Three-Dimensional Craniofacial Bone Reconstruction With SmartBone on Demand

Abstract

This is a report of a 34-year-old male lacking of bone development in the frontal and orbital part of the skull due to a surgical removal of a right orbital-front osteoma at the age of 5. The integrity of the craniofacial district was important for the young patient also for social acceptance and self-esteem. Based on computed tomography patient images, a skull model was reconstructed, both digitally and on 3-dimensional real model, to best design the needed bone graft. Defect wide extension and surface curvature called for the use of the puzzle technique, where the whole graft is composed by several elements, mechanically slotting into each other. The realization was made possible thanks to the use of a composite xenohybrid bone substitute specifically developed for reconstructive surgery (SmartBone, by Industrie Biomediche Insubri SA). SmartBone technology allowed the realization of custom-made grafts which perfectly joined each other and fitted the bone defect thanks to mechanical strength, also at low thicknesses and wide extensions. The postoperative course was uneventful and computed tomography scans showed new bone formation and complete calvaria continuity already 10 months after surgery, with no signs of inflammation over the entire follow-up. This case study represents a proof of concept that SmartBone on Demand custom-made bone grafts, together with puzzle technique, are effective, easy to handle and provide final excellent functional and aesthetic results.

Clinical Case Employing Two Different Biomaterials in Bone Regeneration

“…Conditions required different treatment for the second site. The calcium phosphosilicate did not possess the same mechanical characteristics as those of a xenogenic bone graft, but it was very suitable for socket preservation [25] provided that the treated region received good coverage in order to achieve the proper revascularization of grafts from periosteal vessels. Having a patient with different lesions allowed us to validate the strategy of adapting our choice of biomaterial to the characteristics of the defect.…”

“…At the site where we extracted Region 35, we proceeded to implant xenohybrid graft SmartBone (SB), developed and manufactured by Industrie Biomediche Insubri SA (IBI-SA) via a proprietary process that improves the properties of naturally derived biomaterials [23]. SB was specifically developed for regenerative-medicine applications, and has a long track record of clinical applications [24][25][26][27][28]. SB is composed of a decellularized-bovine-bone matrix reinforced with bioresorbable aliphatic polyesters and RGD-containing collagen fragments [23,29], where RGD is the tripeptide sequence ArginylGlycylAspartic acid that is the most common peptide motif responsible for cell adhesion to the extracellular matrix.…”

Custom-Made Horizontal and Vertical Maxillary Augmentation with Smartbone® On Demand™: A Seven-Year Follow-Up Case

“…The CBCT images were used to create a virtual upper jaw model to support graft design. Further, in order to demonstrate the goodness of the digital design, files have been replicated and verified in a 3D stereolithographic model [16]. This solid model was mounted onto an articulator.…”

“…SmartBone ® (SB ® ), a xeno-hybrid developed and manufactured by Industrie Biomediche Insubri SA (Switzerland), was devised according to a new concept in composite approach, building on a base of bovine decellularized bone-derived mineral matrix, reinforced with bioresorbable aliphatic polymers and RGD-containing collagen fragments derived from animal-sourced gelatin (RGD is the acronym of the tripeptide arginine-glycine-aspartic acid). Such a new concept of biomaterial assembly allows the patient's cells to grow quickly and efficiently into the graft, while its biopolymers degrade, providing osteoconduction, supporting osteogenesis and finally ensuring perfect integration via complete remodeling [7][8][9][10][11][12][13][14][15][16][17][18][19][20]. This composite biomaterial resembles human bone microstructure and provides macro-scale properties: an adequate-sized open porosity with a combined rigid-elastic behavior, in combination with surface properties, which ensures cell viability and rapid tissue integration.…”

Simulated Performance of a Xenohybrid Bone Graft (SmartBone®) in the Treatment of Acetabular Prosthetic Reconstruction

“…Indeed, a 2018 study reported a significant bone volume increase of 40% four months postop [42]. A study from 2019 showed an increment of 16 cc of new bone on the treated area of an important craniofacial district [46], and a study in traumatology showed evidence of not only bone regeneration but also anatomically selective remodeling [45].…”