Craniomaxillofacial Implants

Each year, more than 235,000 Americans undergo reconstructive surgery to repair CMF damage due to injury or disease3,4. Pre-shaped metal, polymer, or bioactive ceramic implants are used in cases that require bone repair or replacement; however, those materials have an average failure rate of 5.5% (12% to 37% in the orbital region)5. Failures due to poor osseointegration; prosthetic infections; and material corrosion, degradation, and fracture6 often lead to revision surgery, hardware removal, debridement, long-term antibiotic use, and implant replacement. A better material is needed to overcome these problems.

Silicon nitride has the essential physical, mechanical, and biological characteristics to fill this gap. It has been shown to accelerate bone healing, reduce the incidence of infection, eliminate metal toxicity, enhance radiographic imaging, lessen patient pain and disability, and decrease the overall health-care burden associated with failed or failing implants, as compared to current materials2.

Why is silicon nitride an ideal material for craniomaxillofacial implants?

Surface Topography

The surface topography of silicon nitride shares some common features with titanium, including sharp corners, points, and pockets. Ishikawa et al. recently demonstrated that this type of surface microstructure is important in resisting bacterial attachment while concurrently promoting cell adhesion and proliferation 57.

Bone Healing

Silicon nitride turns on osteoblasts (bone-forming cells) and suppresses osteoclasts (bone resorbing cells). When silicon nitride is manufactured with nitrogen-annealing, it increases bone formation cells by nearly 200%. This finding has excellent implications for speeding up bone healing, bone fusion, and implant integration into the skeleton.

Bacterial Resistance

Bacterial infection of any biomaterial implant is a serious clinical problem. Silicon nitride offers a potential easy solution, as it is inherently resistant to bacteria and biofilm formation 4, 5, 11, 50. In addition, a recent study has shown a direct bactericidal effect against an oral pathogen.

Superior Imaging

Silicon nitride implants are radiolucent with clearly visible boundaries and produce no artifacts or scattering under CT and no distortion under MRI. This enables an exact view of the implant for precise intraoperative placement and postoperative fusion assessment.
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