connective tissue capsule will grow through into the thickness of the implant and form a «hammock» which will fix it from the significant pressure on the bone. However, to some extent, resorption of the compact plate occurs here as well.

There were cases indicating good infection resistance of the MEDPOR implants:

1. A few years after the installation of the chin implant a patient was injured with a rupture of the soft tissues of the chin. When she went to the clinic, a part of an implant was discovered in the wound. Surgical rules require to remove the implant, but we have limited to resection of the exposed part of the implant. In the future the implant was saved.

2. 10 days after the augmentation of the angles of the jaw, the edges of the wound parted along the lower arch of the vestibule of the mouth. Logically, the implant had to be removed. It was saved, and we connect it with the fact that blood vessels grew into the implant.

Ekoflon

An important benefit Is the easy availability of the material, the production of individual implants by the local manufacturer, contact with the manufacturer ready for fruitful cooperation.

The digital model of the implant, which was obtained based on the computer modeling, transformed into a negative image in press-form, and then by the powder sintering the implant is made from the Ekoflon. The result is a porous structure that includes the ingrowth of the bone and the connective tissue capsule into the implant – the main difference of porous materials from the monolithic ones, for instance, silicone.

As a result, the implant is in the scar tightly holding «hammock» which does not press on the bone, which prevents its destruction.

With the use of implants made of the Ekoflon I have never faced a case of resorption of the bone under the implant. Moreover, in two cases bone formation under the implant was found. The material is easily cut with a scalpel, which allows further modification of the implant during the surgery.

Silicone implants – harm!

I consider the installation of an implant on the surface of the bone a bad idea. According to my data, there is resorption of the bone tissue under it: gradually the implant I embedded in the bone and causes erosion. The result is unstable, because the chin will shrink overtime under the silicone.

Placed on the surface of the bone silicone implant behaves like a foreign body. Under the pressure of stretched soft tissues, under the action of mimic and masticatory (chewing) muscles, the destruction of the bone surface under the implant begins. Rule: the thicker implant is, the more pressure on the bone surface and the harder the destruction of the bone are. In the literature there are descriptions of cases of «bone erosion» even down to the roots of the teeth.

In my practice the number of silicone removal surgeries exceeds the number of installations. The causes of removal of an implant were either patients’ aesthetic dissatisfaction with the form (usually unnatural look) or the lack or absence of the aesthetic result.

The unnatural result is connected with unusual shapes due to the installation, in fact, of the rubber implants on the surface of the bone and because of the thickness of the scars capsule around the implant. This distorts the aesthetic result, supports long-lasting swelling in this area, causes the disorder of sensitivity.

Solution – removal of a silicone implant with excision of the hypertrophied scar capsule and removal of it with the other implant with a more natural shape or with the bone plastic surgery.

Conclusion

Silicone implants used in contouring plastic surgery are not able to create natural results due to the formation of a hypertrophied capsule around them, do not have a possibility to integrate into the surrounding tissues, cause compression and destruction of the bone tissue.

The implants from the Ekoflon meet the requirements of the biocompatibility and minimization of the impact on adjacent tissues more. The capability of precise production of individual implants increases the attractiveness of this material.

The more safe and well-proven are MEDPOR implants: due to the great number of small pores in the structure of the implant, the connective tissue capsule germinates and the bone tissue under it is not exposed to the pathological impact of a foreign body.

Of course, the optimal choice in terms of biocompatibility is autologous bone.

Замена силиконового имплантата костной гениопластикой