Patient-specific polyetheretherketone facial implants in a computer-aided planning workflow

Godoberto Guevara-Rojas, Michael Figl, Kurt Schicho, Rudolf Seemann, Hannes Traxler, Apostolos Vacariu, Claus-Christian Carbon, Rolf Ewers, Franz Watzinger

Research output: Journal article (peer-reviewed)Journal article

35 Citations (Scopus)


PURPOSE: In the present study, we report an innovative workflow using polyetheretherketone (PEEK) patient-specific implants for esthetic corrections in the facial region through onlay grafting. The planning includes implant design according to virtual osteotomy and generation of a subtraction volume. The implant design was refined by stepwise changing the implant geometry according to soft tissue simulations.

MATERIALS AND METHODS: One patient was scanned using computed tomography. PEEK implants were interactively designed and manufactured using rapid prototyping techniques. Positioning intraoperatively was assisted by computer-aided navigation. Two months after surgery, a 3-dimensional surface model of the patient's face was generated using photogrammetry. Finally, the Hausdorff distance calculation was used to quantify the overall error, encompassing the failures in soft tissue simulation and implantation.

RESULTS: The implant positioning process during surgery was satisfactory. The simulated soft tissue surface and the photogrammetry scan of the patient showed a high correspondence, especially where the skin covered the implants. The mean total error (Hausdorff distance) was 0.81 ± 1.00 mm (median 0.48, interquartile range 1.11). The spatial deviation remained less than 0.7 mm for the vast majority of points.

CONCLUSIONS: The proposed workflow provides a complete computer-aided design, computer-aided manufacturing, and computer-aided surgery chain for implant design, allowing for soft tissue simulation, fabrication of patient-specific implants, and image-guided surgery to position the implants. Much of the surgical complexity resulting from osteotomies of the zygoma, chin, or mandibular angle might be transferred into the planning phase of patient-specific implants.

Original languageEnglish
Pages (from-to)1801-1812
Number of pages12
JournalJournal of Oral and Maxillofacial Surgery
Issue number9
Publication statusPublished - Sept 2014


  • Adult
  • Benzophenones
  • Biocompatible Materials
  • Computer-Aided Design
  • Face/anatomy & histology
  • Facial Bones/surgery
  • Female
  • Humans
  • Image Processing, Computer-Assisted/methods
  • Imaging, Three-Dimensional/methods
  • Ketones
  • Models, Anatomic
  • Osteotomy/methods
  • Patient Care Planning
  • Photogrammetry/methods
  • Polyethylene Glycols
  • Polymers
  • Prostheses and Implants
  • Prosthesis Design
  • Surgery, Computer-Assisted/methods
  • Tomography, X-Ray Computed/methods
  • User-Computer Interface
  • Zygoma/abnormalities


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