Surgical performance of 3D-printed polyetheretherketone (PEEK) patient-specific implants and titanium mesh in clinically matched orbital reconstruction. A cadaveric study

Abstract

Orbital reconstruction following trauma remains challenging due to complex three-dimensional (3D) anatomy and limited surgical access. While pre-fabricated titanium mesh is standard, it requires extensive intraoperative manipulation and produces imaging artifacts. The 3D-printed polyetheretherketone (PEEK) patient-specific implants (PSIs) offer potential advantages; however, limited data exists for the acceptance of PEEK PSIs by surgeons compared to other established techniques. Fourteen surgeons performed simulated orbital reconstructions on nine cadaveric heads comparing titanium mesh and the 3D-printed PEEK PSIs. Titanium mesh was used for Class II orbital floor fractures, while the 3D-printed PEEK PSIs (native and radiopaque formulations) were used for Class IV defects. Surgeons were blinded to the PEEK formulation type. Outcomes included operative efficiency, handling characteristics, fit quality, and mechanical stability using validated 5-point Likert scales and objective timing. The 3D-printed PEEK PSIs demonstrated faster procedure times (9.5 ± 5.3 vs. 11.2 ± 5.1 min) and superior fit quality (2.00 ± 1.04 vs. 2.18 ± 0.60) and mechanical stability (1.67 ± 0.49 vs. 1.91 ± 0.54), with 100% rated stable versus 91% for the titanium mesh. Surgeons could not distinguish between the native and radiopaque PEEK formulations. Most surgeons (64.3%) preferred situation-dependent material selection. The 3D-printed PEEK PSIs demonstrated advantages in handling, fit quality, and mechanical stability for complex defects, while the titanium mesh showed a lower learning curve for simple reconstructions. Radiopaque enhancement expands PEEK's clinical utility without compromising handling.