Research Article| Volume 58, ISSUE 7, P753-758, September 2020

Use of CAD-based pre-bent implants reduces theatre time in orbital floor reconstruction: results of a prospective study


      In this prospective study we evaluated the duration of insertion and the accuracy of fitting of computer-aided design (CAD)-based pre-bent orbital floor plates compared with non-preformed orbital plates in reconstruction of the orbital floor. Thirty-six patients with unilateral fractures of the orbital floor were included; pre-bent plates were used in 25 and non-preformed plates in 11. Preoperative computed tomography (CT) scans were used for CAD of individualised implants. The anatomy of the affected orbit was virtually reconstructed “slice by slice”. Individually pre-bent plates were generated using a stereolithographic model of the reconstructed orbit. The mean (SD) duration of insertion was significantly reduced when pre-bent orbital plates were used (5.5 (5.4) min) compared with non-preformed meshes (11.1 (7.7) min). The congruence of pre-bent plates to the infraorbital rim did not differ from that of non-preformed plates. The accuracy of fit was rated as “accurate” in 24 cases. CAD-based individualised titanium meshes reduce theatre time compared with non-preformed orbital plates. Our results confirm the efficacy of CAD-based pre-bent plates in reconstruction of the orbital floor.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to British Journal of Oral and Maxillofacial Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Metzger M.C.
        • Schon R.
        • Schulze D.
        • et al.
        Individual preformed titanium meshes for orbital fractures.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 102: 442-447
        • Schon R.
        • Metzger M.C.
        • Zizelmann C.
        • et al.
        Individually preformed titanium mesh implants for a true-to-original repair of orbital fractures.
        Int J Oral Maxillofac Surg. 2006; 35: 990-995
        • Kozakiewicz M.
        • Szymor P.
        Comparison of pre-bent titanium mesh versus polyethylene implants in patient specific orbital reconstructions.
        Head Face Med. 2013; 9: 32
        • Dietz A.
        • Ziegler C.M.
        • Dacho A.
        • et al.
        Effectiveness of a new perforated 0.15 mm poly-p-dioxanon-foil versus titanium-dynamic mesh in reconstruction of the orbital floor.
        J Craniomaxillofac Surg. 2001; 29: 82-88
        • Al-Sukhun J.
        • Lindqvist C.
        A comparative study of 2 implants used to repair inferior orbital wall bony defects: autogenous bone graft versus bioresorbable poly-L/DL-Lactide [P(L/DL)LA 70/30] plate.
        J Oral Maxillofac Surg. 2006; 64: 1038-1048
        • Baino F.
        Biomaterials and implants for orbital floor repair.
        Acta Biomater. 2011; 7: 3248-3266
        • Metzger M.C.
        • Schon R.
        • Zizelmann C.
        • et al.
        Semiautomatic procedure for individual preforming of titanium meshes for orbital fractures.
        Plast Reconstr Surg. 2007; 119: 969-976
        • Gosau M.
        • Schoneich M.
        • Draenert F.G.
        • et al.
        Retrospective analysis of orbital floor fractures—complications, outcome, and review of literature.
        Clin Oral Investig. 2011; 15: 305-313
        • Allison R.T.
        • Sugar A.W.
        Production of high quality ground sections of bone containing metal implants to demonstrate osseo-integration: a simplified method.
        Med Lab Sci. 1990; 47: 168-171
        • Gear A.J.
        • Lokeh A.
        • Aldridge J.H.
        • et al.
        Safety of titanium mesh for orbital reconstruction.
        Ann Plast Surg. 2002; 48: 1-9
        • Ellis E.
        • Tan Y.
        Assessment of internal orbital reconstructions for pure blowout fractures: cranial bone grafts versus titanium mesh.
        J Oral Maxillofac Surg. 2003; 61: 442-453
        • Metzger M.C.
        • Schon R.
        • Weyer N.
        • et al.
        Anatomical 3-dimensional pre-bent titanium implant for orbital floor fractures.
        Ophthalmology. 2006; 113: 1863-1868
        • Shetty P.
        • Senthil Kumar G.
        • Baliga M.
        • et al.
        Options in orbital floor reconstruction in blowout fractures: a review of ten cases.
        J Maxillofac Oral Surg. 2009; 8: 137-140
        • Schmelzeisen R.
        • Husstedt H.
        • Zumkeller M.
        • et al.
        Preserving and improving the profile in primary and secondary orbital reconstruction.
        Mund Kiefer Gesichtschir. 1997; 1 (paper in German): S87-S89
        • Hughes C.W.
        • Page K.
        • Bibb R.
        • et al.
        The custom-made titanium orbital floor prosthesis in reconstruction for orbital floor fractures.
        Br J Oral Maxillofac Surg. 2003; 41: 50-53
        • Fan X.
        • Zhou H.
        • Lin M.
        • et al.
        Late reconstruction of the complex orbital fractures with computer-aided design and computer-aided manufacturing technique.
        J Craniofac Surg. 2007; 18: 665-673
        • Banica B.
        • Ene P.
        • Vranceanu D.
        • et al.
        Titanium preformed implants in orbital floor reconstruction—case presentation, review of literature.
        Maedica (Buchar). 2013; 8: 34-39
        • Cohen A.
        • Laviv A.
        • Berman P.
        • et al.
        Mandibular reconstruction using stereolithographic 3-dimensional printing modeling technology.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 108: 661-666
        • Kumta S.
        • Kumta M.
        • Jain L.
        • et al.
        A novel 3D template for mandible and maxilla reconstruction: Rapid prototyping using stereolithography.
        Indian J Plast Surg. 2015; 48: 263-273
        • Rana M.
        • Gellrich M.M.
        • Gellrich N.C.
        Customised reconstruction of the orbital wall and engineering of selective laser melting (SLM) core implants.
        Br J Oral Maxillofac Surg. 2015; 53: 208-209
        • Lieger O.
        • Richards R.
        • Liu M.
        • et al.
        Computer-assisted design and manufacture of implants in the late reconstruction of extensive orbital fractures.
        Arch Facial Plast Surg. 2010; 12: 186-191
        • Mustafa S.F.
        • Evans P.L.
        • Bocca A.
        • et al.
        Customized titanium reconstruction of post-traumatic orbital wall defects: a review of 22 cases.
        Int J Oral Maxillofac Surg. 2011; 40: 1357-1362
        • Klein M.
        • Glatzer C.
        Individual CAD/CAM fabricated glass-bioceramic implants in reconstructive surgery of the bony orbital floor.
        Plast Reconstr Surg. 2006; 117: 565-570
        • Kozakiewicz M.
        • Elgalal M.
        • Piotr L.
        • et al.
        Treatment with individual orbital wall implants in humans—1-Year ophthalmologic evaluation.
        J Craniomaxillofac Surg. 2011; 39: 30-36
        • Olszewski R.
        • Reychler H.
        Three-dimensional surgical guide for frontal-nasal-ethmoid-vomer disjunction in Le Fort III osteotomy.
        J Craniofac Surg. 2011; 22: 1791-1792