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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.