26th Annual IAA Conference Anaplastology: Beyond the Horizon

CONFERENCE PROGRAM

NH Belfort Hotel Ghent, Belgium May 30–June 2, 2012

Providing Education and Support to Anaplastology

President’s Welcome

Dear Colleagues, As president of the International Anaplastology Association it is my pleasure to welcome you to the 26th Annual IAA Conference in the beautiful city of Ghent, Belgium. This year’s theme Anaplastology: Beyond the Horizon is about how far we have come as an international allied-health field and what we will endeavor to attain for our future. I have witnessed the growth and maturation of the field of anaplastology; forged by the ideas, dedication, and hard work of a global village of highly skilled committed professionals who have enthusiastically supported the anaplastology association throughout the years. We are grateful to ALL who have made their mark on the field. In 1983 when osseointegrated implants became the new standard in implant technology and the personal computer was in its infancy, I was learning laboratory procedures such as electroplating hand molds to produce rotational castings of polyvinylchloride prosthetic gloves. Techniques that came out of post World War II research developed by my mentors Felix B. Weinberg and Carl Dame Clarke. From the beginning of my career I have been Table of Contents keenly aware that there are untold pioneers in the field whose shoulders we stand on and to whom we owe a great debt. 3 Chairman’s Welcome Through generations we have made great strides. Today we take for granted the reliability of craniofacial osseointegration methods established by Professor Per- 4 About IAA Ingvar Brånemark. There are a multitude of applied processes to choose from, 4 IAA’s Leadership that enable the clinical anaplastologist to incorporate computerized advanced technologies into their daily work flow. High-strength silicones simulating the 5 Scientific Advisory spectrophotometric curves of human skin have replaced initial offerings of the Committee modern age of prosthetics—latex and densely opaque silicones—that lacked even a modicum of tear strength. But today, as the lifespan of each new generation of 5 2012 Conference technology becomes ever more abbreviated, the need to stay abreast of current Sponsors and Exhibitors information becomes imperative. 6 General Information I attended my first American Anaplastology Association conference in 1987. The open exchange of information and the warm collegial environment impressed me 6 Awards so much that I have attended every anaplastology conference since then. I hope 6 Thursday Night Dinner you will have a similar experience! Enjoy the convergence of meeting colleagues and friends from around the globe, as you gain insight into cutting edge research, 7 2012 Program Schedule materials and techniques. 11 Plenary Session It is in this spirit that our synergistic efforts combine to create a productive, 15 Invited Speakers stimulating, and informative meeting. We look forward to a bright future that will greatly benefit generations of patients to come. We anticipate your return for our 27th Annual IAA Conference: The Art of Anaplastology, in Nashville, Tennessee! Warm Regards,

Paula Sauerborn, MA CCA IAA President 2011-2012

26th Annual IAA Conference / 1 2 / Anaplastology: Beyond the Horizon Anaplastology: Beyond the Horizon Chairman’s Welcome

Dear Conference Participants, Colleagues, and Friends, As conference Chair, and host of the 26th International Anaplastology Annual Conference, I warmly welcome you to one of the most beautiful historic cities in Europe. In this, the historical heart of Flanders, pounds the heart of a dazzling city where culture and history and business are in perfect balance, a magnetic center for the people of Ghent and for the more than 60,000 students. Ghent University enjoys an international reputation and is a preferred university for prominent scientists. Within this unique background we’re proud, to host “excellence” in Anaplastology. The conference theme, Anaplastology: Beyond the Horizon, was carefully chosen. This conference is a springboard into a future with a wider horizon. With eminent speakers from all over the world as your guide, we will engage you in an amalgam of exciting topics that are both grounded in traditional Anaplastology and that stretch into areas perhaps unknown in your practice today. The current exponential pace of the evolution of science, and medical science is a great challenge for our profession. It should not be seen as a threat, but rather as an opportunity to merge the past and the future to enlarge our activity base, and evolve as an indispensable discipline within the wider field of patient treatment. I have a dream: “That every facial-related department or every orthopedic workshop would have an anaplastologist on the team, that our ability and skills to manipulate and create in a 3D environment would benefit every surgeon, that anaplastology will heighten, even more, the quality of patient treatment. My thanks to all the keynote speakers, all the invited speakers, and all the participants who are contributing to the further development of anaplastology. I also thank the generous support of our all our sponsors and in particular our by Strategic partners: Materialise and Cochlear. Finally, I thank everybody who participated to the organization and made this conference come true. On behalf of the organizing committee, I wish you a successful, interesting and intellectually challenging meeting. Welcome into the heart of Flanders,

Jan De Cubber, CDT Senior Anaplastologist IAA President Elect

26th Annual IAA Conference / 3 general information

About IAA IAA Leadership

The International Anaplastology Association Board of Directors Committee is an international organization founded Chairs in 1980 as the American Anaplastology bylaws and ethics: Association and incorporated in California Anne-Marie Riedinger as a 501c6 Nonprofit Mutual Benefit president education: Corporation. The association originated to Paula Sauerborn Juan Garcia bring together a wide variety of specialists future sites: involved in providing restorative prostheses Paula Sauerborn for patients with facial and somato disfigurements due to cancer, trauma, or president-elect international journal of anaplastology: congenital origin. Jan De Cubber Robert Mann

IAA’s Mission legislation/advocacy: Julie Jordan Brown The IAA promotes quality patient care immediate past president membership co-chairs: by supporting the development of best Anne-Marie Riedinger Gillian Duncan, practices in anaplastology through Anne-Marie Riedinger educational conferences, networking, newsletter: publication, and advocacy opportunities. Akhila Regunathan vice president elect Jay McClennen IAA’s Vision nominations: Anne Marie Riedinger The International Anaplastology program/site: Association is the recognized global forum Jan De Cubber for excellence in continuing education, secretary research, and innovation in anaplastology. Amanda Behr public relations and communications: Sharon Haggerty The IAA embraces these core values: sponsorship: treasurer Joern Brom To create an intellectual climate where Paul Tanner website: members can come from diverse Paul Tanner professions and turn information into knowledge. To introduce old and new members to ideas director that will encourage critical thinking. Susan Habakuk To provide a respectful atmosphere in which members express their view, show their work and listen and learn from the work and director views of others. Joern Brom

4 / Anaplastology: Beyond the Horizon general information

2012 Conference Sponsors and Exhibitors

Strategic Partners Industry Members

Cochlear Technovent Ltd. Cochlear AG EMEA Headquarters Unit 5 Kingsway Buildings Peter Merian-Weg 4, CH-4052 Basel, Bridgend Industrial Estate Switzerland Bridgend CF31 3YH +41 61 205 0404 UK http://www.cochlear.com +44 (0)1656 768566 Scientific Advisory Cochlear™ is the global leader in [email protected] Committee implantable hearing solutions and http://www.technovent.com implant retained prosthesis for Technovent Ltd. provides the craniofacial rehabilitation. Over complete solution for all aspects of Dr. Kerstin Bergrstrom 25 years Cochlear has helped over maxillofacial prosthetics. Our highly Dr. Richard Bibb 250,000 people either hear for the durable, titanium-based Magnacap Mr. Alan Bocca first time or reconnect them to their Magnetic Attachment System now families, friends, workplaces and incorporates a new and innovative Mr. Trevor Coware communities. Auricular Magnet design. The Mr. Peter Evans product range also includes specially formulated silicone materials, Dr. Jules Pouckens Materialise NV coloring systems, skin adhesives and Technologielaan 15 Dr. Harry Reitsema other patient care products. 3001 Leuven Ms. Rosemary Sealaus Belgium Dr. Joacim Stalfors +32 16 39 66 11 steco-system-technik Dr. Adrian Sugar [email protected] Kollaustr 6 http://cranio-maxillofacial. Hamburg 22529 Dr. Robert Van Oort materialise.com/contacts- Germany Ms. Suzanne Verma locations-4 +49-40-5577810 [email protected] Mr. Steve Worollo With SurgiCase Anaplastology, Materialise equips anaplastologists http://www.steco.de Dr. Phillip Federspil and surgeons with a communication Titanmagnetics are a bi-magnetic Ms. Julie Jordan Brown tool to pre-operative plan implant system used to retain nose, ear, eye Ms. Gillian Duncan systems for bone-anchored prostheses or to couple multipart prosthetics. facial prostheses and obturators. Mr. Steve Gray u Virtual surgery planning services The magnet core is corrosion Ms. Susan Habakuk proof laser welded in titanium. u Pre-operative planning software Dr. Marcelo Ferraz de Oliveira Titanmagnetics fit to most implant for optimal implant placement and miniplate systems for facial Prof. Hubert Vermeersch u Design of patient specific guides prosthetics like Vistafix (Cochlear), Prof. Phillip Blondeel for implant localization and Straumann EO, Epiplating (Medicon) Prof. Vincent Van der Poorten orientation or Lasak. Prof. Jos Claes u Create prosthetic models by mirroring the patient’s anatomy Dr. Thomas Somers Exhibitors Prof. Joseph Schoenaers Cochlear Dr. Monique Decat Materialise NV Prof. Benoit Lengelé Technovent Ltd. Prof. Eric Vandenkerckhove steco-system-technik Prof. Louis Peeraer Walter Spohn Education Fund Mr. Keith Thomas Dr. Jos De Jong Prof. Peter Kessler Dr. Doke Buurman Prof. Pierre Garin

26th Annual IAA Conference / 5 general information

General Information Awards Cameras and video recorders are not IAA Walter Spohn Award gives special recognition for excellence in permitted during any scientific sessions, innovation, outstanding research and contributions to the profession. including general sessions, poster It was named after Walter Spohn, whose enthusiasm for his profession presentations, and workshops. Your and passion to share his knowledge with others lead to the founding of cooperation is appreciated. Use of cell the International Anaplastology Association in 1980. phones and other electronic devices is IAA Literary Award is awarded annually for the best article published prohibited in scientific sessions. Your in the International Journal of Anaplastology (IJA) by a member or cooperation in turning such devices to the non-member. off position is appreciated. IAA Research Award is awarded for innovations in materials or Speaker/Presenter techniques, which benefits the field of Anaplastology. Disclosure Declaration IAA Humanitarian Award is presented in recognition of volunteer It is the policy of the International services, which benefit patients. Anaplastology Association that speakers disclose to the program audience any real or apparent conflict(s) of interest that Thursday Night Dinner may have a direct bearing on the subject matter of the continuing education Join us Thursday night for the Annual IAA Awards Dinner, which will program. This pertains to relationships begin a 20.00. The dinner will be held near the hotel at the Foyer with vendors, biomedical device Restaurant, Sint-Baafsplein 17, Ghent. manufacturers, or other corporations whose products or services are related to the subject matter of the presentation topic. The intent of this policy is not to prevent a speaker with a potential conflict of interest from making a presentation, it is merely intended that any potential conflict be identified openly so that listeners may form their own judgments about the presentation with the full disclosure of facts. The IAA assumes no responsibility for the written quality and content of abstracts. It is the sole responsibility of the author to ensure that abstracts are accurate and in their final edited form.

6 / Anaplastology: Beyond the Horizon 2012 Program Schedule

2012 Program Schedule (subject to modification)

wednesday, May 30 pre-conference course: Rehabilitative Treatment Planning And Implementation in the Digital Age Theory Session

07.15 am Departure from Belfort Hotel, Ghent 08.00 - 09.00 Registration at Materialise/Coffee 09.00 - 09.15 Welcome CEO Materialise, Conference Chair, Jan De Cubber 09.15 - 09.35 Product Presentation Materialise 09.35 – 09.55 Product Presentation Cochlear 09.55 – 10.15 Product Presentation Technovent 10.15 – 10.30 Division into three sub-groups 10.30 – 12.30 Discussion of case treatment (two cases for each group) moderators: Jan De Cubber, Joacim Stalfors, Steve Worollo 12.30 – 13.30 Lunch (optional visit to Materialise workfloor in small groups) Practical Session: Hands-on Workshop

13.30 – 13.35 Split into three groups (same groups as the morning sessio n) 13.35 – 14.35  workshop round 1: Pre-operative Planning (Materialise staff) and Surgical procedure hands on with model (Cochlear staff) 14.35 – 15.35  workshop round 2: Pre-operative Planning (Materialise staff) and Surgical procedure hands on with model (Cochlear staff) 15.35 – 15.45 Coffee Break 15.45 – 16.45 workshop round 3: Developing the prosthesis (Technovent staff) 16.45 - 17.00 Discussion and Close 17.15 Travel back to Gent, Belfort Hotel

During the morning, attendees will be immersed in an academic session. Participants will learn about Technovent’s new attachment system as well as a new implant system with redesigned abutments from Cochlear, then Materialise leads you through software Participants will receive designed for the clinical anaplastologist. Particpants will step through the software’s a model as shown below Anaplastology wizard to acheive optimal pre-surgical planning. The academic session is followed by practical application for an actual patient situation. In this hands-on part of the course you will create your own pre-surgical planning, perform surgery on an model of a skull and learn how to position a magnetic retention system for an auricular epitheses. This model can be used as a valuable visual aid to demonstrate treatment planning for your future patients.

26th Annual IAA Conference / 7 2012 Program Schedule

2012 Program Schedule (subject to modification)

wednesday, May 30 Welcome Reception at the NH Belfort Gent Hotel Welcome Reception for ALL Conference and Preconference Course Attendees 18:30 – 20:30 Conference Registration 19.00 – 20.30 Conference Welcome Reception

thursday, May 31 Scientific Session DAY ONE

Surgical (session chair: Vincent Vander Poorten)

07.30 - 08.30 Check-in 08.30 - 08.40 Paula Sauerborn President’s Welcome Address 08.40 - 08.50 Jan De Cubber Conference Chair’s Welcome Address 08.50 - 09.15 Hubert Vermeersch Reconstructive Possibilities of the Face: State of the Art 09.15 - 09.30 Benoit Lengelé Facial Allotransplants: Historical Overview 09.30 - 09.45 Phillip Blondeel The Importance of 3D Modeling in the Pre-operative Planning of Complex Facial Reconstruction by a Vascularized Composite Tissue Allotransplantation of the Face. 09.45 - 10.00 Jan De Cubber Facial Allotransplants: The Role of the Anaplastologist 10.00 - 10.30 Break and Exhibit Review

Medical (session chair: Vincent Vander Poorten)

10.30 - 10.45 Luc Colenbie The Future Impact of Composite Tissue Allograft Transplants 10.45 - 11.15 Anders Tjellström Facial Osseointegrated Implants: More Than an Alternative 11.15 - 11.30 Peter Kessler Overview: Oncology of the Face 11.30 - 11.45 Gaston Bernier Mastoid Micro Bone Graft for Implant- Retained Ear Prostheses 11.45 - 12.00 Elana Lactan Nasal Pyramid Reconstruction Method 12.00 - 12.15 Mark Flynn Development of a New Implant System for Bone Anchored Craniofacial Prostheses 12.30 - 13.30 Lunch Surgery, Prosthetics, & Technology (session chair: Rosemary Seelaus)

13.30 - 13.55 Joacim Stalfors The Importance of Implant, Abutment and Retention Properties for Clinical Success 13.55 - 14.10 Kerstin Bergström A Lifetime with a Facial Prosthesis 14.10 - 14.25 Thomas Somers Auricular Autologous Reconstructions for Major Ear Malformations: A Global Approach 14.25 - 14.40 Vincent Vander Poorten Surgical Preparation for Mid-face Prosthetic Reconstruction

8 / Anaplastology: Beyond the Horizon 2012 Program Schedule

2012 Program Schedule (subject to modification)

thursday, May 31 14.40 - 14.55 Michaela Calhoun The Cost of Going Digital, Part 1: continues Options and Expenses 14.55 - 15.10 Erin Stevens The Cost of Going Digital, Part 2: Benefits and Solutions 15.10 - 15.25 Bart Vanderschueren Rapid Prototyping: State of the Art 15.35 - 16.00 Break and Exhibit Review 16.00 - 16.15 Carsten Engel World Premiere: The First 3D Printed Lower Jaw Implant 16.15 - 16.30 Hein Daanen Surface Scanners 16.30 - 16.45 Frans De Beer Fablab: A Worldwide Web 16.45 - 17.00 Miranda Bastijns Craftsmanship and Haute Couture: Additive Manufacturing Sets New Standards evening Free

friday, June 1 Scientific Session DAY TWO Osseointegration & Somato Prosthetics (session chair: Juan Garcia)

08.30 - 09.00 Louis Peeraer Future Advances in Technical Orthopedics 09.00 - 09.30 Rikard Brånemark Osseointegration in Limb Prostheses 09.30 - 09.45 Wim Vanhove Osseointegration in Limb Prostheses: Preliminary Results 09.45 - 10.00 Steven Gray Implant-Retained Orthopedic Limb Prostheses 10.00 - 10.30 Break and Exhibit Review 10.30 - 10.45 Keith Thomas Implant Retained Finger Epitheses 10.45 - 11.00 David Robinson The Implementation of High Consistency Silicones in the Orthopedic Workshop 11.00 - 11.30 Table Panel Discussion Should There Be an Anaplastologist in Every Orthopaedic Workshop? participants: Susan Habakkuk, Julie Gordon Brown, Jiri Rosicky, Keith Thomas moderator: Jan De Cubber 11.30 – 11.45 Anne-Marie Riedinger Achieving a Realistic Nasal Prosthesis 11.45 - 12.00 Lindsay McHutchion Thresholds of Perceivable Color Difference in Silicone and Establishing a Clinical Standard for Acceptable Color Differences in the Production of Silicone Facial Prostheses: A Pilot Study 12.00 - 12.15 Kuldeep Raizada Replacement of Ocular Prostheses in Children 12.15 - 12.30 Louise Desmeules Nasal Obturator for Rendu Osler Weber Disease 12.30 - 13.30 Lunch

26th Annual IAA Conference / 9 2012 Program Schedule

2012 Program Schedule (subject to modification)

friday, June 1 Anaplastology: Beyond the Horizon continues (session chair: Alan Bocca)

13.30 - 14.00 Eric Vandenkerckhove The Conservative Treatment of Severe Scars: State of the Art and Guidelines 14.00 - 14.15 Jan Schrama The Implementation of Silicones in Foot Prostheses 14.15 - 14.30 Jay McClennen Forensic Art: A Role for the Anaplastologist? 14.30 - 14.45 Frans De Roeck Direct Modeling in Silicone for Complex Models 14.45 - 15.15 Dawn Forsaw Medical Tattooing in Scar Management 15.15 - 15.30 Maarten De Jong Ameloblastoma Treatment Using Low-cost 3D Technology 15.30 - 15.45 Julian M. Yates CAD/CAM Design and Manufacture of Maxillofacial Soft Tissue Prostheses Using 3D Color Printing 15.45 - 16.00 Yvonne Motzkus Managing Difficulties of Bone-Anchored Prostheses for Extensive Cranio-Facial Defects 16.00 - 16.15 Ricardo Reis New Digital Techniques in the Manufacturing of Orbital Prosthesis: Development and Evaluation 16.15 - 16.30 Gillian Duncan Trouble Shooting Facial Prosthetic Retention Problems: A Checklist 16.30 - 16.45 Jan De Cubber Closing of the Scientific Presentations (Conference Adjourns) 17.30 - 19.00 IAA Annual Business Meeting (Members Only) 20.00 - 23.00 Awards Banquet, The Foyer Restaurant

saturday, June 2 Demonstrations/Workshops DAY THREE There will be four rotating demonstrations/workshops, with a short break after the first two. Demonstrations/Workshops (Rotations at all stations)

10.00 - 10.45 Dawn Forsaw Medical Tattooing 10.45 - 11.30 Maarten Zandbergen Anaplastology Planning Software 11:30 - 11:45 Break 11.45 – 12.30 F. De Roeck/M.De Jong Donor Facial Reconstruction Mask after Allograft 12.30 – 13.15 G. Westrup Low-Cost Printing

10 / Anaplastology: Beyond the Horizon plenary session thursday, may 31, 08.50-09.15

Prof. Hubert Vermeersch, MD, PhD

Reconstructive Possibilities of the Face: State of the Art

abstract: This talk gives an overview for the anaplastologists on the up-to-date reconstructive procedures for facial defects. The procedural details of these reconstructive procedures will be addressed by the speakers following this first talk, which will only highlight and introduce the principles. Loco regional flaps are still very much used due to the color match and texture of the neighboring skin. Nevertheless, microvascular tissue transfers have become more and more important. Epitheses are very much needed for structural defects with delicate anatomical structures like the ear, orbit, and nasal area.

biography: Professor Dr. Hubert Vermeersch is currently Head of the Department for Head and Neck Surgery of the Gent University Hospitals and Academic Departmental Head of the Nose, Ear, Throat and Logopaedics and Audiology Department of the Ghent University. He is also heavily involved in academic training of plastic and reconstructive surgeons in Southern Countries through his project--The Creation of a Reference Centre for Craniofacial Anomalies and for the treatment of Benign Mandibular Tumors in Kampala, Uganda. He finished his medical studies in 1975, got his board certification for ENT in 1980, finished a two year fellowship for ear surgery with Prof. Paparella at the University of Minneapolis, Minnesota (1980-1982) and worked as an associate professor at the Ghent University ENT department until 1988. Between 1989 and 1995 he trained to become a board certified (1995) Plastic Surgeon after which he started the Head and Neck Surgery Department at the Ghent University Hospitals until today. He is the author of 89 international peer-reviewed publications. His current surgical work is mainly in the field of facial reconstructive surgery using conventional techniques and CTA (composite tissue allograft).

26th Annual IAA Conference / 11 plenary session thursday, may 31, 10.45-11.15

Prof. Anders Tjellström, MD, PhD, DSchc

Facial Osseointegrated Implants: More than an Alternative

Implant Unit Sahlgrenska University Hospital Göteborg, SWEDEN

abstract: In this keynote lecture I will share my experience in this field of rehabilitation. It is said that the face is the mirror of our soul. A face shown for less than one second we are able not only to notice, but in fact also evaluate the person. We also often make the same evaluation even when we have the chance to observe the face for a longer time. This is somewhat scaring. The face is only a superficial, but of course an important part of a person. The majority of his/her personality is however under the surface and easily seen as the major part of an iceberg. This has to be taken into account when we are discussing treatment options with our patients. What are the expectations? Are we providing our patients with the best alternative? Do we listen to what rehabilitation the patients really want to get or are we too much focused on our own technical solutions? Plastic surgery or non-implant retained prostheses might be the best alternative. The treatment team should listen to the patient! Today we will discuss the implant retained prostheses that is more than just a cosmetic alternative.

biography: Prof. Dr. Tjellström got his medical education at the University of Göteborg, Sweden. In 1972 he joined Professor Brånemark and wrote his PhD thesis on preformed middle ear ossicles. In 1977 he performed the first extra oral implant surgery for the bone anchored hearing aid—Baha—at the Department of Otolaryngology, Sahlgrenska University Hospital, Göteborg. The concept of implant retained craniofacial prostheses was introduced in 1979. At the Implant Unit many patients with cranio-facial defects have been treated. A close cooperation between the surgeon and the anaplastologist has become the hallmark of our Unit. This has been especially important in the treatment of major facial defects mainly after malignant tumor surgery and trauma. Dr. Tjellström has been teaching a large number of workshops at our unit and elsewhere. He has published more than 150 scientific papers mainly in the field of implantology. Recently he was presented an honorary doctors degree from Chalmers University of Technology. He is Head of the Implant Unit at the Department of Otolaryngology, Sahlgrenska University Hospital.

12 / Anaplastology: Beyond the Horizon plenary session friday, june 1, 08.30-09.00

Prof. Ing. Louis Peeraer

Future Advances in Technical Orthopedics

abstract: Rebuild the human limbs or whole body, augment motor power and capacities to a super human level, bring paralyzed muscles back to life, drive a powerful machine just as it would be part of the body, see, feel and scent better than any biological creature can . . . it is a long standing dream of mankind that is illustrated in science as well as in art. Science fiction fed our fantasy of what could possibly be achieved by shaping super creatures integrating technology that was still to be developed. But how far are we now? What’s the realistic near future perspective? Is it just interfacing with powerful machines, or are the perspectives in sensing, emotions and communication just as important? These are the questions addressed during the lecture.

biography: Louis Peeraer holds a PhD in Rehabilitation Sciences from the Katholieke Universiteit Leuven (Belgium) and has been involved in many research projects integrating new technologies in rehabilitation sciences for more than 25 years. He has a special interest in interfacing orthopedic appliances to the human body, in the design of lower limb prosthetics—in particular computer controlled knee systems, the design of innovative lower limb orthotics, and the development of new production techniques and assessment tools. He is currently a professor at the Katholieke Universiteit Leuven, FaBeR, on the faculty of Kinesiology and Movement Sciences, Research coordinator Health & Care, and head of the Multidisciplinary Research Lab for Biomedical and Rehabilitation Technology MOBILAB (www.Mobilab-khk.be) at the KH Kempen University of Applied Sciences. He also holds the Chair on Health, Innovations and Technology (HIT) at the Fontys University of Applied Sciences Eindhoven, The Netherlands.

26th Annual IAA Conference / 13 plenary session friday, june 1, 09.00-09.30

Rickard Brånemark, MD PhD

Osseointegration in Limb Prostheses

abstract: Problems related to suspension of conventional socket prostheses have lead to a desire to have the artificial limb attached directly to the residual skeleton. The discovery that implants made of commercially pure titanium can provide a stable anchorage of the implant in bone tissue was made by Professor Per- Ingvar Brånemark during the 1950s and the concept of osseointegration has been in successful clinical practice for dental applications since 1965. The method of osseointegration is also successfully used for permanently skin-penetrating applications in the head and neck area including treatment with bone-anchored hearing aids and for anchorage of prosthetic ears and eyes. Treatment with major bone-anchored amputation prostheses using osseointegration (OI-prostheses) has been performed in Sweden since 1990. More recently centers in the United Kingdom, Australia, Spain, Hungary, France, Chile, Denmark, Belgium, and Holland have started to use the treatment. In 1999, a prospective clinical investigation named OPRA (Ossseointegrated Prosthesis for the Rehabilitation of Amputees) was started at the Sahlgrenska University Hospital in Göteborg, Sweden on patients treated with transfemoral OI-prostheses. In accordance with the OPRA protocol patients are treated in two surgical sessions followed by rehabilitation with a total treatment period of approximately 12 months. At the first surgery (S1) a titanium implant (fixture) is inserted in the residual bone and left unloaded for about six months. At the second surgery (S2) a titanium rod (abutment) is inserted into the distal end of the fixture and is then penetrating the skin. The external prosthesis is connected to the abutment with an attachment device. After S2 the patient undergoes a period of rehabilitation during four to six months with gradually increased weight bearing and prosthetic activities. The risks associated with the treatment are loosening, deep infection, superficial infections, skeletal fracture, and mechanical failure of the implant system. The benefits are in many instances related to the removal of the socket as attachment of the prosthesis to the stump. The amputee no longer has skin sores, pain when loading, and problems with stump volume changes. Further, normal sitting comfort and normal hip range of motion can be expected. All these changes lead to a significantly improved quality of life for the individual with a transfemoral amputation. Also other amputation levels can be treated such as thumb, finger and arm amputations.

biography: Rickard Brånemark is trained as an orthopaedic surgeon specializing in the treatment of amputees using osseointegrated implants.

14 / Anaplastology: Beyond the Horizon invited speakers

Prof. Benoît Lengelé, MD Pomahac & Pribasz, Blondeel et al.). Phillip Blondeel, M.D., PhD* Finally, the increasing evidence of the Facial Allotransplants: reliability and versatility of the technique Hubert Vermeersch, MD, PhD Historical Overview led several teams to perform full face thursday, may 31, 09.15-09.30 transplants, as full-thickness soft tissue Nathalie Roche, MD abstract: allografts (Type Va: Lantieri et al., Pomahac et al.) or bone-bearing face Filip Stillaert, MD In the beginning of the 21st century, grafts (Type Vb: Barret et al., Rodriguez the idea of successfully performing a et al.). Upper face transplants (Type III) or The Importance of face transplantation for a human still hemifacial grafts (Type IV) have not been 3D-Modeling in the belonged to the putative universe of done yet. Pre-operative Planning literature legends or science fiction of Complex Facial movies. The feasibility of the procedure, Up to now, 20 face transplantations procedures have been carried out Reconstruction by a however, had been questioned then Vascularized Composite demonstrated in animal models. But its worldwide. Among the recipient patients, transfer in human clinical practice was only two died, as far as we know. Most of Tissue Allotransplantation still regarded as extremely controversial them, however experienced some weak (VCTA) of the Face because of numerous major ethical or more severe medical complications thursday, may 31, 09.30 -9:45 related to the immunosuppressive concerns raised in terms of impaired long abstract: term graft survival, uncertain cost-benefit treatment. Nevertheless, those Introduction: Extreme trauma to the balance, high risk of donor identity brave patients get all the benefit of central part of the face is difficult to transfer, and presupposed low rate of an impressive gain in their quality of reconstruct with traditional autologous neuropsychological acceptance. life. Although the field of FAT is still in constant progress, its ground breaking pedicled or free flaps. The only way to In 2005 the first human face introduction in the armentarium of the restore vital facial functions as breathing, allotransplantation (FAT) carried on reconstructive surgery has brought a speech, mastication, swallowing and in Amiens (Devauchelle, Lengelé & major step forward in pushing beyond non-verbal communication in one single Dubernard) demonstrated that the the ancient boundaries of flap surgery, procedure is to perform a VCTA of the majority of these obstructive concerns the limits of what is possible in facial face. were invalid and that: restorative procedures. Furthermore, Method: A 56 year-old man, victim of a • face transplants were surgically this historical adventure of modern ballistic trauma, lost his maxillo-facial reliable and provided a better multidisciplinary medicine, which bony structure from the skull base aesthetic and functional restoration received a large media attention and down, in addition to his left mandible. of the severely disfigured face coverage, has created new hopes for All soft tissues in the central and lower than conventional reconstructive many severely disfigured patients. two-thirds of the face were absent procedures; or severely damaged except for his biography: • rejection of face allografts could tongue and soft palate. A temporary be prevented by a conventional Benoît Lengelé is an anatomist and plastic solution to reconstruct the nasal and immunosuppressive treatment without surgeon. In his PhD thesis he studied oral cavity was provided by a plicated increasing the risk of life-threatening the neurodevelopmental mechanisms free ALT flap. Digital subtraction of the complications at a higher rate than of cephalogenesis and described the 3D-reconstruction of the skull of the son in other well-accepted visceral segmental organization of the human of the patient from the 3D-reconstruction transplantations (kidney, heart, and face. This knowledge led him to develop of the skull of our patient, made it liver); new techniques in facial reconstructive possible to recreate the 3D model of microsurgery, then to be involved in the • Thanks to their surgically restored the missing bone and to create jigs that scientific planning and surgical realization nervous relationships with the guided the osteotomies both for the of the first human face transplantation brain, the face grafts became really donor and the acceptor. Multiple cadaver carried out in Amiens, France, on reintegrated in the recipient motor dissection sessions were performed to November 27, 2005. and sensitive brain cortex, without any familiarize the team with the osteotomy morphological identity transfer from Chairman in Human Anatomy at the techniques and the soft tissue dissection. the donor. Catholic University of Louvain, he is also Results: In a 20-hour surgical procedure, the head of the UCL Plastic Surgery Historically, the first face allografts the largest amount of bone ever was division, in Brussels. Author of 140 peer- (FAGs) were segmental allografts and allo-transplanted together with the soft reviewed papers (cumulative IF: 230), included only the soft tissues of the lower tissues of the entire lower two-thirds he received numerous scientific awards face (type Ia: Devauchelle & Lengelé, of the face. Vascular anastomosis was (SOCFPRE, EURAPS, Hans Anderl) and Lantieri & Méningaud) or from the performed on both facial arteries and honorary fellowships (RCS (eng.), EAFPS, midface (type II a: Guo et al.) Further veins. Minimal adjustments needed to be AAFPS). Visiting Professor of Surgery experiments involved larger grafts done to the transplanted bony complex at Harvard Medical School (2008), supported by bone segments harvested to achieve perfect fitting in the acceptor. member of the Royal Belgian Academy from the mandible (type Ib: Devauchelle Survival of the graft was complete and no of Medicine, he was ennobled in 2009 by & Lengelé, Cavadas & Landin) or from acute rejection was diagnosed so far. The H.M. King Albert II. the maxilla (type II b: Alam & Siemionow,

26th Annual IAA Conference / 15 invited speakers patient starting drinking and speaking at surgery in his 17-year career. Phillip was Jan will be the president of the p.o. day 6. the initiator of the first Vascularized International Anaplastology Association Conclusion: The first VCTA face Composite Tissue Allotransplantation in 2012-2013. transplant in Belgium (#19 in the world) (VCTA) of the Face in Belgium in was successful because of a meticulous December 2011. Luc Colenbie three-year planning with a large team. 3D-modeling and preparatory cadaver Jan De Cubber, CDT, The Impact of Composite dissections have proven to be essential anaplastologist Tissue Allograft Transplants for a fluent intra-operative course and a superb bony alignment. on Our Future Facial Allotransplants: The thursday, may 31, 10.30-10.45 biography: Role of the Anaplastologist In the past 50 years there has been a Born in Rochester, N.Y. (USA) on May thursday, may 31, 09.45-10.00 tremendous evolution in transplant 20th, 1963 and mainly raised in Belgium, The role of the anaplastologist in facial surgery, since the first heart that gives Phillip Blondeel resides and practices allograft transplantation is relatively patients a new life. The reintegration and now plastic, reconstructive and aesthetic new in our discipline. The skills and the active participation in society became surgery in both Ghent, Belgium and knowledge of the anaplastologist are extremely important towards these Montreux, Switzerland. He studied crucial in the production of the donor’s patients. Beside this, reducing the disease medicine and trained in plastic surgery facial reconstruction mask after removal costs (e.g., termination of dialysis after in Leuven, Belgium and Frankfurt, of the graft on donor side. kidney transplantation) worked as a Germany. He graduated in 1994 and After a three-year multidisciplinary benefit for the Belgium government to obtained his Ph.D. degree ‘maxima cum preparation, including several cadaver stimulate future transplant programs. laude’ as doctor in medical sciences in studies, we learned that the synergy of Recently a new type of transplant, the 1998. Phillip Blondeel is vice-chairman anaplastology, plastic, head and neck Composite Tissue Allograft Transplants, since 1996 and professor of Plastic surgery had an important impact on the made its entry on the field. At the Surgery since 2000 at the department protocol: end of last year, the first successful of Plastic Surgery in Gent, Belgium. He • the design and the realization of the facial transplant in Eurotransplant was is a Diplomat of the European Board of graft transport medium. performed in Ghent. This success was Plastic, Reconstructive and Aesthetic only possible by the perfect cooperation Surgery (EBOPRAS) since 1994 and • the development and implementation between the various medical services. member of numerous societies: treasurer of a production protocol of the donor As transplant coordinator Colenbie was of the Belgian Society for Plastic Surgery, facial reconstruction mask. proud to coordinate this. The preparation, member of the Swiss, American and • the pre-operative planning and which includes making a timetable to European Society for Plastic Surgery, realization of surgical 3D aids. prevent any loss of organs, was worked the American and World Society of The reward of this meticulous out thoroughly. The donor management in Reconstructive Microsurgery and preparation was the successful treatment the operating room was equally important honorary member of the Canadian and of the first Belgian facial transplant at as the donor was on intensive care due to South-African Society of Plastic Surgery. the University Hospital in Gent/Belgium. the long time needed for prelevation of At present, Prof. Blondeel is member Due to the increasing number of facial the face. of the editorial board of ‘Plastic and composite tissue allografts worldwide, The first and most important step Reconstructive Surgery’, the Journal of the role of the anaplastologist will grow. to the whole procedure is the contact Plastic, Reconstructive and Aesthetic The results of our recent experience with the donor family. Because of the Surgery, the Journal of Reconstructive could help your practice tomorrow. Microsurgery and the European Journal good legislation in Belgium (presumed of Plastic Surgery. He is author of 6 books, biography: consent), organ donation is not a taboo 21 chapters in books and about 120 peer- After his training in dental, facial, and anymore. Thanks to sensibilisation of reviewed articles. orthopedic prosthetics, De Cubber patient groups, donor families, transplant became an expert in prosthetics with coordinators, and the start of a national Prof. Blondeel is world renown for international fame. His devoted research donor action project in all hospitals, his contributions in reconstructive and development in the chemistry of Belgium ranks first in the world in organ and aesthetic breast surgery. He silicone led to many new techniques donation. The low percentage (15%) of is one of the pioneers in so-called and medical aids. He was the founder of family refusal is partly attributable to “perforator flap” surgery and was the Silicone House. the European Donor Hospital Education first surgeon in Europe to apply the Program financed by the government “perforator flap” principle in breast Currently he focuses his attention to for doctors and nurses of intensive reconstruction in December 1993. He the Centre of Craniofacial Epithetics. This care. Aftercare for the donor family teaches reconstructive and aesthetic center has become one of the biggest with correct information regarding the breast surgery continuously at his own facial units in the world, with satellites in followup of the transplanted organs is institution and as invited speaker at many Gent (B), Maastricht (NL) and the central very important. universities and conferences all over lab in Brussels (B). They focus strongly on the world. He won numerous awards implementing 3D technology into their The acceptance of the Composite and distinctions in the field of breast routine production protocols. Tissue Allograft transplantation in society

16 / Anaplastology: Beyond the Horizon invited speakers can be stimulated by transplanted from underlying structures such as the Methods & Materials: A bone graft patients and donor families. The respect soft tissue linings of the oral cavity or the protocol was designed to raise the toward the donor body, which has a paranasal sinuses. thickness to 5-8 mm, at the optimal legislative framework, should be priority. Common to all these cancers is planned fixture localization for esthetic The anaplastologists who perform that they affect the outer appearance and function. Graft was limited to 8 mm. reconstruction carry a great responsibility of the patient. All therapy strategies At CHUQ hospital, 3 patients without and their role is very important. Due to have to encounter this functional and external ear received autogenous bone the significance of these transplants and aesthetical challenge. There are therapy graft at ideal sites. One experienced reconstructions, there is the need for a guidelines for nearly all situations. severe skin burn, and two had a car financial regulation. However, combined therapies extend accident. No diabetes, two smokers, no steroid users. biography: the possibilities of oncological treatment today to prolong the life expectancy of Results: Graft healing was allowed 5 to 7 Luc Colenbie has been a Transplant patients suffering from these cancers. months before fixture surgery. All three Coordinator since 1994. Previously he gained sufficient bone to receive a 4 mm worked as a nurse on the intensive care Prevention should be emphasized to depth implants in two sites. Conventional unit of the University Hospital in Ghent avoid cancer in the face. Skin cancers and round gold bar, acrylic plate with clips (1983-1194). certain cancer entities of the oral cavity are relatively easy to prevent. Knowing and silicone ear prosthesis were made. Other qualifications include the the shortcomings and side effects of Observation period last from 10 years to following: cancer therapy in the facial region we are one year. All implants were in function. No • Training course on Transplant obliged to inform our patients to the best bone infection, no bleeding, no audiologic Coordinator in Barcelona 1998 of our knowledge how to avoid (concept impairment. Hip pain was the major side • Certificated European Transplant of healthy living). effect. Coordinator Lisbon 2001 Conclusions: For silicone ear epithesis, biography: • Ex-Member of the Eurotransplant thickness of some mastoid is so thin Procurement Committee 2000-2004 Born in Germany, Kessler studied that fixture surgery is not indicated. The dentistry and medicine at the Friedrich- • Past President of the Belgium possibility of a bone graft may be the Alexander-University in Erlangen/ Transplant Coordinators 2004 - 2009 only option to anchor an ear prosthesis. Nürnberg. Then he went to Lucerne/ Mastoid (temporal) small bone graft is a • Member of the Belgium Council 2004 - Switzerland to start his specialization. In 2008 good option for hollow temporal bone 1998 he returned to Erlangen University. at ideal implant site. In this protocol, • Member of the Belgium Transplant In 1999 Kessler passed the examinations methodic efforts allow success with micro Society (since1994) as Oral and Maxillofacial Surgeon then graft (< 8mm). • Member of the financial committee in 2003 specialization for Plastic Surgery. Clinical Implication: Patients with Eurotransplant Belgian delegate (since Scientific career: Dr. Med. Dent. in dental extremely pneumatized mastoïd may 2008) sciences 1986, Dr. Med. in the medical receive implants at ideal sites. • Associate as expert of the Ministry of field in 1997. In 2001 received the venia Health Belgium (since 2011) legendi at the Friedrich-Alexander- biography: University (PhD, Habilitation). In 2007 • Secretary of the Belgium Council Dr. Gaston Bernier is the head of the he was elected head of the department (since 2011) oncology dental service at CHUQ Cranio-Maxillofacial Surgery at Maastricht Hospital in Quebec, Canada. • Belgian delegate, European committee University (MUMC). on organ transplantation (since 2011) Elena Latcan, MD, PhD Gaston Bernier, MD Prof. Peter Kessler, MD, PhD Medical Center Prain for a Normal Mastoid Micro Bone Graft Hearing and Look, Ltd. Overview of Oncology for Implant Retained Ear Bucharest, Romania in the Face Prosthesis thursday, may 31, 11.15-11.30 Nasal Pyramid thursday, may 31, 11.30-11.45 Reconstruction Method abstract: abstract: abstract: Skin cancer is a lifestyle disease, affecting Purpose: Facial cancer, trauma and This paper describes different young women, older men and everyone congenital agenesis may affect the rehabilitation-reconstruction methods in between. One in five Europeans will integrity of the ear. It is currently nicely of the nasal pyramid: classic-surgical develop skin cancer in the course of a cured with an anaplastologist’s silicone and prosthetic with epitheses and lifetime; among the malignant skin tumors prosthesis. The need for a sound endoprostheses using silicone, titanium basal cell carcinomas (BCC) form the anchoring in the temporal bone is one of implant and magnets in congenital largest entity. Besides BCC’s, squamous the key factors for fixture surgery success. deformities, accidents and after tumor cell carcinomas and melanomas exist. Large pneumatization of the temporal removal (cancer). Melanomas are the most dangerous form bone may preclude implant surgery and of skin cancer. However, there are cancer Methods and Materials: Silicone, as a insufficient mastoid thickness is relatively lesions that perforate the skin originating synthetic material, is very well tolerated frequent.

26th Annual IAA Conference / 17 invited speakers by the body, having been demonstrated from all Romania and some clinics from and implant stability. In an on-going multi- that is a good oxygen carrier. Both nasal Israel, England, Sweden and SUA, with centre clinical investigation evaluating silicone and titanium implants are well patients from Romania and countries the performance of the Baha 3 Implant tolerated, with good aesthetic, functional from Southeastern Europe. compared with the previous generation and psychological results. implant, it has been concluded that the Baha 3 Implant is more stable both There are many methods and Mark C. Flynn, PhD techniques, depending on the defect, initially and over time compared with the doctor’s training and patient’s wishes. Cochlear Bone Anchored Solutions AB previous generation machined-surface Baha implant. The study also shows a Nasal pyramid reconstruction can Göteborg, Sweden be performed under local or general significant improvement in soft tissue anesthesia. There are traditional and new Development of a New outcomes at the 6-month follow up. prosthetic surgical techniques, similar to Implant System for Bone Conclusion: The new implant is the dental, that uses silicone and fixation Anchored Craniofacial significantly more stable at any given time through osseointegration with titanium Prostheses compared with the previous generation implants or magnets. thursday, may 31, 12.00-12.20 implant. Based on the data it is also Results: Patients regain an almost normal anticipated that patients with soft or abstract: appearance, having a good family and compromised bone may benefit from the social integration an improved quality of Objective: To review important areas of improved implant stability and enhanced life. design innovation of a new implant system osseointegration obtained with the new that has been designed to improve Conclusion(s): implant. Furthermore, the design of outcomes for craniofacial bone anchored the abutment may improve soft tissue Classical surgery methods and silicone prostheses and review clinical data outcomes and may result in a reduction in prosthetic rehabilitation of nasal pyramid supporting the design changes. post-surgical complications. with very good results: Methods: The latest implants for 1. Gottlow J, Sennerby L, Rosengren A, • Aesthetic. craniofacial procedures are designed Flynn M. An experimental evaluation • Functional - in breathing, mastication, to provide a number of innovations of a new craniofacial implant using the phonation, and hearing. particularly with regard to the implant rabbit tibia model: part I. Histologic • Psychological implications in geometry and surface. The increased findings. Otol Neurotol. 2010 socialization and a better quality of life. diameter, roughened surface and addition Jul;31(5):832-9. Clinical Implications: The nose–the of small sized threads are designed to 2. Sennerby L, Gottlow J, Rosengren A, nasal pyramid is an essential anatomical improve the strength and speed of the Flynn M. An experimental evaluation element of the central region of the osseointegration process. As the new of a new craniofacial implant using face, with a mainly aesthetic role, brain craniofacial implant design is identical to the rabbit tibia model: Part II. protection in case of accidents (traumatic the Baha® 3 Implant (Cochlear™ Baha® Biomechanical findings. Otol Neurotol. shock attenuation) and functional by its BI300) we reviewed the available pre- 2010 Jul;31(5):840-5. clinical and clinical data. A series of pre- positioning at the beginning of the upper 3. Dun CA, de Wolf MJ, Hol MK, Wigren clinical studies comparing 60 test (new respiratory tract. It has an important role S, Eeg-Olofsson M, Green K, Karlsmo design) and 60 control (previous design) in breathing, smell, taste and protection A, Flynn MC, Stalfors J, Rothera M, implants, was conducted on the tibiae of of the lower respiratory tract (cleans, Mylanus EA, Cremers CW. Stability, 30 rabbits1,2. The implants were left to moistens and warms inspired air). survival, and tolerability of a novel heal for 5, 14 or 28 days. Implant stability Postoperative evolution and Baha implant system: six-month was measured using resonance frequency prognostic are generally favorable. data from a multicenter clinical analysis (RFA) and removal torque (RTQ) Complication are multiple and different, investigation. Otol Neurotol. 2011 tests. RTQ measures the rotational both for the surgeon and the patient, Aug;32(6):1001-7. stability, and gives a good measure of both in the case of classic methods of the quality of the bone integration. prosthetic rehabilitation using silicone biography: In an open, randomized, prospective and titanium implants. Mark Flynn is the Director of Research multicentre clinical investigation3, 77 and Applications at Cochlear Bone biography: adult patients with Baha implants were Anchored Solutions in Sweden. He Elena Latcan, PhD, MD, ENT, included. Implant stability quotient (ISQ) received his PhD in 1998 from the Cranio-Facial and Body Rehabilitation values were recorded using resonance University of Melbourne (Australia) in Private Medical Center PRAIN— frequency analysis at the time of Medicine (Otolaryngology) where he Cranio-Facial and Body prostheses Unit, implantation and at 10 days, at 4, 6, 8, and studied hearing performance in adults Bucharest 12 weeks, and at 6 months after surgery. with a severe hearing loss. His primary Skin reactions were evaluated according Dr. Latcan lives and works in Bucharest, responsibility includes conducting and to the Holgers classification. Romania, in her private medical clinic and coordinating Baha research activities hospital “PRAIN” for a normal hearing Results: Results from a pre-clinical study worldwide focusing on the clinical and look. Her foreign languages include on Baha 3 Implants demonstrates the research for Baha performance, French, English, and Russian. superiority of the new implant design indications, surgery and future sound compared with the previous generation processor and implant development. Currently she works with all the implant, both in terms of osseointegration He is the author of 10 patents and over Clinical Hospitals from Bucharest and

18 / Anaplastology: Beyond the Horizon invited speakers

50 publications on hearing instrument diameter and implant surface topography. biography: performance and development and Different techniques of assessing Department of Otolaryngology, Head has presented at numerous scientific osseointegration and implant stability and Neck Surgery, Sahlgrenska University conferences worldwide. will be described. The features of the Hospital, Goteborg, Sweden. new Cochlear VXI300 implant will be discussed and results from a clinical study Joacim Stalfors, MD CDT, MDhc from the new Cochlear BI300 implant Kerstin Bergström The Importance of will be presented. Different abutment designs and heights and its implication A Lifetime with Implant, Abutment and on stress forces on the implant, hygiene a Facial Prosthesis Retention Properties for and soft tissue outcomes will be thursday, may 31, 13.55-14.10 Clinical Success presented. Different design solutions for Abstract: thursday, may 31, 13.30-13.55 the abutment-implant connections and To treat patients with an Osseointegrated abutment surface technologies can have Abstract: prosthesis is a life-time commitment and influence on the clinical results and will Success with craniofacial prosthesis is a challenge. A challenge for the patient, be discussed. Also, different retention multi-professional teamwork dependent surgeon, and anaplastologist to get a life solutions have properties that need to on several factors. This lecture will long acceptance of the treatment. The be addressed for an optimal outcome. focus on clinical outcome with regard level of acceptance can vary depending It can be concluded that the individual to the titanium implant, abutment on whether the facial defect is acquired components in the implant-abutment- technology and retention strategies. or congenital. We have now followed retention unit affect the outcome and Clinical experiences and literature from some adult patients for 33 years and concern needs to be taken for both the other clinical fields besides craniofacial children growing up for 29 years. In this respectively components as well as for prosthesis will be reviewed in order to presentation special focus will be on long the unit for a successful outcome. The address factors affecting outcome. time follow up in young patients. Everyday choice of components has an effect on life, psychological and functional aspects Successful osseointegration is a the procedure of the surgery, design of will be discussed. A review of some adult prerequisite for functional craniofacial prosthesis and aftercare; therefore, a patients also will be shown. The vital prosthesis. Factors on implant-level dialog in the team and especially between importance of close cooperation between affecting osseointegration will be the anaplastologist and the surgeon is the surgeon and the anaplastologist will discussed such as implant length, implant important. be exemplified.

26th Annual IAA Conference / 19 invited speakers biography: Today, the functional aspect can be biography: Kerstin Bergström is a Certified Dental overcome by: Thomas Somers is vice head of the ENT Technician, 1980. Awarded Honorary 1. A canalplasty/tympanoplasty in a Department Sint-Augustinus Hospital Doctor of Medicine at the University minority of well selected cases and European Institute for ORL, Wilrijk, of Gothenburg, 1996. Kerstin has been 2. Implantable hearing aids (Bone Antwerp. He is a board member of involved since the beginning with the Anchored Hearing Aids called BAHA, the Belgian scientific and professional team of Professor Per-Ingvar Brånemark Middle ear implants) are used in the societies, European Academy of and Professor Anders Tjellström. She is majorities of the atresia cases certainly Otologyand Neuro-otology (treasurer), responsible for the Facial Prosthetic work when the affliction is bilateral. Belgian delegate for the ORL section at at the Department of Otolaryngology the UEMS (European Union of Medical The esthetic “malformative” aspect is at Sahlgrenska University Hospital, specialist) where he was treasurer. treated after making the choice between: Gothenburg, Sweden. He is also a member of the European 1. Reconstructive outer ear techniques She has been the President of The Academy of Facial Plastic Surgery, (Brent or Nagata technique) Scandinavian Association of Maxillofacial Politzer Society, American Academy of 2. Bone anchored protheses Rehabilitation (SKAR) since 2011. ORL, and an honorary member of Indian The esthetic reconstruction with Otology Society, Israelian ORL Society. autologous rib cartilage has been He has written or co-authored of over Thomas Somers, MD performed in our department for 100 papers and has presented in major over 20 years and 250 procedures Dept of Oto-rhino-laryngology ENT, Facial plastic and otology and have been performed. During the first Head and Neck Surgery neurotology meetings. stage of the Nagata technique the European Institute of ORL autologous cartilage is retrieved from Sint-Augustinus Hospital Prof. Vincent Vander the synchondroses of rib 7,8 and 9 and a Wilrijk, Antwerp, Belgium floating rib is used to make the helix. After Poorten, MD, MSc, PhD Auricular Autologous delicate carving the different elements Otorhinolaryngology, Head and Neck Reconstructions for Major are assembled and knotted using metal Surgery Ear Malformations: A wires. The malformed ear cartilage is University Hospitals Leuven, Leuven, Global Approach resected and the framework is inserted Belgium thursday, may 31, 14.10-14.25 in the newly created subdermal pocket. Leuven Cancer Institute Aspiration drainage produces a good skin abstract: co-aptation to the new ear cartilage. After Surgical Preparation for Major congenital ear anomalies six months the second stage (elevation of Mid-face Prosthetical are uncommon and diverse in their the auricle from the head) can take place Reconstruction presentation. and a semilunar piece of ribcartilage is thursday, may 31, 14.25-14.40 A functional impairment due to outer used to elevate the ear, while a skin graft ear canal atresia/stenosis and middle ear taken behind the opposite (usually normal abstract: anomalies is usually associated with an ear) is harvested and is used to line the The current state of the art in midface esthetical malformation, hypoplasia, or newly formed posterior sulcus. prosthetic reconstruction implies bone even aplasia of the auricle. Despite this reconstructive option, anchored retention (by means of titanium implants with minimal roughness Sa In the management of these difficult the auricular prosthesis (epithesis) is 0.5-1.0 µm) and a mostly magnet retained cases, both the functional and the preferred in cases of traumatic avulsion silicone prosthesis (combining soft esthetical aspects have to be taken into of the ear, oncologic auricular amputation, structure that adopts body temperature consideration and addressed. Priorities pronounced wish of the patient in case easily and that allows easy introduction will also vary according to whether the of auricular aplasia (usually adults) or of hair and skin pigmentation, with thin malformation is unilateral (with a focus on failure of past auricular reconstruction. transparent edges that camouflage the esthetical aspect) or bilateral; in the The advantages of the epithesis are the prosthesis-skin interface). Long- latter case the functional rehabilitation the almost perfect esthetic result, the term stability of the implants depends receives our first full attention. single intervention and the fact that the prosthesis is well attached (bone on biocompatibility of the material, In the past beside classical bone implant surface and design, condition of conduction hearing aids, the canalplasty, anchored). The anaplastologist plays here a crucial role and the esthetic result will the recipient area, surgical technique, tympanoplasty was often the only surgical and type and period of the functional alternative available to try to improve be very dependent on his experience and skills. The pros and cons of both loading. Two key elements in this list, the hearing or at least to allow the wearing surgical technique and the condition of a hearing aid. Reconstructive auricular approaches (reconstruction versus prosthesis) will be developed in detail. of the recipient area, will be covered surgery was also often disappointing and in this paper from the point of view Careful and realistic preoperative prosthetic alternatives unsatisfactory. of the cancer surgeon, for prosthetic patient counseling and exact timing of Nowadays, thanks to developments rehabilitation of (1) nasal, (2) orbital and the procedures are important to achieve by pioneers from different parts of our (3) complex midfacial defects resulting satisfactory and predictable results. “global” world the management of these from ablative cancer surgery. Details of difficult cases has changed dramatically. surgical planning and technical aspects

20 / Anaplastology: Beyond the Horizon invited speakers of surgical creation of a stable base for European Salivary Gland Society, the related to initial purchasing, training, implant placement will be presented, European Head and Neck Society, the and servicing. The purpose of this taking into account the effect of International Association of Endocrine presentation is to aid the anaplastologist radiotherapy on the strategy followed, Surgeons, the European Academy of in becoming an informed consumer by with emphasis on pre-and postoperative Facial Plastic Surgery, the AOCMF providing an overview of the advanced communication with the anaplastologist. Craniomaxillofacial group and the Dutch applications that have been integrated Cleft Lip and Palate Association. He is a into clinical anaplastology and the costs of biography: head and neck surgeon focused on adult integration, including important Michaela Vincent Vander Poorten, MD, PhD, oncologic surgery and pediatric head Calhoun1, MS and Erin Stevens2, MS MSc (Epid) is consultant, associate and neck surgery including congenital considerations for institution-based and professor and adjoint clinical head of malformations. private practitioners. the department of Otorhinolaryngology, Methods and Materials: Literature Head and Neck Surgery at the University reviews were conducted to obtain data Hospitals Leuven, Leuven, Belgium Michaela Calhoun, MS concerning the intended application (1999). He earned a degree of Master Prosthetics at Graphica Medica, LLC1, of newly acquired technologies in of Science in Epidemiology at the Free The University of Illinois at Chicago anaplastology, the monetary expense University of Amsterdam, Amsterdam, Medical Center2 for such acquisitions, and return on the Netherlands (1998). He defended his investment. Particular interest is also PhD thesis, “Salivary gland carcinoma. The Cost of Going Digital, focused on the educational investment Stepping up the prognostic ladder” and Part 1: Options and for competency in employing these earned the Degree of Doctor in Medicine Expenses technologies. at the Universiteit van Amsterdam, thursday, may 31, 14.40-14.55 Amsterdam, the Netherlands (2002). Results: Data gathered reveals both monetary- and time-related investments, He is member of The Netherlands abstract: upfront and long-term, required for the Epidemiological Society, The Royal Purpose: In the last few years, advances acquisition and implementation of digital Belgian Society for Otorhinolaryngology, in technology have changed the field of technology in anaplastology. Factors Head and Neck Surgery, the Netherlands anaplastology, offering innovative digital influencing the selection of technologies Society for Otorhinolaryngology and applications for imaging, design, and and services best suited for one’s practice Cervicofacial Surgery, the American fabrication. However, incorporation of are discussed. Head and Neck Society, The Flemish these technologies into one’s practice Head and Neck Society (president), the comes with a number of expenses

26th Annual IAA Conference / 21 invited speakers

Conclusions: The cost of going digital available can be a significant undertaking. biography: in anaplastology for many practitioners As these technologies grow more Erin Stevens studied Anaplastology in can be significant. However, there are popular, so does our need to be informed the Biomedical Visualization Master’s solutions for tackling these expenses, of the added value they offer to the Program at the University of Illinois already employed by many in the field, anaplastology practice, and the choices at Chicago. She conducted her that can inform our approach toward we have for acquiring and employing undergraduate studies in both Studio Art participating in the technological them. The purpose of this presentation and Biology at Texas A&M University and advances serving the practice of is to highlight the potential benefits the University of St. Thomas in Houston. anaplastology. of integrating innovative technologies Her research at UIC expanded upon Clinical Implications: This presentation and to address realistic solutions for previous studies’ affirmation of stereo- combines a summary of the overwhelming such integration into the scope of one’s photogrammetry as an accurate means world of digital technology in practice. of 3D data acquisition, as she aimed anaplastology and a breakdown of the Methods and Materials: An extensive to address a variety of challenges that realistic costs of this technology. An literature review was performed to arise with the clinical use of 3d stereo- understanding of these concepts is identify clinical case studies that highlight photogrammetry, especially as they relate essential in order for digital technologies the use of digital technology to improve to clinical protocols for head positioning. to be effectively incorporated into daily imaging, design, and fabrication for Erin has conducted clinical research clinical applications in anaplastology. facial prosthetics, as well as relevant at The Craniofacial Center (Department applications by non-prosthetic industries. biography: of Surgery, College of Medicine, The This review was extended globally, University of Illinois at Chicago), Michaela Calhoun joined Prosthetics including reports from private and investigating the effects of different head at Graphica Medica, LLC, in institution-based practitioners. positioning protocols on the reliability of January 2011. Michaela earned a Results: Results outline the benefits of anthropometric measurements obtained Master of Science in Biomedical these technologies as they relate to from 3d stereo-photogrammetric images. Visualization from the University individual case types and to the overall She continues to conduct research and operations of an anaplastology practice, explore digital technologies and their of Illinois at Chicago where she elucidating which applications may best clinical applications within the scope completed a one-year internship serve the unique needs of its patient of her work as an anaplastologist at the in clinical anaplastology. As a population and the clinical environment. Craniofacial Center. member of the team at Prosthetics Solutions for funding acquisition, training, at Graphica Medica, LLC, Michaela and maintenance of technologies are Ing. Bart Van der hopes to incorporate the use of discussed. Schueren advanced technologies, including Conclusions: There is evident value in “going digital” in the field of anaplastology; CT navigational software and rapid Rapid Prototyping: however, with the embrace of technology State of the Art prototyping, into the processes of must also come adaptation, upfront surgical planning and facial prosthetic expenses and awareness of one’s thursday, may 31, 15.10-15.25 treatment. In addition to these options. A synchronous understanding Abstract: interests in technology, Michaela of traditional and alternative materials, 3D Printing, Additive Manufacturing, has research interests in the areas techniques and technologies empowers Rapid Prototyping, these are all synonyms the anaplastologist to weigh the impacts of evidence-based practices and of a group of technologies that create of such integration as they relate to outcomes reporting in anaplastology. products layer by layer. One of the main productivity and economic practicality. advantages of this layer wise fabrication Clinical Implications: This presentation approach is that products with an almost 1 Erin Stevens* , MS and shares examples of the growing unlimited complexity can be produced. Michaela Calhoun2, MS number of digital technologies being This is an interesting feature for applied to improve the processes of anatomical geometries. The presentation The University of Illinois at Chicago, facial rehabilitative treatment at every will give an overview of the state of the art College of Medicine1, and Prosthetics at level, including, but not limited to, in 3D Printing, but also in some software Graphica Medica, LLC2 patient imaging, implant and prosthesis tools that are required to make 3D Chicago, IL1, and Rochester and positioning, prototype fabrication, Printing feasible. Minneapolis, MN2 sculpting, color assessment, digital cataloging, and chronological analysis. biography: The Cost of Going Digital, Bart Van der Schueren obtained a master Part 2: Benefits and Increased awareness of the diverse means by which anaplastologists can degree in mechanical engineering at Solutions take advantage of the benefits these the Catholic University of Leuven (KU thursday, may 31, 14.55-15.10 technologies afford will expand the Leuven) Belgium in 1990. After his graduation he joined the University abstract: toolsets we have to draw from in customizing treatment and building a as a liaison for the newly founded Purpose: Familiarizing oneself with the successful and sustainable practice. Materialise and established the basic vast number of digital technologies research activities for the company.

22 / Anaplastology: Beyond the Horizon invited speakers

Bart then went on to obtain a PhD in Centre of the Belgian Technology floppy drives, a keyboard, a display with metal selective laser sintering. In 1995, Industry) in the additive manufacturing 80 characters per line and a parallel port he officially joined Materialise and ran department. His main work involves to connect a printer. Soon, this PC was their service bureau. Over the years, his R&D projects in the field of biomedical equipped with a hard disk of 10 MB. The dedication and expertise has grown the applications. IBM PC was the basis for the popular service bureau from a regional player IBM-PC compatible computers or many to one of the most prominent additive Prof. Hein Daanen, PhD clones. Compare the current PC with the manufacturing facilities in Europe. In PC from the 1980s. 2011, Bart became an Executive Vice Surface Scanners The market asked for a small cheap President of Materialise mainly focusing thursday, may 31, 16.15-16.30 computer. The big computers from on production, engineering services and the 1980s were stripped to smaller software development. He continues to abstract: versions. These machines could not be be a driving force toward the company’s The presentation will give an overview compared with the PC that was built up long term vision. of 3D surface scanning techniques of from simple components and compare the human body. The following surface them now to the PCs of today. That is Carsten Engel scanning methods can be distinguished: also what happens to the 3D printers at laser, structured light projection, this moment. The large machines that World Premiere: stereophotogrammetry, and millimeter can create highly accurate 3D models First 3D-Printed Lower Jaw waves. The benefits and disadvantages of are getting smaller, but they hold their Implant the systems will be discussed. Resolution own technology. There is also another and speed of the scanning systems development in sight. RepRap is an open thursday, may 31, 16.00-16.15 show a continuous improvement over source project with the aim of a good abstract: the recent years with a simultaneous and cheap rapid prototyping machine. The University of Hasselt has come out reduction in costs. Surface scanners offer The RepRap project started on 23 March with a world première: The Functional a good potential for clinical applications; 2005 with the introduction of the Darwin. Morphology research group of the in particular, recent developments in In 2009, Mendel introduced a simpler and UHasselt BIOMED research institute principle component analysis of 3D scans better to handle machine that processes has created the method behind the improve the insight in human variability in materials such as ABS and PLA (a bio very first customized 3D-printed lower body dimensions. degradable plastic). These developments are supported by jaw. The implant procedure was carried biography: out a few months ago on an 83-year an initiative of Massachusetts Institute of Hein Daanen obtained a masters degree old patient with a serious jaw infection. Technology in Boston USA. This initiative in Human Movement Sciences in 1984 This procedure rescued important vital started FabLab like a wildfire over the and a PhD on human thermoregulation functions (breathing, speech, chewing, world wide web. FabLab is a place where in 1997. He is principal scientist at TNO, sensation) as well as the aesthetic aspect the 3D idea is conveyed to an interested the Dutch organization for Applied that would otherwise have been lost. young generation – like schools. That is Scientific Research, holds a chair in BIOMED worked on this project with where the open source idea of the early Thermal Physiology at the Faculty of the Xios College, the Catholic University university intent was propagated. “We’ve Human Movement Sciences of VU of Leuven, the Oral- and Maxillofacial got the information; come and get it!” University Amsterdam and is the director Surgeons of the Orbis Medical Centre of the company Sizing Science. In a joint biography: Sittard-Geleen (the Netherlands), effort with the CARD-research group of After his education in technical business SIRRIS – Collective Centre of the Belgian Wright Patterson Air Force Base (Ohio), management, Frans de Beer worked as Technology Industry, Xilloc Medical BV he organized the first multinational a product manager for miniature lamps (Maastricht, the Netherlands – 3D design) 3D anthropometric scanning survey at the Lighting department of Philips. and LayerWise NV (Leuven – Production). (CAESAR) in 1999. He is the author After five years his interest was drawn to This is the first time that a complete lower of 65 refereed publications on 3D dentistry and he graduated in 1984 from jaw has been replaced in a patient. The anthropometry, thermal physiology, and the dental school in Utrecht. From the 3D printing technique using a powdered the relation between the two areas. first days of his general dental practice he metal is ideally suited for producing this became interested is the use of the PC. In type of patient-specific implant. The fact 1993 he became a member of the special that the technique can now be used for Drs. Ing. FP de Beer dentistry group at the Atrium Hospital a complete lower jaw implant is unique. tandarts MFP in Heerlen. As early as 1998 he made his “The introduction of printed implants can first virtual implant planning on a PC. be compared to man’s first venture on Fablab: A Worldwide Web In 2008 de Beer switched hospitals the moon: a cautious, but firm step,” says thursday, may 31, 16.30-16.45 Professor Jules Poukens of BIOMED. to the Academic Hospital Maastricht abstract: where he joined Henk Verdonck at Biography: Remember the first personal computer? the Department of Oral Surgery. He is Carsten Engel graduated at the ULB The IBM PC was introduced August interested in the development of simple/ as a biomedical engineer and currently 12, 1981, by IBM. A simple Personal low cost 3D design and 3D printing works as a researcher at Sirris (Collective Computer type 5150 with one or two systems.

26th Annual IAA Conference / 23 invited speakers

Miranda Bastijns friday, june 1 Also the treatment program with the associated clinical research setup will be Director i.materialise and .MGX Dr. W. Vanhove, presented. MDX: Rapid Prototyping University Hospital Ghent biography: as an Art Dr. Wim MF Vanhove trained in the thursday, may 31, 16.45-17.00 Osseointegration Ghent University Hospital to become abstract: in Limb Prostheses: an orthopaedic surgeon in 1993. During fellowships both in the UK (Edinburgh and In craftsmanship and haute couture, Preliminary Results Wrightington) and the USA (Louisville) additive manufacturing sets new friday, june 1, 09.30-09.45 he specialized in hand and microsurgery, standards. abstract: which he practices in the UZGent since This started as a proof of concept by In the 1960’s different techniques 1996. He has a special interest in brachial Materialise, the world leader in additive emerged that shaped the medical plexus palsy (both adult and obstetric), manufacturing (aka rapid prototyping or practice of today. Microvascular repair congenital differences of the hand and 3D printing) service and software. The developed into complex reconstructive limb reconstruction (microsurgery, tendon Design unit “.MGX by Materialise” has surgery with composite tissue grafts and transfer, prosthetic replacement). established a strong reputation with its finally transplants. Total hip replacements high end design products in the field of using bone cement led to a vast array Steven J. Gray, Anaplastologist 3D printed lamps, interior decoration, of implants for replacement of just furniture and recently also fashion. The about any joint and a thriving science The Alfred Hospital .MGX designs feature in museums and of biocompatible materials. Dental Melbourne, Australia gallery’s all over the world and are part of titanium implants without cement Director Osseointegration –Plastic, Hand the permanent collection of the MoMA in made way for a science of its own: & Facio-Maxillary Unit New York, le Centre Pompidou in Paris, osseointegration (OI). Some elements of The Alfred Hospital, Melbourne, Australia the Victoria & Albert museum in London OI-research trickled into the mainstream and the Design museum in Barcelona. orthopaedic world but for fixation of an A Brief Review of Last year .MGX opened in the Brussels endoprosthesis cementing is/was always Osseointegration and Sablon area a flagship store, which is the considered as the gold standard. The safe OPRA Surgical System first store dedicated to 3D printed design exteriorization of part of an orthopaedic Cases 1992–2012, with a worldwide. implant was considered as outright Focus on Hand and Upper biography: impossible. and Lower Limb Miranda was trained in Marketing Microvascular surgery was practiced abstract: in our orthopaedic department at the Vlerick Leuven-Gent The Plastic Surgery Unit at the Alfred since the early days and new ways of Management School 1987 – 1988. Hospital began treating patients using reconstruction of limb function both for osseointegration in 1991. Beginning with She was General Marketing Manager limb palsy (brachial plexus, tetraplegia) intra-oral and craniofacial applications of Materialise from 1998-2010. and amputation have always been followed by the first BAHA (Bone Today she is director of i.materialise sought after. The newest prosthetic Anchored Hearing Aid) case in Australia. developments (Prodigits, I-limb and and .MGX. Both product lines cater In 1995, working closely with Prof others) where monitored closely just as to the end-user, whereas .MGX P.I. Brånemark and Rickard Brånemark, the different solutions for skeletal fixation the unit applied the osseointegration offers a collection of high-end 3D of exoprostheses. In a close cooperation treatment to amputee patients with loss prints, made by a selected group of with the Department of Physical medicine of thumb and digit. The patients selected designers, i.materialise offers every and Rehabilitation the introduction of were very focused on obtaining function the OPRA-treatment, as developed individual to make or customize a and were seeking a non-autogenous in Gothenburg by R. Brånemark, was personal 3D printed object. reconstruction. Following success with prepared in our hospital as from 2008. the hand applications the unit stepped up Our first (transhumeral) amputee its collaboration with Rickard Brånemark patient was operated in 2010. Just as and Integrum AB of Sweden to apply straightforward as the treatment went the OPRA System--Osseointegrated for this patient, just as difficult was the Prosthetic Rehabilitation of the Amputee. (administrative) path of implementation of this technique, which is new in Belgium. Two transfemoral amputee patients Our treatment program has since been were treated in 2000 followed by extended with a broad investigational transhumeral cases. A brief review of the project and more patients have started unit’s osseointegration experience will the treatment (transfemoral amputees). be discussed, with a focus on hand and upper and lower limb amputee cases. Our considerations concerning the OPRA-technique will be discussed. Osseointegration can improve the function and reduce socket problems

24 / Anaplastology: Beyond the Horizon invited speakers

and improve the quality of life. Long- Centre for Plastic Surgery and Burns, has succeeded in incorporating HCR into term prospective studies are needed to Billericay, Essex. During this time he the fabrication of various prosthetic and confirm these preliminary findings. spent several years teaching the Facial orthotic devices, in an effort to improve prosthetics element of the Advanced their function, durability, ease of use and biography: Maxillofacial Technology course at comfort. By doing so, we have managed Steven was born in Melbourne in 1957. South London College. Following to replace preexisting materials that After graduating from RMIT Royal relocation of the Plastic Surgery service have been the standard for decades, as Melbourne Institute of Technology to Broomfield Hospital in Chelmsford well as complement other materials in and completing four years specialist Essex in 1998, Keith is now Consultant order to enhance them. With the use training as consultant clinical specialist Clinical Specialist-Prosthetics at the of HCR, we have been able to: create -Camouflage Prosthetics ‘Anaplastology world-renowned St. Andrews Institute custom assistive devices to help restore at the Victorian Plastic Surgery Unit of Prosthetics. He is a Fellow of the fine motor function to amputees with (VPSU), Steven joined The Alfred Institute of Maxillofacial Prosthetists compromised hand anatomy; replace Hospital in 1979 and was appointed and Technologists, and a member of the a traditional thermoplastic elastomer Manager Camouflage Prosthetics, Plastic International Anaplastology Association. (TPE) in order to design an above- Surgery & Facio-Maxillary Units. He is also a member of the editorial elbow socket with a flexible interface He is currently the Director: board of both the Journal of Maxillofacial containing expandable air bladders; form Osseointegration with the Plastic, Hand & Prosthetics & Technology, and The a custom eye patch in order to treat a Facio–Maxillary Surgery Unit at the Alfred International Journal of Anaplastology. young child with Amblyopia; fabricate and also is a session Clinical Specialist In 2002 he was made Honorary custom pediatric Hammertoe splints; and to the Plastic Surgery Unit at the Austin Professor and Member of the Centre of sculpt comfortable and supportive foot Hospital. Investigations for Medical and Surgical prostheses for individuals with partial Steven has published many papers and Research in Havana, Cuba. foot amputations, as a longer lasting, abstracts on osseointegration, has made Keith has an international reputation more aesthetically pleasing alternative to contributions to three international books for high quality, innovative, cutting edge plastazote toe fillers. While discussing the and given many lectures in Australia and prosthetics, and regularly lectures advantages of using HCR for these cases, overseas. His efforts have resulted in internationally. He is also one of the few I will also highlight some of the challenges research grants, education programs, practitioners globally, with over 16 years that HCR presented. Fabrication of international collaboration, philanthropy, clinical experience of Osseointegrated these devices would have been possible sponsorship and good clinical outcomes finger implants utilizing both the using traditional materials found in any for those less fortunate amputee patients. Brånemark and Southern Implant orthopedic workshop; however, by using systems. He has been contributing HCR, a more comfortable, supportive, responsive, and durable result was Keith Thomas FIMPT IAA author to three professional textbooks in addition to being sole author of achieved. St. Andrews Institute of Prosthetics Prosthetic Rehabilitation (1994) and The biography: St. Andrews Centre for Plastic Surgery & Art of Clinical Anaplastology (2006). Keith David Robinson is a Clinical Burns also organizes the Forum – International Anaplastologist at Westcoast Brace & Broomfield Hospital, Chelmsford Facial and Body Prostheses Conferences, Limb in Tampa, Florida. Originally from Essex England specialist limited attendance conferences Ontario, Canada, David earned his that are held every 4-6 years, in order Implant Retained Bachelor of Arts degree in Art Studio to provide detailed state of the art from the University of South Florida, Finger Epitheses information/techniques. friday, june 1, 10.30-10.45 Tampa. He chose to transfer his talents in the fine arts, as both a painter and abstract: David Robinson, sculptor, to the healthcare field. David’s Current review of the new abutment Anaplastologist origins in the orthopedic industry began mechanism relating to the Southern in 2000 as a Prosthetic Technician. As Implant Osseointegrated Finger implant. Westcoast Brace & Limb one of the few Anaplastologists in the The conclusions are the user advantages Tampa, Florida USA country working in an in-house, custom of the new design in comparison with The Implementation orthotics and prosthetics facility, original design. The implications are of High Consistency David has spent more than a decade at user advantages of the new design in Silicones in the Orthopedic Westcoast perfecting his craft and its comparison with original design. applications for conventional orthotic Workshop and prosthetic devices. David is known biography: friday, june 1, 10.45-11.00 for his advancements in the fabrication Keith Thomas qualified in 1975, after and application of high realism custom training at the Eastman Dental Hospital abstract: protective skins for both passive and London. After spending time in the The emergence of high consistency myoelectric prostheses. His areas of Middle East he returned to the UK, where silicone (HCR) in the orthopedic industry specialty include custom silicone somatic he established a comprehensive clinic has allowed for many developments in the and maxillofacial appliances, as well as treating patients who required facial design of orthotic and prosthetic devices. custom breast prostheses. and body prostheses at the St. Andrews In the past year, Westcoast Brace & Limb

26th Annual IAA Conference / 25 invited speakers

There Should be an Anne-Marie is an International each sample (Commission Internationale Anaplastologist in Every consultant for bone anchored surgery, de l’Eclairage CIE (L*a*b*)). Ranges in ∆E Orthopaedic Workshop and has given lectures, workshops and values for the light and dark sample sets has written a number of articles in the fell between 0.29 and 4.63, and 0.06 and friday, june 1, 11.00-11.30 field, in French, English, and German 6.01 respectively. Samples were placed in Table Discussion languages. random order next to a standard sample under controlled lighting conditions, and subjects were asked “Do these samples Anne-Marie Riedinger, CCA Lindsay McHutchion, MS appear to be the same color?” Subject Achieving a Realistic Thresholds of Perceivable responses were analyzed to calculate the Nasal Episthesis ∆E value of the threshold of perceivable Color Difference in Silicone color difference in silicone for each friday, june 1, 11.30-11.45 and Establishing a Clinical subject. Subject thresholds were used to abstract: Standard for Acceptable determine average thresholds for each This lecture reviews the basics for Color Differences in the subject group, and for all participants. achieving a realistic nasal epithesis as Production of Silicone Results: There was no significant follows: Facial Prostheses: A Pilot difference in the thresholds of • listening to the patient, dealing with Study perceivable color difference among the realistic expectations, selecting an friday, june 1, 11.45-12.00 three subject groups, or between light adapted retention: adhesive, self and dark sample sets. ∆E = 1.025 was abstract: retained, on glasses, bone anchored; calculated as the average threshold of Thresholds of Perceivable Color • surgical procedures: after tumor perceivable color difference. Difference in Silicone: A Pilot Study resection, ideal sites and compromises Conclusion: The results of this study Lindsay McHutchion BSc. MS1, 2, for a bone anchored prosthesis, how to indicate that ∆E = 1.0 can be used as a Rosemary Seelaus MAMS1, 2, Linping deal with the edges of the defect; threshold of perceivable color difference Zhao PhD1, Scott Dixon, MS2 • artistic considerations: how the bone in silicone used in facial prosthesis University of Illinois at Chicago Hospital structure influences the sculpture; fabrication. Furthermore understanding and Health System this threshold will be useful in evaluating • technical procedure: temporary 1The Craniofacial Center, Department of and integrating technology into the prosthesis after surgery and final Surgery color-matching process of prosthesis prosthesis using different types of 2 production. It can also be used as a silicone; Biomedical Visualization, Department of Biomedical and Health Information clinical standard for color difference • dealing with airways, adaptation to comparisons and prosthesis quality Sciences. glasses and finishing touches. control. Introduction: Color matching is one of the biography: most difficult and important aspects of biography: Anne-Marie Riedinger, CCA, former creating facial prostheses. Color matching Lindsay McHutchion is a recent graduate President of the IAA ( 2009-2011), has remains problematic due to metamerism, of the University of Illinois Biomedical been an IAA member since 1988. She variability in the practitioner’s skill, and Visualization Master’s of Science graduated in Medical Art from the Ecole the amount of time required to complete Program. Her focus at the University of Supérieure des Arts Décoratifs de this task. Researchers have investigated Illinois was in maxillofacial prosthetics Strasbourg, France, where she eventually solutions to this challenge with the and surgical planning. She completed her became a teacher (1996-2000 ). She use of technology, including the use of undergraduate degree at University of specialized in facial prosthetics at the instruments to measure color difference Alberta, majoring in Biological Sciences University of Illinois, Chicago, USA. (∆E). Determining the threshold of and minoring in Art and Design in 2010. A pioneer in France for facial bone- perceivable color difference (∆E) within She has special interest in clinical anchored prostheses since 1986, she has silicone will contribute to improving applications of color matching and mainly worked in Paris and Strasbourg. quality of patient treatment and allow for measurement technology, and rapid She is the owner of Epithèses Faciales, better applications of technology in the prototyping. which is based in Strasbourg, France. production of facial prosthetics. Her areas of interest are facial Methods: Two sets (one simulating bone-anchored prostheses. She treated a lighter skin tone, one simulating a patients and educated anaplastologists darker skin tone) of 40 silicone samples at the Brånemark Institute, Bauru, Brazil, and one standard sample were shown in October 2010, and gave advanced to 29 subjects from three groups (12 lectures and patient treatment in Tampa, professionals who work with color, 6 Florida, in March 2011. She was also the patients with a facial prosthesis, and 11 Program Chair of the 24th IAA Congress laypeople). Sample color was measured in Paris, France, in 2009. using a CM-700d/600d portable spectrophotometer (Konica Minolta Optics), and ∆E values were calculated for

26 / Anaplastology: Beyond the Horizon invited speakers

Kuldeep Raizada, regular intervals, can be taken care of and patients have been treated since this first avoid short changes of prosthesis. case. PhD, Clinical Ocularist, Anaplastologist biography: biography: Kuldeep Raizada completed his basic • Épithésiste, Hôtel-Dieu de Québec Replacement of Ocular optometry education at Ghandi Eye in Radiation Oncology from 2000 to Prostheses in Children Hospital, Aligarh, and has his training at 2012. friday, june 1, 12.00-12.15 L V Prasad Eye Institute, Hyderabad. • Dental assistant in oncology, Hotel- He completed a second fellowship in Dieu de Québec from 1989 to 2006. abstract: Anaplastology at MD Anderson Cancer • Technical nurse, graduate of Limoilou To evaluate the indications, outcome Centre, Houston. He has also been College in 1988. and replacement schedule of custom trained by the top most ocularist and • Dental assistant, Murray Bay in 1980- ocular prostheses (COP) in children. anaplastologist in the United States of 1984. Retrospective review evaluating America. • Practical nurse, graduate of Chicoutimi indications, outcome and replacement His clinical interest includes ocular and in 1980. schedule of COP in children (≤16 years). facial prosthesis, particularly in pediatric Three hundred and thirty children patients. His research interests lie in Training were fitted with COP. With average newer advancements in development of • March 2011 Advanced Course on the follow-up of 18.05 months (range new types of prostheses, newer solution latest facial prostheses Tampa USA. 1-50 months), 136 (41.2%) children for ptosis corrective glasses. Kuldeep • June 2010 training course in England needed replacement/modification of Raizada has been recognized by the to acquire their technology on the prosthesis. Information regarding American Society of Ocularist and the the manufacture of custom breast indications for replacement/modification American Anaplastology Association, prostheses. of prosthesis was available in 125 cases. and by several other professional • October 2007: Training in Strasbourg Indications included enophthalmic organizations, for his excellence in • Laboratory epithesis with craniofacial prosthesis in 34 (27.2%), prosthesis research and clinical practice. He has épithésiste, Anne-Marie Riedinger. rotation within the socket in 25 (20%), published and presented widely. loose fit in 16 (12.8%), decentration of • August 2003: Training in Strasbourg • Laboratory epithesis with craniofacial the cornea in 15(12%), color touch up Louise Desmeules, in 13 (10.4%), lost prosthesis in 8(6.4%), épithésiste, Anne-Marie Riedinger. cosmetically significant ptosis in 2 (1.6%), Anaplastologist • July 2001: Sunny Brook Drive in replacement following implant exchange Toronto with épithésistes, David surgery in 2(1.6%) and combination Nasal Obturator for Rendu Morrison and Todd Kubon. of above factors in 10(8%). Time for Osler Weber Disease • June 2000: Training in épithésie with replacement/modification of prosthesis friday, june 1, 12.15-12.30 Dr. Gaston Bernier, chief medical was assessed in 3 age groups. In ≤3 years, abstract: dental oncology. 47% (36 out of 76) children underwent replacement/modification at a mean Rendu Osler Weber disease is an etiology duration of 18 months (range 3-39 of major nasal bleeding. There are few E. Van den Kerchove 1 2 months) from the date of prosthesis medical solutions that may reduce the Ph.D.,P.T , fitting. In the 3-12 years age group, 43% problem. The key factor seems to be the (80 out of 184) underwent replacement/ interaction between weak blood vessels The Conservative modification at 21 months (range 2-48 and air from breathing. From literature Treatment of Severe months); and in the 12-16 year age review, we developed a silicone nasal Scars: State of the Art and group, 29% (20 out of 70) underwent obturator that closes the nasal cavity Guidelines from air, is easily removable, comfortable, replacement/modification of prosthesis at friday, june 1, 13.30-14.00 a mean duration of 26 months (range 3-50 and harmless. Volume augmentation is 1University Hospitals Gasthuisberg, months). needed to get adequate stability and effective occlusion. Dept. of Burns and Plastics, Dept. of A change of prosthesis is required Rehabilitation Herestraat 49, 3000 between 18-26 months following Great reduction of hospitalization, transfusion, and ENT medical visits Leuven, Belgium and Faculty of prosthesis placement in children. Over Kinesiology and Rehabilitation Sciences. an average of 18 months, a change in were achieved. The obturator is worn 2Dept.of Plastic and Reconstructive the prosthesis was required in 41%, permanently. Side effects are reduced Surgery, P. Debeyelaan 25, 6202 AZ with the youngest age group having the to throat dryness. We present one Maastricht highest exchange rate (47%), and the case report with a great improvement oldest group the lowest (29%). Custom of quality of life after two years of Correspondence: ocular prosthesis do not require change observation. No treatment options other [email protected] than permanent surgical nasal closure are frequently as ready-made eyes. Patients abstract: possible. Great attention was paid to not who have anophthalmic socket have In this presentation, after a brief very slow gradual changes and if seen on harm the vessels at impression phase. It is possible to obtain an esthetic obturator definition of severe scarring, an and secure without adhesive. Two other overview of conservative strategies to

26th Annual IAA Conference / 27 invited speakers treat or prevent problematic scars will consultant at the Department of Plastic, deceased persons. This talk will introduce be discussed. The level of scientific Reconstructive and Hand Surgery of the these disciplines, but focus primarily evidence of the available strategies will Academic Hospital of Maastricht (10%) on 3-Dimensional Forensic Facial be highlighted and some (hypothetical) Reconstruction and the parallels to the working mechanisms explained. Two work of an anaplastologist. Jan Schrama, OTC therapies that are considered the Materials and Methods: Careful molds mainstay in this regard, the use of silicone The Implementation of are made of the evidentiary skull so that (usually contact media) and pressure Silicones in Foot Prostheses the remains are not subjected to oil (applied with orthopaedic devices) will based clays, glues and solvents used with friday, june 1, 14.00-14.15 be presented in detail. Finally, some traditional 3D clay facial reconstruction. guidelines in daily practice are suggested. abstract: Accurate resin models are created biography: This lecture will focus on silicone foot from these molds. Clay is carefully built up following a series of craniometric Since 02/’86: Master in Physical Therapy prostheses. This device has a specific landmarks. The forensic artist works at the Katholieke Universiteit Leuven need for expertise, since it usually closely with a forensic anthropologist (KUL). involves a unique and abnormal anatomy of the foot and a high demand for and will incorporate any personal details From 03/’86-06/’87: Civil service as functionality. uncovered by science. The clay sculpture physical therapist at the department The lecture will involve: is photographed in the Frankfort of Burns and Plastics of the University horizontal plane and converted to a • various anatomical aspects of the Hospitals of Leuven. black and white image. Hair treatment partial foot Since 07/’87: Fulltime employment as can be done practically with real wigs physical therapist at the department • the need for a loaded casting before photographing or created on the of Burns and Plastics of the University technique photographic image later in a Photoshop Hospitals of Leuven. • requirements of the test prosthesis program. Since 01/’92: part-time (30%) scientifical • problem solving: examples Results: The finished photographic images co-worker at the department of are turned over to law enforcement as a biography: Rehabilitation Sciences of the KUL “sketch” of what the unidentified person Jan Schrama was trained as an orthopedic combined with employment as physical could have looked like in life. Although technician (Orthotics and Prosthetics) in therapist at the previous mentioned this method is not recognized in a court of The Netherlands. He spent several years department of Burns and Plastics (70%). law, it has proven successful at identifying of his career as an orthopedic technician Since 09/’98: Part-time physical therapist numerous unidentified human remains in Africa. at the burns and Plastics unit (50%) and over the years which can then be proven Later he joined Otto Bock Benelux part-time scientifical consultant for Otto in a court of law with other evidence such and became a part of Silicon House Bock Orthopaedic Industries (50%). as DNA comparisons. department. He became an expert in On 14/12/’99: A multicenter trial Conclusion: With the proper training, silicones and responsible for Silicone entitled “Assessment of pressure and an experienced anaplastologist has an House Benelux. Later he left the Otto silicone therapy on burn related scars” is excellent skill set to offer to the field of Bock group and started his own private accepted as a PhD project. forensic art. Both fields are a blend of company Silicorto. Since 01/’02: Part-time consultant at the art and science and use these skills to outpatient scar clinic of the Department artificially reconstruct the human face of Plastic and Reconstructive Surgery Jay D. McClennen, and better the lives of those affected. of the Academic Hospital of Maastricht AOCA (BFA), CCA, CFm Biography: Jay McClennen is a classically (10%) combined with employment as trained figurative sculptor. Upon Certified Clinical Anaplastologist physical therapist (Burns and Plastics, graduation from the Ontario College of The Anaplastology Clinic 50%) and scientifical co-worker Art & Design in Canada, Jay spent 17 Durham, North Carolina, USA (KUL,50%). years working as a successful freelance On 17/11/’03: Public defense of the Forensic Art: A Role for the artist with his own company; Spire Art & PhD: “Assessment of pressure and Anaplastologist? Design. Specializing in silicone prosthetics for the Hollywood film industry, Jay silicone therapy on burn related scars” friday, june 1, 14.15-14.30 at the Department of Rehabilitation received several awards including an Sciences of the Faculty of Kinesiology and abstract: Emmy nomination for prosthetic make-up Rehabilitation Sciences of the KUL. Purpose: Forensic art has quickly become in HBO’s Truman in 1995 and he was an emerging field partly due to exposure shortlisted for an Academy Award for Since 10/2004: Appointed as part- from news media, film and television. prosthetic make-up on X2 in 2003. time Professor at the Department of There are several different disciplines Rehabilitation Sciences of the KUL (30%) At Toronto’s Sunnybrook Regional within the forensic art field. These and employment as physical therapist Cancer Center, Jay worked in the disciplines can aid in the identification, at the Burns and Plastics unit of the Craniofacial Prosthetic Unit where he apprehension and sometimes conviction University Hospitals of Leuven (70%) and honed his clinical and implant skills before of criminal offenders. They can also moving to Durham, North Carolina where aid in the identification of unknown he owns The Anaplastology Clinic; a

28 / Anaplastology: Beyond the Horizon invited speakers clinic that has a 40-year history at Duke facial prostheses, silicone manipulation She conducts workshops at The Royal University Medical Center. techniques and finger and hand College of Surgeons as well as lectures at Fully trained in the art of Forensic prostheses. overseas conferences in both Europe and Facial Reconstruction, Jay has done work America. She has been keynote speaker for the Ontario Provincial Police and Dawn Forshaw at on medical tattooing for leading the Ontario Coroner’s Office in Canada conferences such as BAAPS, BAPS, helping to put a face to unidentified Medical Tattooing ORBS and BASO. remains. in Scar Management Jay is a Certified Clinical friday, june 1, 14.45-15.15 Maarten De Jong, Anaplastologist and an active member BOA, Anaplastologist of both the International Anaplastology abstract: Association, where he is the current Vice Surgical intervention will take a patient to Ameloblastoma Treatment President Elect, for the International a certain point and further treatment is Using Low-cost 3D Association for Identification, the world’s often prevented due to cost, availability Technology oldest and largest forensic science/ or resources. friday, june 1, 15.15-15.30 identification association. Although there are many effective lotions, creams and surgeries available abstract: Frans De Roeck, for scar management one of the most Objective: An open source software CDT, Anaplastologist effective techniques falls within medical pipeline that allows low cost 3D-printed tattooing. models to be manufactured that can aid Direct Modeling in Silicone By gently needling the scar using in preoperative planning and mandibular for Complex Models a targeted technique known as Skin reconstruction with a fibula graft after Rejuvination by MCA (Multitrepannic the resection of an ameloblastoma. friday, june 1, 14.30-14.45 Collagen Actuation) both old and new This process can be used in third world abstract: scars can be softened and flattened countries to void expensive software Medical sculpting is an ancient art: simple allowing for improved skin texture and packages and printers. and complex models are created using flexibility. When this technique is used on Methods: The use of four different types conventional modeling techniques. It is burns patients it can alleviate discomfort of computer software allows a 3D model important not to forget the versatility from contractures and offer patients to be obtained from Dicom information. and ability of the human hands and what better skin mobility. The virtual model can be printed with a complex and beautiful shapes can be In addition to scar management low cost 3D printer. created. medical tattooing is the only answer Results: The models obtained from However, the opportunity offered for skin re-coloration and long-term this production process are accurate. by digital design, both in the precision camouflage, offering a visual answer Anatomic models as well as molds can and efficient use of man hours is which is sometimes a major factor for be made to be used before and during immeasurable. Being able to use each patients who may relive their trauma or surgery. approach, digital and conventional, is the injury every time they look at their scar. Conclusion: Low cost rapid prototyping ideal combination. biography: is possible. However the open source software is unstable and limited. Direct modeling versus conventional Dawn Forshaw is the founder, co-owner Therefore it’s more time consuming to mold making techniques offers the and Managing Director of Finishing obtain a model then when using closed possibility to create complex models. Touches which was established in 1996. source software packages. Also for the manufacturing of hand and The company was initially set up as a finger prostheses, direct modeling in clinic offering procedures for cosmetic biography: combination with digital technologies and medical tattooing to clients in her hair Maarten was born is Den Haag, the gives us a lot of advantages to create restoration company. Using pioneering Netherlands, in 1984. During his training realistic prostheses. procedures the company grew and at the Art Academy, Maarten specialized biography: Finishing Touches moved into training in realistic painting. After his graduation Frans De Roeck is a certified dental and supplying products to other UK in 2006 he was a paint artist for three technician with over 18 years of technicians. With the help ofco-director years. In 2009 he joined the Centre experience in silicone manipulation Samantha Jones, the company has of Craniofacial Epithetics (CCE) in techniques. He was trained by Jan De expanded to design and manufacture its Brussels and started an internal training Cubber and active in his Silicone House own machines and pigments, which are in anaplastology in the lab of Jan De team. He was also a member of the sold worldwide. Cubber. Combined with his training Otto Bock group Benelux and became a Dawn was involved in writing the initial in Anaplastology, Maarten started his specialist in finger and hand prostheses. draft industry standards with HABIA, master in Medical Illustration with He is presently active in the Center which is the benchmark set today by focus on craniofacial anatomy. At CCE of Craniofacial Epithetics in Brussels governmental authorities for the beauty he’s providing implant-retained facial with focus 3D technology. His areas sector. prostheses and oculars. of interest include implant-retained

26th Annual IAA Conference / 29 invited speakers

Julian M Yates*, Kaida and provide the patient specific color to his patients in a relaxing atmosphere. Xaio, Fareadon Zardawi, the prosthesis. Julian’s research interests include the development of CAD/CAM technologies David Wildgoose, Manufacture: To manufacture the prosthesis 3D color printing was then for patient benefit. To date this research Richard van Noort used to achieve layered fabrication of a has focused on design and manufacture and Fripp Design and biocompatible powder held together by custom made/bespoke titanium Research Limited aqueous binders containing resin and implants to help correct facial deformity. colored inks. This was then processed However, recently the focus has shifted CAD/CAM Design with a medical grade silicone polymer towards utilizing new and innovative and Manufacture of in order to produce the final prosthesis. manufacturing techniques to automate Maxillofacial Soft Tissue Final touches were then made using the production of facial sift tissue Prostheses Using 3D Color matting dispersion solution if required. prostheses. Printing Results: The development of this unique friday, june 1, 15.30-15.45 and innovative method utilizing additive Julian M. Yates, MD BSc 3D color printing has allowed the Julian M Yates BSc BDS PhD, BDS PhD MFDSRCPS FDSRCPS research team to produce custom made/ MFDSRCPS, FDSRCPS, FDSRCS patient specific silicone based facial Professor of Oral and Maxillofacial CAD/CAM Design and soft tissue prostheses. The prostheses Surgery 3D Color Orienting of produced are biocompatible, lightweight, School of Dentistry Maxillofacial Soft Tissue flexible, color matched and can utilize University of Manchester, UK Prostheses attachment points to increase retention. abstract: Furthermore, it allows for the utilization friday, june 1, 15.30-15.45 Purpose: A collaborative research team of patient and stock prostheses to be abstract: at the University of Sheffield and Fripp stored electronically in an image library A research team at the University of Design and Research Ltd, a Sheffield for subsequent prosthesis replacement. Sheffield with the help and support based industrial design company; have This results in a significant reduction in Fripp Design and Research, a Sheffield developed a method of manufacturing both production time and cost. based Industrial Design Company; facial soft tissue prostheses using CAD/ Conclusion: CAD/CAM and additive have developed a novel method CAM and additive manufacturing manufacturing techniques – 3D color of manufacturing soft tissue facial techniques with the use of 3D color printing, have been used to successfully prostheses using additive manufacturing printing. This has been achieved by produce custom made lifelike facial soft with the use of 3D color printing. This layered fabrication of a biocompatible tissue prostheses. has been achieved by layered fabrication powder held together by an aqueous Clinical significance: This method of of a starch powder held together by an binder containing a resin and colored soft tissue prosthesis production may aqueous binder containing a resin and inks, and then processed with a medical supplement or enhance those methods inks and then infiltrated with a medical grade silicone polymer. The scope of already employed by anaplastologists. grade silicone polymer. Earlier work this project was to utilize modern CAD/ Furthermore, it may also allow for the has shown that the prosthesis thus CAM and manufacturing technologies provision of prostheses in areas where produced does not cause any cytotoxic to enhance and support the traditional these skills are not available. reaction. However, the powders and the skills of the maxillofacial anaplastologist binders employed by the printer are biography: and provide a method of provision where used for industrial rather than medical these skills are not available. Professor Julian Yates – Professor of Oral applications. To date, these powders Method: Data capture: Three dimensional & Maxillofacial Surgery and binders have not been tested for patient data (geometry and color) was Professor Julian M Yates BSc BDS their suitability in medical applications. captured using a 3D camera system PhD MFDSRCPS FDSRCPS FDSRCS Therefore the aim of this study was to (3dMD, UK). Alternative methods of qualified from the University of Glasgow evaluate the biocompatibility of the capturing/replacing missing facial tissues in 1996 and is a Professor in Oral & binders used in the printing of these soft using stock CAD images or “mirrored” Maxillofacial Surgery at the University of tissue facial prostheses. facial parts were also utilized. Additional Manchester, UK. Within the specialty of Biocompatibility was investigated by color information was also captured using Oral & Maxillofacial Surgery Professor testing four binders (clear, magenta, cyan 2D photography, and data utilized within Yates is a clinical teacher in all aspects and yellow) at three concentrations (0.1, the CAD/CAM process. of OMFS including implant dentistry 0.5 and 1.0%) on two cell lines (ROS Data manipulation: CAD manipulation of at the University of Manchester and -osteoblasts and L929 - fibroblasts). the captured data was then undertaken is extensively involved in the post The binders were exposed to the cells using both standard and project specific graduate “hands on” and MSc courses. for 3, 5 and 7 days, after which the cells computer software to refine the shape He has extensive experience in all were treated with 10% Alamar Blue of the potential prosthesis, provide an aspects of implantology – intra and extra (Invitrogen, UK) and incubated for 4 h. optimal fitting surface (facial contour and oral, including soft and hard tissue After this time, samples from each test feathered edge), attachment points (for reconstruction/augmentation. He works were placed into a 96-well plate, and the magnets or bars), create surface texture within an experienced multidisciplinary fluorescence intensity of each well was team and aims to provide treatment to

30 / Anaplastology: Beyond the Horizon invited speakers measured using a fluorescent plate reader Motzkus Y*; Voigt A; mimics, e.g., laughing, without the threat (Infinite® 200 PRO, Tecan, Reading, UK) at Menzel K; Herzog M; of loosing the prosthesis; in others, not an excitation wavelength of 570 nm and only aesthetical rehabilitation but also emission wavelength of 600 nm. Binder Hoffmeister B functional aspects have been restored toxicity was measured as a comparison Department of Oral and Maxillofacial and integrated into the restoration while against the uninfected media only cell Surgery maintaining retention. control. The Alamar Blue assays of the Berlin Center of Medical Mechatronics From our experience these situations binders are shown in Table 1 and Table 2 University Medicine Berlin benefit from a corporate approach and for the ROS cell line and the L929 cell line Charité Campus Virchow team-work by surgeons, dentists and respectively. 13353 Berlin anaplastologists alike. For the ROS cell line for all days no Germany biography: significant toxic effects were observed Berlin Center of Artificial Face Parts at a binder concentration of 0.1% when Yvonne Motzkus has been engaged 13353 Berlin since 1990 as Epithetics Specialist and compared with the control group. At a Germany 0.5% concentration of the four binders Anaplastologist for the Berlin Centre for Unfallkrankenhaus Berlin there is evidence of a reduction in cell Artificial Facial Parts. Since then, she has 12683 Berlin viability and it appears to be more constructed several hundred epitheses. pronounced at seven days, especially for Managing Difficulties of Among other things, she participated in the clear binder. At 1.0% concentration Bone-Anchored Prostheses the research project to develop an active the clear binder showed a toxic effect for Extensive Cranio-Facial (= moveable) eye epithesis. at 3, 5 and 7 days, becoming most Defects Since 2004, she has been working pronounced at seven days, causing in-house, together with Kerstin Menzel, at friday, june 1, 15.45-16.00 complete cell death. the Epithetics Laboratory of the Charité The results for the L929 cell line abstract: and also at the Unfallkrankenhaus Berlin. were very similar in that an increase in Surgical treatment of malignant tumors She is Vice President and founding concentration an exposure time resulted often creates large defects in the facial member of “Deutscher Bundesverband in measurable cell death and again the region, impairing function and aesthetics der Epithetiker/ dbve” and holds clear binder caused a more significant considerably. These defects regularly international lectures at conventions and reduction in cell viability than the other extend over multiple aesthetic units in hospitals (among others in Vietnam, binders. and present a challenging task for the China, and India). The Alamar Blue assay highlighted anaplastologist. We present example the potentially toxic effect for the four cases with difficult-to-treat defects Ricardo Reis colored binders used in the manufacture corrected by facial prostheses and of soft tissue facial prostheses when used possible solutions to particularly avoid New Digital Techniques in concentrations greater than 0.1%. This problems in areas of facial mimics. in the Manufacturing effect was most pronounced for the clear When the rim of the facial prosthesis of Orbital Prosthesis: binder at seven days exposure. There is placed onto soft tissue a firm fit cannot Development and was no difference in the results obtained always be achieved by surgical measures Evaluation with the two types of cell lines used in this alone. When the relatively rigid structure friday, june 1, 16.00-16.15 study (ROS and L929). of the material is exposed to facial mimics, the prosthesis may lose retention abstract: biography: and might uncouple from the anchoring Development and evaluation of two Julian qualified from Glasgow Dental devices which will result in disclosing the digital techniques in the manufacture of School in 1996 and is a Senior Lecturer/ defect. orbital prosthesis. 1) Obtaining an ocular Honorary Consultant in Oral Surgery at In order to adapt to the individual prosthesis using digital photography the University of Sheffield. Dr. Yates is situation, certain features require of the iris revealed on photographic a clinical teacher in all aspects of Oral special attention. For example, hiding paper and evaluation of color stability 2) Surgery including routine and advanced the immobility of the prosthesis while technique of sculpture of the eyelid and dental implantology. At the University optically reducing the size by means of eye (ocular prosthesis) separately and of Sheffield he is extensively involved coloring and shaping as well as an altered later inserted symmetrically in the rest of in the postgraduate “One-to-One” and rim design can contribute to maintaining the sculpture. MSc courses, and has been responsible the original impression even in active First technique involves digital for the introduction of “hands-on” dental facial mimics. photography of the iris revealed on implant treatment to the undergraduate The cases presented here include photographic paper and to assess the curriculum. He has experience in all both an obturator and a facial prosthesis stability of the proposed technique aspects of implant dentistry including soft as anchoring devices. In some patients compared it with the technique of and hard tissue augmentation. Julian has the otherwise mandatory symmetrical painting with acrylic paint subjecting recently been appointed as Professor reconstruction by “mirroring” existing the monochrome specimens to the in Oral and Maxillofacial surgery at collateral facial structures has been accelerated aging test (ASTM 154 ) Manchester Dental School. omitted in favor of enabling facial and colorimetric reading to obtain the

26th Annual IAA Conference / 31 invited speakers color degradation (delta E), clinical biography: communication, the identification and threshold<3.7). Dr. Reis is a specialist of maxillofacial resolution of the patient’s retention issues To evaluate the technique of sculpture prosthesis at the University of São depends on the experience and expertise were performed simulating orbital Paulo School of Dentistry in Brazil and a of the anaplastologist. The protocol helps defects in facial plaster models of 12 professor for the Brazilian Association to identify the major and minor issues volunteers. In each model two sculptures of Dental Education. He is a published with retention and which members of the were made: Group 1 free sculpture researcher on the subjects of digital healthcare team need to solve them. and Group 2 sculpture guided by the techniques and anthropometrics facial Clinical Implications: As a trusted proposed technique through photographs rehabilitation. ally of the patient and physician, the of the face and positioned in a model anaplastologist is able to understand calibrated device with millimeter scale Gillian F. Duncan, the patient’s problems and issues and and setting of head and face model. Ten facilitate communication between MS, CMI, CCA facial anthropometric measurements members of the healthcare team to were established. To measure and obtain Prosthetics at Graphica Medica, LLC achieve the best possible outcome and the measurements of the face and Rochester, Minnesota emphasize the personalized focus of the the sculpture was used for the digital patient’s treatment. photometry and Corel Draw. Data were Trouble Shooting Facial biography: analyzed by t-test (p <0.05). Prosthetic Retention In the ocular prosthesis technical Problems: Protocol for Gillian Duncan is a board-certified proposal, both in painting and in Continuity of Care medical illustrator and clinical photography, there was the minimal friday, june 1, 16.30-16.45 anaplastologist with over 30 years of degradation in brown and black, slightly abstract: experience. She is owner and director above in yellow and green and intense of Prosthetics at Graphica Medica, blue. In the technique of sculpture, in Purpose: A facial prosthetic retention LLC, with offices in Rochester and group 1, the measures 1 and 2 in the protocol can be a valuable guide and region of the palpebral fissure and reference for the anaplastologist. The Minneapolis, Minnesota. In 1977 Gillian measures 5 and 6, distances along the protocol systematically outlines the received a Master of Science degree in edges of eyelids facial axis showed important questions relating to retention Medical Illustration from the Medical issues and assists the anaplastologist significant differences, while in Group College of Georgia in Augusta, Georgia, in formulating a treatment plan. This 2 there were no statistically significant and spent the next 14 years as director differences. protocol can be used as an interactive tool when the anaplastologist and patient of the Institute for Medical Illustration Both techniques were effective are communicating face-to-face, via and Craniofacial Epithetics in Homburg, in making the orbital prosthesis: the telephone or using the latest technology. fidelity reproduction of the eye in ocular Germany. Since returning to the United prosthesis using digital iris and low color Materials and Methods: This retention States in 1991, Gillian has been active degradation. In the technique of sculpture protocol is based on anecdotal evidence in the International Anaplastology from cases and experience of a clinician the superposition image of the face on Association as President, board member, in private practice. Cases illustrating plaster in the model it was possible to and committee chair. She is recognized reproduce faithfully the eye and eyelids trouble-shooting retention problems will nationally and internationally as a clinician with the anatomical details and better be discussed. centralization in the rest of the sculpture Results: The protocol is a guideline for and educator in the field of anaplastology. with precise symmetry. discussing important questions with the In 2011 the IAA presented Gillian with In the prosthetic eye, the digital patient related to retention. In addition the Walter Spohn Award for a lifetime image of the iris possible reduction in to issues of retention, it is also important of distinctive leadership and exemplary to consider these two points for the fabrication time, and image storing to service to the profession. eventual prosthesis changing. In the long-term success of a facial prosthesis: technique of sculpture as the facial model the patient’s acceptance and satisfaction is obtained with closed eyes and difficulty with the prosthesis and the long-term in obtaining a perfect centralization of the relationship between the patient and the eyes in relation to the unaffected side, anaplastologist. the evaluation technique eliminated these Conclusions: Anaplastologists routinely limitations and enabled the development encounter and mitigate the problems of of sculpture in the region of eyes without facial prosthetic retention. Regardless the physical presence of the patient. of geographical distance and means of

32 / Anaplastology: Beyond the Horizon 26th Annual IAA Conference / 33 34 / Anaplastology: Beyond the Horizon