Assessment of Accuracy and Orbital Volume Using Patient-Specific Titanium Implant Versus Patient-Specific Zirconia Implant for Orbital Floor Reconstruction in Blowout Fractures: A Randomized Clinical Trial

Abstract

This randomized clinical trial aimed to compare patient-specific titanium and zirconia implants for orbital floor reconstruction with respect to reconstruction accuracy, orbital volume restoration, patient satisfaction, and cost-effectiveness. Twenty-four patients presenting with orbital blowout fractures underwent open reduction and internal fixation with orbital floor and/or medial wall reconstruction using patient-specific implants through a transconjunctival approach. Virtual surgical planning was performed by mirroring the contralateral intact orbit combined with digital fracture reduction. Postoperative evaluation included orbital volume measurements and 3-dimensional superimposition analysis to assess reconstruction accuracy. Patient satisfaction and implant manufacturing cost were also recorded. Both zirconia and titanium implants achieved comparable restoration of orbital volume and reconstruction accuracy, with no statistically significant differences between groups. Patient satisfaction scores were better in the zirconia group, although the difference was not statistically significant. Postoperative complications occurred only in the titanium group, including one case of globe restriction requiring partial implant removal and 2 cases suggestive of titanium hypersensitivity managed medically. Zirconia implants demonstrated a significantly lower manufacturing cost. Zirconia patient-specific implants provide anatomic and clinical outcomes similar to titanium implants, with a favorable cost profile, supporting their use as a viable alternative for orbital reconstruction.