Search results

This study aims to find the usefulness of the customized surgical osteotomy guide (CSOG) for accurate mandibular tumor resection for boosting the accuracy of prefabricated customized implant fixation in mandibular reconstructions.

In all, 30 diseased mandibular RP models (biomodels) were allocated for the study (for experimental group [n = 15] and for control group [n = 15]). To reconstruct the mandible with customized implant in the experimental group, CSOGs and in control group, no CSOG were used for accurate tumor resections. In control group, only preoperative virtual surgical planning (VSP) and reconstructed RP mandible model were used for the reference. Individually each patient’s preoperative mandibular reconstructions data of both the groups were superimposed to the preoperative VSP of respective patient by registering images with the non-surgical side of the mandible. In both the groups, 3D measurements were taken on the reconstructed side and compared the preoperative VSP and postoperative reconstructed mandible data. The sum of the differences between pre and postoperative data was considered as the total error. This procedure was followed for both the groups and compared the obtained error between the two groups using statistical analysis.

The use of CSOG for accurate tumor resection and exact implant fixation in mandibular reconstruction produced a smaller total error than without using CSOG.

The results showed that, benefits provided with the use of CSOG in mandibular reconstruction justified its use over the without using CSOG, even in free hand tumor resection using rotating burr.

The purpose of this study is to evaluate the intra- and post-operative performance and safety of direct three dimensional printing (3DP) porous polyethylene implants in cranial reconstruction.

Prefabricated porous polyethylene implants were prepared by direct 3DP, and cranioplasty implantation was performed. Postoperative aesthetics, patient satisfaction, firmness of the implant, reactions to the implant and 3D computed tomography (CT) scanning were assessed after 2, 6, 12 and 24 months postoperatively.

No complications after surgery were encountered. Excellent aesthetic results were obtained in all cases, and all the patients were satisfied with the reconstruction outcome. Bone density structure was found to ingrowth into these direct 3DP porous polyethylene implants and the content increased with increasing follow-up times.

This study was a pilot study conducted in a single group and evaluated in a short-term period. The bone formation and ingrowth were indirectly assessed by 3D CT evaluation.

This work reported the use and evaluation of direct 3DP porous polyethylene in middle- to large-sized cranial reconstructions. It evidently showed the bonding of implants to surrounding tissues which would result in the long-term stability and infection resistance of the implant.

To obtain a vascularized autologous bone graft by in-vivo tissue transformation, a biocompatible tissue transformation mold (TTM) is needed. An ideal TTM is of high geometric accuracy and X-ray radiolucent for monitoring the bone tissue formation. The purpose of this study is to present the TTM design and fabrication process, using 3D reconstruction, stereolithography (SLA) and silicone molding.

The rat mandible, the targeted bone graft, was scanned by micro-computed tomography (CT). From the micro-CT images, the 3D mandible model was identified and used as the cavity geometry to design the TTM. The TTM was fabricated by molding the biocompatible and radiolucent silicone in the SLA molds. This TTM was implanted in a rat for in vivo tests on its biocompatibility and X-ray radiolucency.

SLA can fabricate the TTM with a cavity shape that accurately replicates that of the rat mandible. The bone formation inside of the silicone TTM can be observed by X-ray. The TTM is feasible for in vivo tissue transformation for vascularized bone reconstruction.

Research of the dimensional and geometrical accuracy of the TTM cavity is required in the future study of this process.

The TTM fabricated in this presented approach has been used for in-vivo tissue transformation. This technique can be implemented for bone reconstruction.

The precision fabrication of the TTMs for in-vivo tissue transformation into autogenous vascularized bone grafts with complex structures was achieved by using SLA, micro-CT and silicone molding.

The purpose of this paper is to demonstrate the route to digitize the customized mandible implants consisting of image acquisition, processing, implant design, fitting rehearsal and fabrication using fused deposition modeling and electron beam melting methodologies.

Recent advances in the field of rapid prototyping, reverse engineering, medical imaging and image processing have led to new heights in the medical applications of additive manufacturing (AM). AM has gained a lot of attention and interest during recent years because of its high potential in medical fields.

Produced mandible implants using casting, milling and machining are of standard sizes and shapes. As each person’s physique and anatomical bone structure are unique, these commercially produced standard implants are manually bent before surgery using trial and error methodology to custom fit the patient’s jaw. Any mismatch between the actual bone and the implant results in implant failure and psychological stress and pain to the patient.

The novelty in this paper is the construction of the customized mandibular implant from the computed tomography (CT) scan which includes surface reconstruction, implant design with validation and simulation of the mechanical behavior of the design implant using finite element analysis (FEA). There has been few research studies on the design and customization of the implants before surgery, but there had been hardly any study related to customized design implant and evaluating the biomechanical response on the newly designed implant using FEA. Though few studies are related to FEA on the reconstruction plates, but their paper lacks the implant design model and the reconstruction model. In this research study, an integrated framework is developed for the implant design, right from the CT scan of the patient including the softwares involved through out in the study and then performing the biomechanical study on the customized design implant to prove that the designed implant can withstand the biting and loading conditions. The proposed research methodology which includes the interactions between medical practitioners and the implant design engineers can be incorporated to any other reconstruction bone surgeries.

To relieve intracranial pressure and save patient inflicted with severe head injury, neurosurgeons restore cranial defects. These defects can be caused because of trauma or diseases (Osteomyelitis of bone) which are treated by cranioplasty, using the preserved bone of patient. In case of non-availability of bone, a cranial implant is generated using a biocompatible synthetic material, but this process is less accurate and time-consuming. Hence, this paper aims to present the use of rapid prototyping technology that allows the development of a more accurate patient-specific template and saves the surgery time.

A five-year-old girl patient having cranial defect was taken up for cranioplasty. CT (computed tomography) scans of the patient were used to generate 3D design of the implant suitable to conceal the defect on the left frontal portion using CAD/CAM (computer-aided design/ computer-aided manufacturing) software. The design was used for 3D printing to manufacture a base template, which was finally used to fabricate the actual implant using Simplex® P bone cement material to conceal the defect.

Surgery using Simplex® P implant was performed successfully on the patient, giving precise natural curvature to left frontal portion of the patient, decreasing surgery time by about 30 per cent.

The case demonstrates the development of a convenient, time-saving and aesthetically superior digital procedure to treat cranial defect in the absence of preserved bone flap using CT scan as input. 3D modelling and printing were deployed to produce an accurate template which was used to generate an implant using bone cement biocompatible material.

Traditional standard bone substitutes cannot realize the individualized matching for the bones of different patients. In order to make a bone substitute match the shape of a patient's bone easily, a technology based on reverse engineering (RE) and rapid prototyping (RP) is put forward to design and fabricate a customized bone substitute. By RE, the customized bone substitute is designed according to the CT sectional pictures, and the customized localizer is designed to locate the customized bone substitute in the patient's body at the right position. A customized mandible substitute designed and fabricated by RE and RP has been put into clinical use and is discussed in detail. The results confirm that the advantage of RP in the field of bone restoration is that it can fabricate the customized bone substitute rapidly and accurately.

This study aims to assess the design, manufacturing and surgical implantation of three-dimensional (3D) customized implants, including surgical preoperative planning, surgery and postoperative results, for cranioplasty along with zygomatic and orbital floor implants using additive manufacturing (AM) technics for a 23-year-old female who suffered from severe craniomaxillofacial trauma.

The skull biomodel was produced in polyamide while implants were made of Ti-6Al-4V alloy by AM.

The method enabled perfectly fitting implants and anatomical conformance with the craniomaxillofacial defect, providing complete healing for the patient. Surgical planning using a customized 3D polyamide biomodel was effective. This proved to be a powerful tool for medical planning and manufacturing of customized implants, as complete healing and good craniofacial aesthetic results were observed.

Satisfactory surgical procedures, regarding surgery time reduction and good craniofacial aesthetic results, were achieved. Furthermore, the 3D titanium customized implants represented a favorable alternative for the repair of craniomaxillofacial defects.

The purpose of this study is to obtain an effective implant with porous structures on its surface, named porous-surfaced implant, which helps to improve the overall stability of the implant and promote the combination of implant and alveolar bone.

Porous-surfaced implants with a porosity of 16%, 21%and 32% were designed and the effect of porosity on the strength of the implant was analyzed by ABAQUS software. Porous-surfaced implants with different porosity were printed by selective laser melting and the surface morphology was observed. Animal experiments of implants with porous structures and coating were carried out in healthy beagle dogs. The experimental group was treated with hydroxyapatite coating and the control group was not treated. Bone volume (BV) and total volume (TV) of the implant surface of the experimental group and control group were calculated by Skyscan CTvol software.

With the increase of porosity of porous-surfaced implants, the neck stress of the porous-surfaced implants increased and their strength decreased. In addition, in animal vivo experiments, the ratio value of BV to TV of the porous-surfaced implants was between 55.38% and 79.86%, which was the largest when the porosity of porous-surfaced implants was 16%. The internal and surrounding bone formation content of porous-surfaced implants with hydroxyapatite coating was higher than porous-surfaced implants without coating.

The results of this study show that the pores on the surface of implants can be filled with the new bone and porous-surfaced implants with 16% porosity provide better space for the growth of new bone. The porous structures with hydroxyapatite coating are beneficial to the growth of new bone around implants. The results of this study are helpful to improve the overall stability of implants and to promote the combination of implant and alveolar bone.

The purpose of this study is to suggest the joint use of computer-aided design (CAD) and additive manufacturing (AM) technology for the fabrication of custom-made moulds, designed for the manufacture of polymethyl methacrylate (PMMA) implants for cranio-maxillofacial reconstruction to reduce their fabrication time. Even though tailor-made skull prostheses with a high technological level and state-of-the-art materials are available in the market, they are not always accessible to the general population in developing countries.

Computed tomography data were handled to create a three-dimensional (3D) model of the injury of the patient, by reconstructing Digital Imaging and Communications in Medicine (DICOM) images into an Standard Tessellation Language (STL) file that was further used to design the corresponding implant using CAD software. Accordingly, a two-piece core and cavity moulds that replicated the implant geometry was also CAD designed. The 3D-CAD data were sent to an AM machine (fused deposition modelling) and the moulds were fabricated using polycarbonate as thermoplastic material. A reacting mixture to produce PMMA was poured directly into the fabricated moulds, and left to polymerise until cure. Finally, a clear bubble-free case of study PMMA implant was obtained.

The fabrication of CAD-designed moulds with AM, replacing the production of the injury model, resulted in the reduction of the lead-time in the manufacturing of PMMA around 45 per cent. Additionally, the implant showed better fit than the one produced by conventional process. The use of AM moulds for the fabrication of PMMA implants has demonstrated the reduction in lead-time, which potentially can reduce the waiting time for patients.

Currently, the demand of cranio-maxillofacial implants at only the Hospital General de México “Dr Eduardo Liceaga” (HGM) is 4,000 implants per year, and the average waiting time for each patient is between 5 and 10 weeks, including third-party services’ delays and the time needed to obtain the economical resources by the patient. Public hospitals in Mexico lack manufacturing facilities, so patients have to make use of laboratories abroad and most of the population have no access to them. The implementation of this suggested procedure in public hospitals may improve the accuracy of the implant, increase the number of patients attended per year (up to 83 per cent) and the reduction in waiting time can also reduce mortality and infection rates.

The authors of this paper suggest the joint use of CAD and AM technologies to significantly reduce the production time of PMMA implants by producing moulds rather than the injury model, maintaining the general terms and known steps of the process already established for PMMA implants.

This study aims to provide an overview of rapid prototyping (RP) and shows the potential of this technology in the field of medicine as reported in various journals and proceedings. This review article also reports three case studies from open literature where RP and associated technology have been successfully implemented in the medical field.

Key publications from the past two decades have been reviewed.

This study concludes that use of RP-built medical model facilitates the three-dimensional visualization of anatomical part, improves the quality of preoperative planning and assists in the selection of optimal surgical approach and prosthetic implants. Additionally, this technology makes the previously manual operations much faster, accurate and cheaper. The outcome based on literature review and three case studies strongly suggests that RP technology might become part of a standard protocol in the medical sector in the near future.

The article is beneficial to study the influence of RP and associated technology in the field of medicine.