A Multi-Criteria Assessment Strategy for 3D Printed Porous Polyetheretherketone (PEEK) Patient-Specific Implants for Orbital Wall Reconstruction

Abstract

Pure orbital blowout fractures occur within the confines of the internal orbital wall. Restoration of orbital form and volume is paramount to prevent functional and esthetic impairment. The anatomical peculiarity of the orbit has encouraged surgeons to develop implants with customized features to restore its architecture. This has resulted in worldwide clinical demand for patient-specific implants (PSIs) designed to fit precisely in the patient’s unique anatomy. Material extrusion or Fused filament fabrication (FFF) three-dimensional (3D) printing technology has enabled the fabrication of implant-grade polymers such as Polyetheretherketone (PEEK), paving the way for a more sophisticated generation of biomaterials. This study evaluates the FFF 3D printed PEEK orbital mesh customized implants with a metric considering the relevant design, biomechanical, and morphological parameters. The performance of the implants is studied as a function of varying thicknesses and porous design constructs through a finite element (FE) based computational model and a decision matrix based statistical approach. The maximum stress values achieved in our results predict the high durability of the implants, and the maximum deformation values were under one-tenth of a millimeter (mm) domain in all the implant profile configurations. The circular patterned implant (0.9 mm) had the best performance score. The study demonstrates that compounding multi-design computational analysis with 3D printing can be beneficial for the optimal restoration of the orbital floor.

Evaluation of Customized Polyether Ether Ketone Implant in Reconstruction of Orbital Floor Fractures (Clinical Trial)”

“…They conducted that the solid, non-porous, configuration possess the least deformation and maximum durability when compared to the different sheets with different porosity configurations. Regarding the sheet thickness, an inverse correlation was noted, where a less marked deformity is reported with gain in implant thickness (32). The chosen configuration in this study showed perfect fit in all of the cases while at the same time attain its shape and integrity across the recorded follow-up period, verified by its clinical and radiographic performance.…”

“…There is a consensus about the minimum producible thickness of PEEK material using milling machines, which is based on the manufacture recommendation is 0.4 mm (9,30,31). Sharma et al (2021) conducted a computational finite element orbital model to test the durability and maximum deformation values for different thicknesses and porosity of PEEK orbital sheets (32). They conducted that the solid, non-porous, configuration possess the least deformation and maximum durability when compared to the different sheets with different porosity configurations.…”

“…In the sample collected in this study, none of the patients showed a preoperative diplopia and the placement of the less than 0.9 mm PEEK sheet seems to possess no detrimental effect on the action of the extraocular muscle. PEEK owns a convenient characteristics for the PSI manufacturing processes, with either a milling machine or an extrusion additive rapid prototyping technology (32). PEEK is a contemporary reconstructive option for the management of orbital defects.…”

Preservation of Infraorbital Nerve in Orbital Floor and Maxillary Defect Reconstruction With Patient-Specific Three-Dimensional Implant: A Case Report

“…Nonetheless, as the technology matures with the development of low-cost 3D printing processes using in-house devices, such as fused filament fabrication, the cost will inevitably decrease and thus increase the accessibility of PSIs for major maxillofacial reconstruction. 14,15 Postoperatively, both of our patients had satisfactory restoration of orbital volume, globe position, and facial contours without any visual restrictions. As expected, both experienced temporary paresthesia during the immediate postoperative period, likely from manipulation, but recovered in subsequent months without significant sensory deficits.…”

“…Nonetheless, as the technology matures with the development of low-cost 3D printing processes using in-house devices, such as fused filament fabrication, the cost will inevitably decrease and thus increase the accessibility of PSIs for major maxillofacial reconstruction. 14,15…”