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This paper aims to present a new design in the area of basal osseointegrated implant (BOI) for oral and maxillofacial surgery using a patient-specific computer-aided design (CAD) and additive manufacturing (AM) approach. The BOI was designed and fabricated according to the patient’s specific requirement, of maxilla stabilisation and dental fixation, a capacity not currently available in conventional BOI. The combination of CAD and AM techniques provides a powerful approach for optimisation and realisation of the implant in a design which helps to minimise blood loss and surgery time, translating into better patient outcomes and reduced financial burdens on healthcare providers.

The current study integrates the capabilities of conventional medical imaging techniques, CAD and metal AM to realise the BOI. The patient’s anatomy was scanned using a 128-slice spiral computed tomography scanner into a standard Digital Imaging and Communication in Medicine (DICOM) data output. The DICOM data are processed using MIMICS software to construct a digital representative patient model to aid the design process, and the final customised implant was designed using Creo software. The final, surgically implanted BOI was fabricated using direct metal laser sintering in titanium (Ti-64).

The current approach assisted us to design BOI customised to the patient’s unique anatomy to improve patient outcomes. The design realises a nerve relieving option and placement of porous structure at the required area based up on the analysis of patient bone structural data.

The novelty in this work is that developed BOI comprises a patient-specific design that allows for custom fabrication around the patients' nerves, provides structural support to the compromised maxilla and comprises a dual abutment design, with the capacity of supporting fixation of up to four teeth. Conventional BOIs are only available for a signal abutment capable of holding one or two teeth only. Given the customised nature of the design, the concept could easily be extended to explore a greater number of fixation abutments, abutment length/location, adjusted dental fixation size or greater levels of maxilla support. The study highlights the significance of CAD packages to construct patient-specific solution directly from medical imaging data, and the efficiency of metal AM to translate designs into a functional implant.

The computer‐aided design (CAD) and manufacture of custom‐fitting surgical guides have been shown to provide an accurate means of transferring computer‐aided planning to surgery. To date guides have been produced using fragile materials via rapid prototyping techniques such as stereolithography (SLA), which typically require metal reinforcement to prevent damage from drill bits. The purpose of this paper is to report case studies which explore the application of selective laser melting (SLM) to the direct manufacture of stainless steel surgical guides. The aim is to ascertain whether the potential benefits of enhanced rigidity, increased wear resistance (negating reinforcement) and easier sterilisation by autoclave can be realised in practice.

A series of clinical case studies are undertaken utilising medical scan data, CAD and SLM. The material used is 316L stainless steel, an alloy typically used in medical and devices and surgical instruments. All treatments are planned in parallel with existing techniques and all guides are test fitted and assessed on SLA models of the patients' anatomy prior to surgery.

This paper describes the successful application of SLM to the production of stainless steel surgical guides in four different maxillofacial surgery case studies. The cases reported address two types of procedure, the placement of osseointegrated implants for prosthetic retention and Le Fort 1 osteotomies using internal distraction osteogenesis. The cases reported here have demonstrated that SLM is a viable process for the manufacture of custom‐fitting surgical guides.

The cases have identified that the effective design of osteotomy guides requires further development and refinement.

This paper represents the first reported applications of SLM technology to the direct manufacture of stainless steel custom‐fitting surgical guides. Four successful exemplar cases are described including guides for osteotomy as well as drilling. Practical considerations are presented along with suggestions for further development.

This paper aims to present novel techniques for designing maxillofacial prostheses using computer-aided design (CAD) and additive manufacture (AM), focusing on the integration of osseointegrated retention components. A fully computer-aided approach is considered as a major step towards reducing patient consultation time and an efficient workflow.

The workflow was illustrated through a phantom model. 3D laser scanning was used to capture the phantom anatomy and pre-fabricated geometric features, which enabled the implant positions to be precisely reverse engineered in the data. A novel CAD workflow was used to design the retention mechanisms and a mould. The individual components were fabricated using AM. A definitive silicone prosthesis that incorporated a bar/clip retention mechanism was then fabricated.

The research demonstrated that retention components can be integrated into prostheses using appropriate CAD and AM technologies.

This study demonstrates the feasibility of a computer-aided workflow for designing facial prostheses that incorporate osseointegrated retention mechanisms. Novel techniques were developed to: digitise abutment details using custom scanning locators; design retention components; manufacture retention components using AM; integrate retention components into a CAD and AM prosthesis mould. This overcomes limitations identified in previously published cases and demonstrated significant potential to reduce patient consultation time and create a clinically viable process.

The present study investigates the mechanical properties of three types of Ti6Al4V ELI bone screws realized using the laser powder bed fusion (LPBF) process: a fully threaded screw and two groups containing differently arranged sectors made of lattice-based Voronoi (LBV) structure in a longitudinal and transversal position, respectively. This study aims to explore the potentialities related to the introduction of LBV structure and assess its impact on the implant’s primary stability and mechanical performance.

The optimized bone screw designs were realized using the LPBF process. The quality and integrity of the specimens were assessed by scanning electron microscopy and micro-computed tomography. Primary stability was experimentally verified by the insertion and removal of the screws in standard polyurethane foam blocks. Finally, torsional tests were carried out to compare and assess the mechanical strength of the different designs.

The introduction of the LBV structure decreases the elastic modulus of the implant. Longitudinal LBV type screws demonstrated the lowest insertion torque (associated with lower bone damage) while still displaying promising torsional strength and removal force compared with full-thread screws. The use of LBV structure can promote improved functional performances with respect to the reference thread, enabling the use of lattice structures in the biomedical sector.

The paper fulfils an identified interest in designing customized implants with improved primary stability and promising features for secondary stability.

The purpose of this paper is to describe two different approaches for manufacturing pre-formed titanium meshes to assist prosthetically guided bone regeneration of atrophic maxillary arches. Both methods are based on the use of additive manufacturing (AM) technologies and aim to limit at the minimal intervention the bone reconstructive surgery by virtual planning the surgical intervention for dental implants placement.

Two patients with atrophic maxillary arches were scheduled for bone augmentation using pre-formed titanium mesh with particulate autogenous bone graft and alloplastic material. The complete workflow consists of four steps: three-dimensional (3D) acquisition of medical images and virtual planning, 3D modelling and design of the bone augmentation volume, manufacturing of biomodels and pre-formed meshes, clinical procedure and follow up. For what concerns the AM, fused deposition modelling (FDM) and direct metal laser sintering (DMLS) were used.

For both patients, a post-operative control CT examination was scheduled to evaluate the progression of the regenerative process and verify the availability of an adequate amount of bone before the surgical intervention for dental implants placement. In both cases, the regenerated bone was sufficient to fix the implants in the planned position, improving the intervention quality and reducing the intervention time during surgery.

A comparison between two novel methods, involving AM technologies are presented as viable and reproducible methods to assist the correct bone augmentation of atrophic patients, prior to implant placement for the final implant supported prosthetic rehabilitation.

This paper aims to provide an overview of applications of medical rapid prototyping (MRP)-assisted customized surgical guides (CSGs) and shows the potential of this technology in complex surgeries. This review paper also reports two case studies from open literature where MRP-assisted CSGs have been successfully used in complex surgeries.

Key publications from the past two decades have been reviewed.

This study concludes that the use of MRP-assisted CSGs improves the accuracy of surgery. Additionally, MRP-assisted CSGs make the surgery much faster, accurate and cheaper than any other technique. The outcome based on literature review and two case studies strongly suggested that MRP-assisted CSGs might become part of a standard protocol in the medical sector to operate the various complex surgeries, in the near future.

Advanced technologies like radiology, image processing, virtual surgical planning (VSP), computer-aided design (CAD) and MRP made it possible to fabricate the CSGs. MRP-assisted CSGs can easily transfer the VSP into the actual surgery.

This paper is beneficial to study the development and applications of MRP-assisted CSGs in complex surgeries.

This paper aims to introduce a novel method for the analysis of open cell porous components fabricated by laser-based powder bed metal additive manufacturing (AM) for the purpose of quality control. This method uses photogrammetric analysis, the extraction of geometric information from an image through the use of algorithms. By applying this technique to porous AM components, a rapid, low-cost inspection of geometric properties such as material thickness and pore size is achieved. Such measurements take on greater importance, as the production of porous additive manufactured orthopaedic devices increases in number, causing other, slower and more expensive methods of analysis to become impractical.

Here the development of the photogrammetric method is discussed and compared to standard techniques including scanning electron microscopy, micro computed tomography scanning and the recently developed focus variation (FV) imaging. The system is also validated against test graticules and simple wire geometries of known size, prior to the more complex orthopaedic structures.

The photogrammetric method shows an ability to analyse the variability in build fidelity of AM porous structures for use in inspection purposes to compare component properties. While measured values for material thickness and pore size differed from those of other techniques, the new photogrammetric technique demonstrated a low deviation when repeating measurements, and was able to analyse components at a much faster rate and lower cost than the competing systems, with less requirement for specific expertise or training.

The advantages demonstrated by the image-based technique described indicate the system to be suitable for implementation as a means of in-line process control for quality and inspection applications, particularly for high-volume production where existing methods would be impractical.

This study aims to design and fabricate a customized multi-rooted dental implant (MRDI) for a canine strategic tooth to reduce surgical time/effort, and better assembly features, leading to enhanced primary and secondary stability and load-bearing capabilities by direct-metal laser sintering (DMLS).

A fractured tooth of a male German Shepherd three-year-old dog (extracted from a cadaver) was selected as the subject for the proposed work. The computer-aided design model of the implant was developed on SOLIDWORKS after a detailed review of literature and consultation with a veterinary doctor about the surgical procedures. Static stress analysis on the implant assembly and residual stress analysis with boundary distortion were performed on each part of the implant subassembly to ensure the fool-proof design.

The functional prototype of the innovative MRDI assembly through DMLS was successfully prepared with acceptable dimensional stability, surface roughness (Ra) and refined microstructure. The 3D printed functional prototype was observed to be residual stress-proof during printing and can bear up to 800 N bite force (required for an adult dog).

Innovative MRDI assembly has been 3D printed by using 17–4 precipitate hardened stainless steel without compromising the strength and can be implanted without bone grafting for better primary stability. Also, the prepared implant will be better for secondary stability due to enhanced osseointegration.

With technology advances, metallic implants claim to improve the quality and durability of human life. In the recent decade, Ti-6Al-4V biomaterial has been additively manufactured via selective laser melting (SLM) for orthopedic applications. This paper aims to provide state-of-the-art on mechanobiology of these fabricated components.

A literature review has been done to explore the potential of SLM fabricated Ti-6Al-4V porous lattice structures (LS) as bone substitutes. The emphasize was on the effect of process parameters and porosity on mechanical and biological properties. The papers published since 2007 were considered here. The keywords used to search were porous Ti-6Al-4V, additive manufacturing, metal three-dimensional printing, osseointegration, porous LS, SLM, in vitro and in vivo.

The properties of SLM porous biomaterials were compared with different human bones, and bulk SLM fabricated Ti-6Al-4V structures. The comparison was also made between LS with different unit cells to find out whether there is any particular design that can mimic the human bone functionality and enhance osseointegration.

The implant porosity plays a crucial role in mechanical and biological characteristics that relies on the optimum controlled process variables and design attributes. It was also indicated that although the mechanical strength (compressive and fatigue) of porous LS is not mostly close to natural cortical bone, elastic modulus can be adjusted to match that of cortical or cancellous bone. Porous Ti-6Al-4V provide favorable bone formation. However, the effect of design variables on biological behavior cannot be fully conclusive as few studies have been dedicated to this.

There are over 40 million amputees globally with more than 185,000 Americans losing their limbs every year. For most of the world, prosthetic devices remain too expensive and uncomfortable. This paper aims to outline advancements made by a multidisciplinary research group, interested in advancing the restoration of human motion through accessible lower limb prostheses.

Customization, comfort and functionality are the most important metrics reported by prosthetists and patients. The work of this paper presents the design and manufacturing of a custom made, cost-effective and functional three-dimensional (3D) printed transtibial prosthesis monocoque design. The design of the prosthesis integrates 3D imaging, modelling and optimization techniques coupled with additive manufacturing.

The successful fabrication of a functional monocoque prosthesis through 3D printing indicates the workflow may be a solution to the worldwide accessibility crisis. The digital workflow developed in this work offers great potential for providing prosthetic devices to rural communities, which lack access to skilled prosthetic physicians. The authors found that using the workflow together with 3D printing, this study can create custom monocoque prostheses (Figure 16). These prostheses are comfortable, functional and properly aligned. In comparison with traditional prosthetic devices, the authors slowered the average cost, weight and time of production by 95%, 55% and 95%, respectively.

This novel digital design and manufacturing workflow has the potential to democratize and globally proliferate access to prosthetic devices, which restore the patient’s mobility, quality of life and health. LIMBER’s toolbox can reach places where proper prosthetic and orthotic care is not available. The digital workflow reduces the cost of making custom devices by an order of magnitude, enabling broader reach, faster access and improved comfort. This is particularly important for children who grow quickly and need new devices every few months or years, timely access is both physically and psychologically important.

In this manuscript, the authors show the application of digital design techniques for fabricating prosthetic devices. The proposed workflow implements several advantageous changes and, most importantly, digitally blends the three components of a transtibial prosthesis into a single, 3D printable monocoque device. The development of a novel unibody transtibial device that is properly aligned and adjusted digitally, greatly reduces the number of visits an amputee must make to a clinic to have a certified prosthetist adjust and modify their prosthesis. The authors believe this novel workflow has the potential to ease the worldwide accessibility crisis for prostheses.