scholarly journals Imaging, Virtual Planning, Design, and Production of Patient-Specific Implants and Clinical Validation in Craniomaxillofacial Surgery

2012 ◽  
Vol 5 (3) ◽  
pp. 137-143 ◽  
Author(s):  
Per Dérand ◽  
Lars-Erik Rännar ◽  
Jan-M Hirsch
Keyword(s):  
Additive Manufacturing ◽  
Treatment Plan ◽  
Maxillofacial Surgery ◽  
Bone Substitutes ◽  
Patient Specific ◽  
Virtual Design ◽  
Patient Specific Implants ◽  
Cutting Guide ◽  
Ablative Surgery ◽  
Cutting Guides

The purpose of this article was to describe the workflow from imaging, via virtual design, to manufacturing of patient-specific titanium reconstruction plates, cutting guide and mesh, and its utility in connection with surgical treatment of acquired bone defects in the mandible using additive manufacturing by electron beam melting (EBM). Based on computed tomography scans, polygon skulls were created. Following that virtual treatment plans entailing free microvascular transfer of fibula flaps using patient-specific reconstruction plates, mesh, and cutting guides were designed. The design was based on the specification of a Compact UniLOCK 2.4 Large (Synthes®, Switzerland). The obtained polygon plates were bent virtually round the reconstructed mandibles. Next, the resections of the mandibles were planned virtually. A cutting guide was outlined to facilitate resection, as well as plates and titanium mesh for insertion of bone or bone substitutes. Polygon plates and meshes were converted to stereolithography format and used in the software Magics for preparation of input files for the successive step, additive manufacturing. EBM was used to manufacture the customized implants in a biocompatible titanium grade, Ti6Al4V ELI. The implants and the cutting guide were cleaned and sterilized, then transferred to the operating theater, and applied during surgery. Commercially available software programs are sufficient in order to virtually plan for production of patient-specific implants. Furthermore, EBM-produced implants are fully usable under clinical conditions in reconstruction of acquired defects in the mandible. A good compliance between the treatment plan and the fit was demonstrated during operation. Within the constraints of this article, the authors describe a workflow for production of patient-specific implants, using EBM manufacturing. Titanium cutting guides, reconstruction plates for fixation of microvascular transfer of osteomyocutaneous bone grafts, and mesh to replace resected bone that can function as a carrier for bone or bone substitutes were designed and tested during reconstructive maxillofacial surgery. A clinically fit, well within the requirements for what is needed and obtained using traditional free hand bending of commercially available devices, or even higher precision, was demonstrated in ablative surgery in four patients.

scholarly journals Additive manufacturing in medical sciences: past, present and the future

2018 ◽  
Vol 5 (1) ◽  
pp. 201
Author(s):  
Lakshya P. Rathore ◽  
Naina Verma
Keyword(s):  
Tissue Engineering ◽  
Additive Manufacturing ◽  
Biological Tissue ◽  
Patient Specific ◽  
Basic Fact ◽  
Medical Sciences ◽  
Novel Technique ◽  
Patient Specific Implants ◽  
Tissue Replacement ◽  
The Future

Additive manufacturing (AM) is a novel technique that despite having been around for more than 35 years, has been underutilized. Its great advantage lies in the basic fact that it is incredibly customizable. Since its use was recognized in various fields of medicine like orthopaedics, otorhinolaryngology, ophthalmology etc, it has proved to be one of the most promising developments in most of them. Customizable orthotics, prosthetics and patient specific implants and tracheal splints are few of its advantages. And in the future too, the combination of tissue engineering with AM is believed to produce an immense change in biological tissue replacement.

scholarly journals A multidisciplinary approach for the rehabilitation of a patient with chondrosarcoma: prosthetically-driven digital workflow for maxillary reconstruction and implant treatment

2021 ◽  
Vol 8 (3) ◽  
pp. 207-215
Author(s):  
Yanjun Ge ◽  
◽  
Danni Guo ◽  
Xiaofeng Shan ◽  
Lei Zhang ◽  
...  
Keyword(s):  
Multidisciplinary Approach ◽  
Treatment Plan ◽  
Maxillofacial Surgery ◽  
Tumor Resection ◽  
Previous Treatment ◽  
Functional Results ◽  
Primary Treatment ◽  
Virtual Design ◽  
Anterior Teeth ◽  
Guide Plate

Aim To describe a comprehensive digital therapy oriented towards the final restoration for treating an oral maxillofacial defect caused by maxillary chondrosarcoma. Summary The prosthetically-driven multidisciplinary approach was applied to achieve perfectly functional-aesthetic reconstruction for a male patient with maxillary chondrosarcoma. The complete tumor resection was ensured by the design of virtual osteotomy and surgical guide plate. A reverse engineering technique was used to reconstruct the bone defect in the maxillary aesthetic area, which offered reference for a three-dimensional printing guide plate to shape and fix the free vascularized iliac bone flap. On the solid basis of previous treatment, the implant placement was performed under the guidance of the prosthetic-driven implant plate. Vestibular extension and tissue graft were performed to increase keratinized gingiva width to improve implant-supported fixed prosthesis effect. Key learning points 1. A multidisciplinary approach including maxillofacial surgery, prosthodontic and periodontal treatment can provide better esthetic and functional results for complex rehabilitation of a patient with oral maxillofacial defect. 2. Predictability of maxillary reconstruction and implant restoration can be increased with prosthetic-driven treatment plan. 3. Applying preoperative virtual design and personalized guide plate is beneficial to achieve an ideal outline of reconstructed upper jaw. 4. Obtaining comprehensive aesthetic parameters of the expected restoration is one of the key principles of upper anterior teeth rehabilitation. 5. Digital technology provides an opportunity for consistency between the primary treatment design and the final restoration outcome.

scholarly journals Applications of 3D Planning, Plastic Materials and Additive Manufacturing in Functional Rehabilitations in the Head and Neck Surgery

2018 ◽  
Vol 55 (3) ◽  
pp. 431-433
Author(s):  
Gheorghe Muhlfay ◽  
Zoltan Fabian ◽  
Radu Neagoe ◽  
Karin Ursula Horvath
Keyword(s):  
Additive Manufacturing ◽  
Surgical Planning ◽  
Standard Of Care ◽  
Neck Surgery ◽  
Patient Specific ◽  
Patient Specific Implants ◽  
Planning Software ◽  
Plastic Materials ◽  
Potential Benefits ◽  
Manufacturing Technologies

The developments in the biocompatible materials and additive manufacturing technologies gave birth to new possibilities in reconstructive surgery. In addition to revolutionizing the diagnostic possibilities, the modern medical imaging has led to the development of surgical planning software. Using these state-of-the-art technologies, a new standard of care is rising with the spread of patient specific implants. Our view in studying and using these materials and technologies goes beyond their biocompatibility, focusing on the functional and esthetic impact of these restorations. Our aim is to show their potential benefits and pitfalls presenting a couple of posttraumatic and oncological application possibilities, focusing on the new presurgical planning, choice of materials and manufacturing technologies.

scholarly journals Application of 3D Printing Technology in Orthopedic Medical Implant -Spinal surgery as an example

2019 ◽  
Vol 5 (2) ◽  
pp. 3
Author(s):  
Rong Feng Zhang ◽  
Peng Yun Wang ◽  
Ming Yang ◽  
Xuebo Dong ◽  
Xue Liu ◽  
...  
Keyword(s):  
Additive Manufacturing ◽  
Spinal Surgery ◽  
Surgical Planning ◽  
Operating Time ◽  
Manufacturing Technology ◽  
Patient Specific ◽  
Additive Manufacturing Technology ◽  
Patient Specific Implants ◽  
Surgical Guides ◽  
Communication Aid

Additive manufacturing has been used in complex spinal surgical planning since the 1990s and is now increasingly utilized to produce surgical guides, templates, and more recently customized implants. Surgeons report beneficial impacts using additively manufactured biomodels as pre-operative planning aids as it generally provides a better representation of the patient’s anatomy than on-screen viewing of computed tomography (CT) or magnetic resonance imaging (MRI). Furthermore, it has proven to be very beneficial in surgical training and in explaining complex deformity and surgical plans to patients/ parents. This paper reviews the historical perspective, current use, and future directions in using additive manufacturing in complex spinal surgery cases. This review reflects the authors’ opinion of where the field is moving in light of the current literature. Despite the reported benefits of additive manufacturing for surgical planning in recent years, it remains a high niche market. This review raises the question as to why the use of this technology has not progressed more rapidly despite the reported advantages – decreased operating time, decreased radiation exposure to patients intraoperatively, improved overall surgical outcomes, pre-operative implant selection, as well as being an excellent communication aid for all medical and surgical team members. Increasingly, the greatest benefits of additive manufacturing technology in spinal surgery are customdesigned drill guides, templates for pedicle screw placement, and customized patient-specific implants. In view of these applications, additive manufacturing technology could potentially revolutionize health care in the near future.

scholarly journals Microporosities in 3D-Printed Tricalcium-Phosphate-Based Bone Substitutes Enhance Osteoconduction and Affect Osteoclastic Resorption

2020 ◽  
Vol 21 (23) ◽  
pp. 9270
Author(s):  
Chafik Ghayor ◽  
Tse-Hsiang Chen ◽  
Indranil Bhattacharya ◽  
Mutlu Özcan ◽  
Franz E. Weber
Keyword(s):  
Additive Manufacturing ◽  
Tricalcium Phosphate ◽  
Major Complication ◽  
Bone Substitutes ◽  
In Vivo Studies ◽  
Patient Specific ◽  
Osteoclastic Resorption ◽  
3D Printed ◽  
High Degree

Additive manufacturing is a key technology required to realize the production of a personalized bone substitute that exactly meets a patient’s need and fills a patient-specific bone defect. Additive manufacturing can optimize the inner architecture of the scaffold for osteoconduction, allowing fast and reliable defect bridging by promoting rapid growth of new bone tissue into the scaffold. The role of scaffold microporosity/nanoarchitecture in osteoconduction remains elusive. To elucidate this relationship, we produced lithography-based osteoconductive scaffolds from tricalcium phosphate (TCP) with identical macro- and microarchitecture, but varied their nanoarchitecture/microporosity by ranging maximum sintering temperatures from 1000 °C to 1200 °C. After characterization of the different scaffolds’ microporosity, compression strength, and nanoarchitecture, we performed in vivo studies that showed that ingrowth of bone as an indicator of osteoconduction significantly decreased with decreasing microporosity. Moreover, at the 1200 °C peak sinter temperature and lowest microporosity, osteoclastic degradation of the material was inhibited. Thus, even for wide-open porous TCP-based scaffolds, a high degree of microporosity appears to be essential for optimal osteoconduction and creeping substitution, which can prevent non-unions, the major complication during bone regeneration procedures.

scholarly journals 3D printing of patient-specific implants for osteochondral defects: workflow for an MRI-guided zonal design

2021 ◽  
Author(s):  
David Kilian ◽  
Philipp Sembdner ◽  
Henriette Bretschneider ◽  
Tilman Ahlfeld ◽  
Lydia Mika ◽  
...  
Keyword(s):  
Additive Manufacturing ◽  
Implant Design ◽  
Patient Specific ◽  
Osteochondral Defects ◽  
Technological Gap ◽  
Patient Specific Implants ◽  
Cad Cam ◽  
Magnetic Resonance Imaging Mri ◽  
Common Clinical Practice ◽  
Geometric Compatibility

Abstract Magnetic resonance imaging (MRI) is a common clinical practice to visualize defects and to distinguish different tissue types and pathologies in the human body. So far, MRI data have not been used to model and generate a patient-specific design of multilayered tissue substitutes in the case of interfacial defects. For orthopedic cases that require highly individual surgical treatment, implant fabrication by additive manufacturing holds great potential. Extrusion-based techniques like 3D plotting allow the spatially defined application of several materials, as well as implementation of bioprinting strategies. With the example of a typical multi-zonal osteochondral defect in an osteochondritis dissecans (OCD) patient, this study aimed to close the technological gap between MRI analysis and the additive manufacturing process of an implant based on different biomaterial inks. A workflow was developed which covers the processing steps of MRI-based defect identification, segmentation, modeling, implant design adjustment, and implant generation. A model implant was fabricated based on two biomaterial inks with clinically relevant properties that would allow for bioprinting, the direct embedding of a patient’s own cells in the printing process. As demonstrated by the geometric compatibility of the designed and fabricated model implant in a stereolithography (SLA) model of lesioned femoral condyles, a novel versatile CAD/CAM workflow was successfully established that opens up new perspectives for the treatment of multi-zonal (osteochondral) defects. Graphic abstract

scholarly journals Patient-specific hip prostheses designed by surgeons

2016 ◽  
Vol 2 (1) ◽  
pp. 565-567
Author(s):  
Florian Coigny ◽  
Adi Todor ◽  
Horatiu Rotaru ◽  
Ralf Schumacher ◽  
Erik Schkommodau
Keyword(s):  
Additive Manufacturing ◽  
Patient Specific ◽  
Shape Information ◽  
Hip Prostheses ◽  
Patient Specific Implants ◽  
Aesthetic Results ◽  
Design Software ◽  
Low Volume ◽  
Ct Data ◽  
User Friendly

AbstractPatient-specific bone and joint replacement implants lead to better functional and aesthetic results than conventional methods [1], [2], [3]. But extracting 3D shape information from CT Data and designing individual implants is demanding and requires multiple surgeon-to-engineer interactions. For manufacturing purposes, Additive Manufacturing offers various advantages, especially for low volume manufacturing parts, such as patient specific implants. To ease these new approaches and to avoid surgeon-to-engineer interactions a new design software approach is needed which offers highly automated and user friendly planning steps.

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