Current applications of porous polyethylene in tissue regeneration and future use in alveolar bone defect Craniomaxillofacial reconstruction

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Teerapan Sosakul
Jintamai Suwanprateeb
Bunyong Rungroungdouyboo


The success of dental implant depends on the quantity and quality of the alveolar bone support. Autogenous bone is still the gold standard for using as a bone graft to reconstruct or augment the alveolar ridge to properly support the dental implant placement.  However, it has been associated with the increase in operation time, cost and donor site morbidity. Various allografts, xenografts and synthetic materials have been used as substitutes for autogenous bone, but they have been reported to not heal as predictably as autogenous bone and new type of bone grafts are still needed to be sought. Porous polyethylene has been successfully used in several applications such as cranial reconstruction, nasal reconstruction, ear reconstruction, orbital reconstruction and correction of maxillofacial contour deformities due to its highly stable, adaptable and has been shown to stimulate tissue regeneration by acting as a scaffold for rapid hard and soft tissue ingrowth. In this paper, the properties and current applications of porous polyethylene in tissue regeneration are reviewed and the outlook for its use in alveolar bone defect is discussed.


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[1] Hannink G, Arts JJ. Bioresorbability, porosity and mechanical strength of bone substitutes: what is optimal for bone regeneration?. Injury. 2011;42(Suppl 2):S22-5.
[2] Aloy Prósper A, Maestre Ferrín L, Penarrocha-Oltra D, Penarrocha M. Bone regeneration using particulate grafts: an update. Med Oral Patol Oral Cir Bucal. 2011;16(2):e210-4.
[3] Leonetti JA, Koup R. Localized maxillary ridge augmentation with a block allograft for dental implant placement: case reports. Implant Dent. 2003;12:217-26.
[4] Dougherty WR, Wellisz T. The natural history of alloplastic implants in orbital floor reconstruction: an animal model. J Craniofac Surg. 1994;5(1):26-32.
[5] Sultana M. Porous biomaterials: classification, fabrication and its applications in advanced medical science. American Journal of Nanosciences. 2018;4(2):16-20.
[6] Torres-Sanchez C, Al Mushref FRA, Norrito M, Yendall K, Liu Y, Conway PP. The effect of pore size and porosity on mechanical properties and biological response of porous titanium scaffolds. Mater Sci Eng C. 2017;77:219-28.
[7] Cavo M, Scaglione S. Scaffold microstructure effects on functional and mechanical performance: Integration of theoretical and experimental approaches for bone tissue engineering applications. Mater Sci Eng C. 2016;68:872-9.
[8] Dutta Roy T, Simon J, Ricci J, Rekow E, Thompson V, Parsons J. Performance of degradable composite bone repair products made via three-dimensional fabrication techniques. J Biomed Mater Res A. 2003;66:283-91.
[9] Tarafder S, Dernell WS, Bandyopadhyay A, Bose S. SrO- and MgO-doped microwave sintered 3D printed tricalcium phosphate scaffolds: mechanical properties and in vivo osteogenesis in a rabbit model. J Biomed Mater Res B Appl Biomater. 2015;103:679-90.
[10] Karageorgiou V, Kaplan D. Porosity of 3D biomaterial scaffolds and osteogenesis. Biomaterials. 2005;26:5474-91.
[11] Hulbert SF, Young FA, Mathews RS, Klawitter JJ, Talbert CD, Stelling FH. Potential of ceramic materials as permanently implantable skeletal prostheses. J Biomed Mater Res. 1970;4:433-56.
[12] Itälä AI, Ylänen HO, Ekholm C, Karlsson KH, Aro HT. Pore diameter of more than 100 microm is not requisite for bone ingrowth in rabbits. J Biomed Mater Res. 2001;58:679-83.
[13] Habibovic P, Gbureck U, Doillon C, Bassett D, Blitterswijk C, Barralet J. Osteoconduction and osteoinduction of low-temperature 3D printed bioceramic implants. Biomaterials. 2008;29:944-53.
[14] Jones AC, Arns CH, Sheppard AP, Hutmacher DW, Milthorpe BK, Knackstedt MA. Assessment of bone ingrowth into porous biomaterials using MICRO-CT. Biomaterials. 2007;28:2491-504.
[15] Botchwey EA, Dupree MA, Pollack SR, Levine EM, Laurencin CT. Tissue engineered bone: measurement of nutrient transport in three-dimensional matrices. J Biomed Mater Res A. 2003;67:357-67.
[16] Bandyopadhyay A, Balla V, Xue W, Bose S. Application of Laser Engineered Net Shaping (LENS) to manufacture porous and functionally graded structures for load bearing implants. J Mater Sci: Mater Med. 2009;20(Suppl 1):S29-34.
[17] Huiskes R, Weinans H, van Rietbergen B. The relationship between stress shielding and bone resorption around total hip stems and the effects of flexible materials. Clin Orthop Relat Res. 1992:124-34.
[18] Kuiper JH, Huiskes R. Mathematical optimization of elastic properties: application to cementless hip stem design. J Biomech Eng. 1997;119:166-74.
[19] Hollister SJ. Porous scaffold design for tissue engineering. Nat Mater. 2005;4(7):518-24.
[20] Hollister SJ, Lin CY, Saito E, Lin CY, Schek RD, Taboas JM, et al. Engineering craniofacial scaffolds. Orthod Craniofac Res. 2005;8:162-73.
[21] Niinomi M, Nakai M. Titanium-Based biomaterials for preventing stress shielding between implant devices and bone. Int J Biomater. 2011;2011:836587.
[22] Kaido T, Noda T, Otsuki T, Kaneko Y, Takahashi A, Nakai T, et al. Titanium alloys as fixation device material for cranioplasty and its safety in electroconvulsive therapy. J ect. 2011;27:e27-8.
[23] Kurtz SM, Muratoglu OK, Evans M, Edidin AA. Advances in the processing, sterilization, and crosslinking of ultra-high molecular weight polyethylene for total joint arthroplasty. Biomaterials. 1999;20:1659-88.
[24] Park HK, Dujovny M, Diaz FG, Guthikonda M. Biomechanical properties of high-density polyethylene for pterional prosthesis. Neurol Res. 2002;24:671-6.
[25] Sobieraj MC, Rimnac CM. Ultra high molecular weight polyethylene: Mechanics, morphology, and clinical behavior. J Mech Behav Biomed Mater. 2009;2:433-43.
[26] Haug RH, Kimberly D, Bradrick JP. A comparison of microscrew and suture fixation for porous high-density polyethylene orbital floor implants. J Oral Maxillofac Surg. 1993;51:1217-20.
[27] Menderes A, Baytekin C, Topcu A, Yilmaz M, Barutcu A. Craniofacial reconstruction with high-density porous polyethylene implants. J Craniofac Surg. 2004;15:719-24.
[28] Baumann A, Burggasser G, Gauss N, Ewers R. Orbital floor reconstruction with an alloplastic resorbable polydioxanone sheet. Int J Oral Maxillofac Surg. 2002;31:367-73.
[29] Hollier LH, Rogers N, Berzin E, Stal S. Resorbable mesh in the treatment of orbital floor fractures. J Craniofac Surg. 2001;12:242-6.
[30] Rudman K, Hoekzema C, Rhee J. Computer-assisted innovations in craniofacial surgery. Facial Plast Surg. 2011;27:358-65.
[31] Naumkin AV, Krasnov AP, Said-Galiev EE, Volkov IO, Nikolaev AY, Afonicheva OV, et al. Carbon dioxide in the surface layers of ultrahigh molecular weight polyethylene. Dokl Phys Chem. 2008;419:68-72.
[32] Sachlos E, Czernuszka JT. Making tissue engineering scaffolds work. Review: the application of solid freeform fabrication technology to the production of tissue engineering scaffolds. Eur Cell Mater. 2003;5:29-39.
[33] Leong KF, Cheah CM, Chua CK. Solid freeform fabrication of three-dimensional scaffolds for engineering replacement tissues and organs. Biomaterials. 2003;24:2363-78.
[34] Suwanprateeb J, Thammarakcharoen F, Wongsuvan V, Chokevivat W. Development of porous powder printed high density polyethylene for personalized bone implants. J Porous Mater. 2011;19:623-32.
[35] Maksimkin AV, Kaloshkin SD, Tcherdyntsev VV, Chukov DI, Stepashkin AA. Technologies for manufacturing ultrahigh molecular weight polyethylene-based porous structures for bone implants. Biomed Eng. 2013;47:73-7.
[36] Kwon JH, Kim SS, Kim BS, Sung WJ, Lee SH, Lim JI, et al. Histological behavior of HDPE Scaffolds fabricated by the “press-and-baking” method. J Bioact Compat Polym. 2005;20:361-76.
[37] Liu X, Ma PX. Polymeric scaffolds for bone tissue engineering. Ann Biomed Eng. 2004;32:477-86.
[38] Suwanprateeb J, Suvannapruk W, Rukskul P. Cranial reconstruction using prefabricated direct 3DP porous polyethylene. Rapid Prototyp J. 2019;26:278-87.
[39] Suwanprateeb J. Tissue integrated 3D printed porous polyethylene implant. Key Eng Mater. 2019;798:65-70.
[40] Ranjan R, Kumar A, Kumar R, Badiyani K. Role of High Density Porous Polyethylene (H.D.P.E) implants in correction of maxillofacial defects and deformity: a review. Int J Pre Clin Dent Res 2015;2(2):71-5.
[41] Suwanprateeb J, Suvannapruk W, Wasoontararat K, Leelapatranurak K, Wanumkarng N, Sintuwong S. Preparation and comparative study of a new porous polyethylene ocular implant using powder printing technology. J Bioact Compat Polym. 2011;26:317-31.
[42] Yaremchuk MJ. Facial skeletal reconstruction using porous polyethylene implants. Plast Reconstr Surg. 2003;111:1818-27.
[43] Mohammadi S, Mohseni M, Eslami M, Arabzadeh H, Eslami M. Use of porous high-density polyethylene grafts in open rhinoplasty: no infectious complication seen in spreader and dorsal grafts. Head Face Med. 2014;10:52.
[44] Liebelt BD, Huang M, Baskin DS. Sellar floor reconstruction with the medpor implant versus autologous bone after transnasal transsphenoidal surgery: outcome in 200 consecutive patients. World Neurosurg. 2015;84:240-5.
[45] Romo T 3rd, Sclafani AP, Sabini P. Reconstruction of the major saddle nose deformity using composite allo-implants. Facial Plast Surg. 1998;14:151-7.
[46] Berghaus A, Stelter K, Naumann A, Hempel JM. Ear reconstruction with porous polyethylene implants. Adv Otorhinolaryngol. 2010;68:53-64.
[47] Lin AY, Kinsella CR Jr, Rottgers SA, Smith DM, Grunwaldt LJ, Cooper GM, et al. Custom porous polyethylene implants for large-scale pediatric skull reconstruction: early outcomes. J Craniofac Surg. 2012;23:67-70.
[48] Janecka IP. New reconstructive technologies in skull base surgery: role of titanium mesh and porous polyethylene. Arch Otolaryngol Head Neck Surg. 2000;126:396-401.
[49] Liu JK, Gottfried ON, Cole CD, Dougherty WR, Couldwell WT. Porous polyethylene implant for cranioplasty and skull base reconstruction. Neurosurg Focus. 2004;16(3):Ecp1.
[50] Rapidis AD, Day TA. The use of temporal polyethylene implant after temporalis myofascial flap transposition: clinical and radiographic results from its use in 21 patients. J Oral Maxillofac Surg. 2006;64:12-22.
[51] Lin IC, Liao SL, Lin LLK. Porous polyethylene implants in orbital floor reconstruction. J Formos Med Assoc. 2007;106:51-7.
[52] Khorasani M, Janbaz P, Rayati F. Maxillofacial reconstruction with Medpor porous polyethylene implant: a case series study. J Korean Assoc Oral Maxillofac Surg. 2018;44:128-35.
[53] Rai A, Datarkar A, Arora A, Adwani DG. Utility of high density porous polyethylene implants in maxillofacial surgery. J Maxillofac Oral Surg. 2014;13:42-6.
[54] Chalasani R, Poole-Warren L, Conway RM, Ben-Nissan B. Porous orbital implants in enucleation: a systematic review. Surv Ophthalmol. 2007;52:145-55.
[55] Rahmani B, Jampol LM, Feder RS. Clinicopathologic reports, case reports, and small case series: peripheral pigmented corneal ring: a new finding in hypercarotenemia. Arch Ophthalmol. 2003;121:403-7.
[56] Park WC, Han SK, Kim NJ, Chung TY, Khwarg SI. Effect of basic fibroblast growth factor on fibrovascular ingrowth into porous polyethylene anophthalmic socket implants. Korean J Ophthalmol. 2005;19:1-8.
[57] Park SW, Seol HY, Hong SJ, Kim KA, Choi JC, Cha IH. Magnetic resonance evaluation of fibrovascular ingrowth into porous polyethylene orbital implant. Clin Imaging. 2003;27:377-81.
[58] Liu XL, Shi B, Zheng Q, Li CH. Alveolar bone grafting and cleft lip and palate: a review. Plast Reconstr Surg. 2017;140:359e-60e.
[59] Wang Y, Zhang Y, Zhang Z, Li X, Pan J, Li J. Reconstruction of mandibular contour using individualized high-density porous polyethylene (Medpor(®)) implants under the guidance of virtual surgical planning and 3D-printed surgical templates. Aesthetic Plast Surg. 2018;42:118-25.
[60] Hart KL, Bowles D. Reconstruction of alveolar defects using titanium-reinforced porous polyethylene as a containment device for recombinant human bone morphogenetic protein 2. J Oral Maxillofac Surg. 2012;70:811-20.
[61] Song JC, Suwanprateeb J, Sae-Lee D, Sosakul T, Kositbowornchai S, Klanrit P, et al. Clinical and histological evaluations of alveolar ridge augmentation using a novel bi-layered porous polyethylene barrier membrane. J Oral Sci. 2020;62:308-13.
[62] Mercier P. Failures in ridge reconstruction with hydroxyapatite. Analysis of cases and methods for surgical revision. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995;80:389-93.
[63] Dewi AH, Ana ID. The use of hydroxyapatite bone substitute grafting for alveolar ridge preservation, sinus augmentation, and periodontal bone defect: a systematic review. Heliyon. 2018;4:e00884.
[64] Kumar P, Vinitha B, Fathima G. Bone grafts in dentistry. J Pharm Bioallied Sci. 2013;5:S125-7.
[65] Felice P, Marchetti C, Piattelli A, Pellegrino G, Checchi V, Worthington H, et al. Vertical ridge augmentation of the atrophic posterior mandible with interpositional block grafts: bone from the iliac crest versus bovine anorganic bone. Eur J Oral Implantol. 2008;1:183-98.
[66] Lin KY, Bartlett SP, Yaremchuk MJ, Fallon M, Grossman RF, Whitaker LA. The effect of rigid fixation on the survival of onlay bone grafts: an experimental study. Plast Reconstr Surg. 1990;86:449-56.
[67] Bhatt RA, Rozental TD. Bone graft substitutes. Hand Clin. 2012;28:457-68.
[68] Pikos MA. Mandibular block autografts for alveolar ridge augmentation. Atlas Oral Maxillofac Surg Clin North Am. 2005;13:91-107.
[69] Sheikh Z, Hamdan N, Ikeda Y, Grynpas M, Ganss B, Glogauer M. Natural graft tissues and synthetic biomaterials for periodontal and alveolar bone reconstructive applications: a review. Biomater Res. 2017;21:9.
[70] Klawitter JJ, Bagwell JG, Weinstein AM, Sauer BW. An evaluation of bone growth into porous high density polyethylene. J Biomed Mater Res. 1976;10:311-23.
[71] Später T, Menger MD, Laschke MW. Vascularization Strategies for Porous Polyethylene Implants. Tissue Eng Part B Rev. 2021;27:29-38.
[72] Sosakul T, Tuchpramuk P, Suvannapruk W, Srion A, Rungroungdouyboon B, Suwanprateeb J. Evaluation of tissue ingrowth and reaction of a porous polyethylene block as an onlay bone graft in rabbit posterior mandible. J Periodontal Implant Sci. 2020;50:106-20.
[73] Hong KS, Kang SH, Lee JB, Chung YG, Lee HK, Chung HS. Cranioplasty with the Porous Polyethylene Implant(Medpor) for Large Cranial Defect. J Korean Neurosurg Soc. 2005;38:96-101.