Biomaterials in craniofacial surgery: experimental studies and clinical application

The increasing variety of biomaterials available to the craniofacial surgeon today, with advantages of "off-the-shelf availability" and lack of donor-site morbidity, provides a formidable armamentarium for applications in reconstruction and augmentation. Although biomaterials are invaluable alternatives to autogenous bone graft, there is lack of uniformity in clinical application. In this article, we review our experience with the use of hydroxyapatite derivatives in animal studies and subsequently discuss our experience with the use of 3 classes of biomaterials (cement pastes, osteoactive biomaterials, and prefabricated polymers) for craniofacial reconstruction. We subsequently offer guidelines to dictate the choice of biomaterials for different applications, based on the site of reconstruction (onlay versus inlay reconstruction) and skeletal maturity.