[Biomaterials in plastic and maxillofacial surgery]

The major progress in biomaterials over recent years have concerned osteosynthesis, reconstruction and creation of the shapes of bones and soft tissues and gluing. In the authors' field of osteosynthesis, "pure" medical titanium, particularly T40, is perfectly adapted to situations (face, hand) in which the bone constraints are much lower than those encountered in hip and long bone surgery. Two improvements can be recommended: reheated titanium T40 due to its improved ductility; cermets (ceramo-metallic biomaterials) which have an excellent biocompatibility and which allow bone-implant liaisons, particularly for the bony fixation of epithesis supports. Ceramics and coral can be safely used to fill bone defects, in situations with low constraints. Numerous products are available and improve each year. For an equal quality, it is preferable to use the least expensive. Numerous products are available for reconstruction or creation of soft tissues, but present various disadvantages such as collagen, which is not resorbed, collagen-bioceramic, bone-collagen, hydroxyapatite-gelatin composites have a promising future, but the follow-up is too short at the present time. Fluorinated polymers, of which Gore-Tex is the leader, have been used for about thirty years in multiple applications, and certainly have a great future. The technology of biological glues is difficult, but this line of research is very interesting and promising for glues derived from non-living substances.