Biomaterialien zur Wiederherstellung des knöchernen Schädels

Zusammenfassung

Biomaterialien zur Wiederherstellung des knöchernen Schädels umfassen solche zur Osteosynthese nach Traumata oder Osteotomien und solche zur Rekonstruktion knöcherner Substanzdefekte als Folge von Fehlbildungen, Traumata oder Tumorresektionen. Weitere Anwendungsgebiete sind funktionelle Augmentationen für (meist dentale) Implantate oder ästhetische Augmentationen im Gesichtsbereich.

Bei der Osteosynthese bieten Mini- oder Mikroplatten aus Titanlegierungen die größten Vorteile hinsichtlich Stabilität, individueller Anpassung an das Implantatbett und Biokompatibilität. Die Frage der Entfernung asymptomatischer metallischer Osteosynthesematerialien wird nach wie vor kontrovers diskutiert. Der Notwendigkeit und den Risiken des Zweiteingriffs steht eine nur geringe Komplikationsrate bei Verbleib der Implantate (durch metallische Korrosionsprodukte) gegenüber. Resorbierbare Osteosynthesesysteme zeigen vergleichbare mechanische Stabilität wie die metallischen Systeme und eignen sich besonders für den wachsenden kindlichen Schädel. Die Vielfalt von Knochenersatzmaterialien ist groß. Ein ideales Knochenersatzmaterial, welches alle Anforderungen hinsichtlich Biokompatibilität, Stabilität, Produktsicherheit und Kosten erfüllt, existiert bisher nicht. Die unterschiedlichen Materialklassen umfassen Knochen (vor allem autogenen) und zahlreiche alloplastische Materialien wie Metalle (Titan), Keramiken, Kunststoffe und Komposite. Zukünftige Entwicklungen zielen auf verbesserte physikalische und biologische Eigenschaften vor allem der Oberflächen der Materialien ab. Per tissue engineering hergestellter Knochen ist bisher noch fern des breiten klinischen Einsatzes.

Abstract

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.

Schlüsselwörter

Osteosynthese - Knochenersatz - Biomaterialien - Titan - kraniofaziale Rekonstruktion

Key words

osteosynthesis - bone replacement - biomaterials - titanium - craniofacial reconstruction

Literatur

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