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Third-generation modular mandible endoprosthesis in Macaca fascicularis.

Y Liu¹, R Lim², N Chanchareonsook³

¹National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore; Oral Health Academic Clinical Programme, Duke-NUS Medical School, Singapore.

International Journal of Oral and Maxillofacial Surgery

|December 4, 2020

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A new modular mandible endoprosthesis design with incorporated movement reduces stress, enhancing bone integration. This improved stability in animal models suggests potential for better long-term outcomes in reconstructive surgery.

Area of Science:

Biomaterials Engineering
Oral and Maxillofacial Surgery
Orthopedic Implant Design

Background:

Mandible reconstruction often requires endoprostheses, but stress concentration at implant stems can lead to micromotion and instability.
Previous generations of modular mandible endoprostheses have faced challenges with long-term osseointegration due to stress-related issues.
Developing a third-generation endoprosthesis aims to overcome these limitations by minimizing stress and promoting biological fixation.

Purpose of the Study:

To develop and evaluate a third-generation modular mandible endoprosthesis designed to reduce stress concentration at the implant stems.
To investigate the hypothesis that incorporating controlled movement between modular interfaces enhances osseointegration and long-term stability.
To compare the performance of a modular endoprosthesis with integrated movement against a rigid design in a preclinical model.

Keywords:

biomaterials device design in vivo mandible mandibular reconstructive surgery maxillofacial surgery oral surgery osseointegration preclinical

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Main Methods:

A three-piece modular mandible endoprosthesis system was designed with varying degrees of movement at module interfaces.
The endoprosthesis was fabricated from commercially pure grade 4 titanium, with specific machining and surface treatments.
The system was implanted in segmental mandible defects in nine Macaca fascicularis, followed by clinical, radiological, histological, and histomorphometric assessments at 4 months.

Main Results:

Endoprostheses incorporating movement demonstrated significantly superior performance compared to the rigid system.
A 30.9-34.8 times higher percentage of bone-implant contact and a 3.4-4.1 times greater bone area were observed (P<0.0001).
Osseointegration was evident at the posterior stems, though fibrous encapsulation occurred around anterior stems in all groups.

Conclusions:

The degree of movement incorporated into the modular mandible endoprosthesis favorably impacted bone healing and implant stability.
The findings support the potential of this design to improve osseointegration in mandible reconstruction.
Further research is needed to optimize strategies for reducing stem loading and ensuring predictable osseointegration throughout the implant.