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Bečulić H, Spahić D, Begagić E, Pugonja R, Skomorac R, Jusić A, Selimović E, Mašović A, Pojskić M. Breaking Barriers in Cranioplasty: 3D Printing in Low and Middle-Income Settings-Insights from Zenica, Bosnia and Herzegovina. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1732. [PMID: 37893450 PMCID: PMC10608598 DOI: 10.3390/medicina59101732] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/16/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Cranial defects pose significant challenges in low and middle-income countries (LIMCs), necessitating innovative and cost-effective craniofacial reconstruction strategies. The purpose of this study was to present the Bosnia and Herzegovina model, showcasing the potential of a multidisciplinary team and 3D-based technologies, particularly PMMA implants, to address cranial defects in a resource-limited setting. Materials and Methods: An observational, non-experimental prospective investigation involved three cases of cranioplasty at the Department of Neurosurgery, Cantonal Hospital Zenica, Bosnia and Herzegovina, between 2019 and 2023. The technical process included 3D imaging and modeling with MIMICS software (version 10.01), 3D printing of the prototype, mold construction and intraoperative modification for precise implant fitting. Results: The Bosnia and Herzegovina model demonstrated successful outcomes in cranioplasty, with PMMA implants proving cost-effective and efficient in addressing cranial defects. Intraoperative modification contributed to reduced costs and potential complications, while the multidisciplinary approach and 3D-based technologies facilitated accurate reconstruction. Conclusions: The Bosnia and Herzegovina model showcases a cost-effective and efficient approach for craniofacial reconstruction in LIMICs. Collaborative efforts, 3D-based technologies, and PMMA implants contribute to successful outcomes. Further research is needed to validate sustained benefits and enhance craniofacial reconstruction strategies in resource-constrained settings.
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Affiliation(s)
- Hakija Bečulić
- Department of Neurosurgery, Cantonal Hospital Zenica, 72000 Zenica, Bosnia and Herzegovina
- Department of Anatomy, School of Medicine, University of Zenica, 72000 Zenica, Bosnia and Herzegovina; (R.S.); (A.M.)
| | - Denis Spahić
- Department of Constructions and CAD Technologies, School of Mechanical Engineering, University of Zenica, 72000 Zenica, Bosnia and Herzegovina;
- iDEAlab, School of Mechanical Engineering, University of Zenica, 72000 Zenica, Bosnia and Herzegovina
| | - Emir Begagić
- Deparment of General Medicine, School of Medicine, University of Zenica, 72000 Zenica, Bosnia and Herzegovina;
| | - Ragib Pugonja
- Deparment of General Medicine, School of Medicine, University of Zenica, 72000 Zenica, Bosnia and Herzegovina;
| | - Rasim Skomorac
- Department of Anatomy, School of Medicine, University of Zenica, 72000 Zenica, Bosnia and Herzegovina; (R.S.); (A.M.)
- Department of Surgery, School of Medicine, University of Zenica, 72000 Zenica, Bosnia and Herzegovina;
| | - Aldin Jusić
- Department of Anatomy, School of Medicine, University of Zenica, 72000 Zenica, Bosnia and Herzegovina; (R.S.); (A.M.)
| | - Edin Selimović
- Department of Surgery, School of Medicine, University of Zenica, 72000 Zenica, Bosnia and Herzegovina;
| | - Anes Mašović
- Department of Anatomy, School of Medicine, University of Zenica, 72000 Zenica, Bosnia and Herzegovina; (R.S.); (A.M.)
| | - Mirza Pojskić
- Department of Neurosurgery, University Hospital Marburg, Baldinger Str., 35033 Marburg, Germany
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Sharma N, Zubizarreta-Oteiza J, Tourbier C, Thieringer FM. Can Steam Sterilization Affect the Accuracy of Point-of-Care 3D Printed Polyetheretherketone (PEEK) Customized Cranial Implants? An Investigative Analysis. J Clin Med 2023; 12:jcm12072495. [PMID: 37048579 PMCID: PMC10094830 DOI: 10.3390/jcm12072495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/19/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Polyetheretherketone (PEEK) has become the biomaterial of choice for repairing craniofacial defects over time. Prospects for the point-of-care (POC) fabrication of PEEK customized implants have surfaced thanks to the developments in three-dimensional (3D) printing systems. Consequently, it has become essential to investigate the characteristics of these in-house fabricated implants so that they meet the necessary standards and eventually provide the intended clinical benefits. This study aimed to investigate the effects of the steam sterilization method on the dimensional accuracy of POC 3D-printed PEEK customized cranial implants. The objective was to assess the influence of standard sterilization procedures on material extrusion-based 3D-printed PEEK customized implants with non-destructive material testing. Fifteen PEEK customized cranial implants were fabricated using an in-house material extrusion-based 3D printer. After fabrication, the cranial implants were digitalized with a professional-grade optical scanner before and after sterilization. The dimensional changes for the 3D-printed PEEK cranial implants were analyzed using medically certified 3D image-based engineering software. The material extrusion 3D-printed PEEK customized cranial implants displayed no statistically significant dimensional difference with steam sterilization (p > 0.05). Evaluation of the cranial implants’ accuracy revealed that the dimensions were within the clinically acceptable accuracy level with deviations under 1.00 mm. Steam sterilization does not significantly alter the dimensional accuracy of the in-house 3D-printed PEEK customized cranial implants.
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Affiliation(s)
- Neha Sharma
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167C, 4123 Allschwil, Switzerland
- Correspondence:
| | - Jokin Zubizarreta-Oteiza
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167C, 4123 Allschwil, Switzerland
| | - Céline Tourbier
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167C, 4123 Allschwil, Switzerland
| | - Florian M. Thieringer
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167C, 4123 Allschwil, Switzerland
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3
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Jackson D, Obayomi T, Mir F. Reconstruction of frontal bone using patient specific implant poly-ether-ketone-ketone via a lateral nasal/lynch incision. ORAL AND MAXILLOFACIAL SURGERY CASES 2023. [DOI: 10.1016/j.omsc.2023.100293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
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Bouzidi S, Ayadi M, Boulila A. Feasibility Study of the SPIF Process Applied to Perforated Sheet Metals. ARABIAN JOURNAL FOR SCIENCE AND ENGINEERING 2022. [DOI: 10.1007/s13369-022-06570-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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5
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Sharma N, Aghlmandi S, Dalcanale F, Seiler D, Zeilhofer HF, Honigmann P, Thieringer FM. Quantitative Assessment of Point-of-Care 3D-Printed Patient-Specific Polyetheretherketone (PEEK) Cranial Implants. Int J Mol Sci 2021; 22:8521. [PMID: 34445228 PMCID: PMC8395180 DOI: 10.3390/ijms22168521] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 07/26/2021] [Accepted: 08/05/2021] [Indexed: 12/18/2022] Open
Abstract
Recent advancements in medical imaging, virtual surgical planning (VSP), and three-dimensional (3D) printing have potentially changed how today's craniomaxillofacial surgeons use patient information for customized treatments. Over the years, polyetheretherketone (PEEK) has emerged as the biomaterial of choice to reconstruct craniofacial defects. With advancements in additive manufacturing (AM) systems, prospects for the point-of-care (POC) 3D printing of PEEK patient-specific implants (PSIs) have emerged. Consequently, investigating the clinical reliability of POC-manufactured PEEK implants has become a necessary endeavor. Therefore, this paper aims to provide a quantitative assessment of POC-manufactured, 3D-printed PEEK PSIs for cranial reconstruction through characterization of the geometrical, morphological, and biomechanical aspects of the in-hospital 3D-printed PEEK cranial implants. The study results revealed that the printed customized cranial implants had high dimensional accuracy and repeatability, displaying clinically acceptable morphologic similarity concerning fit and contours continuity. From a biomechanical standpoint, it was noticed that the tested implants had variable peak load values with discrete fracture patterns and failed at a mean (SD) peak load of 798.38 ± 211.45 N. In conclusion, the results of this preclinical study are in line with cranial implant expectations; however, specific attributes have scope for further improvements.
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Affiliation(s)
- Neha Sharma
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (N.S.); (H.-F.Z.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
| | - Soheila Aghlmandi
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, CH-4031 Basel, Switzerland;
| | - Federico Dalcanale
- Institute for Medical Engineering and Medical Informatics, University of Applied Sciences and Arts North-Western Switzerland, CH-4132 Muttenz, Switzerland; (F.D.); (D.S.)
| | - Daniel Seiler
- Institute for Medical Engineering and Medical Informatics, University of Applied Sciences and Arts North-Western Switzerland, CH-4132 Muttenz, Switzerland; (F.D.); (D.S.)
| | - Hans-Florian Zeilhofer
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (N.S.); (H.-F.Z.)
| | - Philipp Honigmann
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
- Hand Surgery, Cantonal Hospital Baselland, CH-4410 Liestal, Switzerland
- Amsterdam UMC, Department of Biomedical Engineering and Physics, University of Amsterdam, Amsterdam Movement Sciences, NL-1105 Amsterdam, The Netherlands
| | - Florian M. Thieringer
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (N.S.); (H.-F.Z.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
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Basgul C, Spece H, Sharma N, Thieringer FM, Kurtz SM. Structure, properties, and bioactivity of 3D printed PAEKs for implant applications: A systematic review. J Biomed Mater Res B Appl Biomater 2021; 109:1924-1941. [PMID: 33856114 DOI: 10.1002/jbm.b.34845] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 03/09/2021] [Accepted: 03/31/2021] [Indexed: 12/14/2022]
Abstract
Additive manufacturing (AM) of high temperature polymers, specifically polyaryletherketones (PAEK), is gaining significant attention for medical implant applications. As 3D printing systems evolve toward point of care manufacturing, research on this topic continues to expand. Specific regulatory guidance is being developed for the safe management of 3D printing systems in a hospital environment. PAEK implants can benefit from many advantages of AM such as design freedom, material and antibacterial drug incorporation, and enhanced bioactivity provided by cancellous bone-like porous designs. In addition to AM PAEK bioactivity, the biomechanical strength of 3D printed implants is crucial to their performance and thus widely studied. In this review, we discuss the printing conditions that have been investigated so far for additively manufactured PAEK implant applications. The effect of processing parameters on the biomechanical strength of implants is summarized, and the bioactivity of PAEKs, along with material and drug incorporation, is also covered in detail. Finally, the therapeutic areas in which 3D printed PAEK implants are investigated and utilized are reviewed.
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Affiliation(s)
- Cemile Basgul
- Implant Research Core, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Hannah Spece
- Implant Research Core, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Neha Sharma
- Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland.,Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Basel, Switzerland
| | - Florian M Thieringer
- Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland.,Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Basel, Switzerland
| | - Steven M Kurtz
- Implant Research Core, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA.,Exponent, Inc, Philadelphia, Pennsylvania, USA
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Lastovickova DN, Toulan FR, Mitchell JR, VanOosten D, Clay AM, Stanzione JF, Palmese GR, La Scala JJ. Resin, cure, and polymer properties of photopolymerizable resins containing
bio‐derived
isosorbide. J Appl Polym Sci 2021. [DOI: 10.1002/app.50574] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | - Faye R. Toulan
- CCDC‐Army Research Laboratory FCDD‐RLW‐M Aberdeen Maryland USA
| | | | - David VanOosten
- CCDC‐Army Research Laboratory FCDD‐RLW‐M Aberdeen Maryland USA
| | - Anthony M. Clay
- CCDC‐Army Research Laboratory FCDD‐RLW‐M Aberdeen Maryland USA
| | - Joseph F. Stanzione
- Department of Chemical Engineering Rowan University Glassboro New Jersey USA
| | - Giuseppe R. Palmese
- Department of Chemical and Biological Engineering Drexel University Philadelphia Pennsylvania USA
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8
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Schön SN, Skalicky N, Sharma N, Zumofen DW, Thieringer FM. 3D-Printer-Assisted Patient-Specific Polymethyl Methacrylate Cranioplasty: A Case Series of 16 Consecutive Patients. World Neurosurg 2021; 148:e356-e362. [PMID: 33418118 DOI: 10.1016/j.wneu.2020.12.138] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/27/2020] [Accepted: 12/27/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND To develop a novel 3D-printer-assisted method to fabricate patient-specific implants for cranioplasty and to demonstrate its feasibility and its use in 16 consecutive cases. METHODS We report on 16 consecutive patients who have undergone cranioplasty surgery for an extensive skull defect after decompressive surgery and in which the bone flap was not available. We present the workflow for the implant production using a 3D-printer-assisted molding technique. Preoperative, intraoperative, and postoperative data were analyzed/evaluated. RESULTS Eleven out of our 16 patients (68.7%) presented with extensive hemispheric bone defects. Indication for initial craniotomy were traumatic brain injury (4; 25%), acute subdural hematoma (4; 25%), ischemic stroke (3; 18.8%), tumor (3; 18.8%), and ruptured aneurysm (2; 12.5%). Median (range) operation time was 121 (89-206) minutes. Median (range) intraoperative blood loss was 300 (100-3300) mL. The mean (range) follow-up period is 6 (0-21) months. Complications occurred in 7 out of our 16 patients (43.8%), in 6 (37.5%) of which a reoperation was required to evacuate an extra-axial hematoma (3; 50%), for shunting of an epidural fluid collection (1; 16.7%), or for skin flap necrosis (1; 16.7%). One patient (16.7%) developed a chronic asymptomatic subdural fluid collection that was stable over the follow-up period. CONCLUSIONS Our workflow to intraoperatively produce patient-specific implants in a timely manner to cover cranial defects proved to be feasible. The results are cosmetically appealing, and postoperative CT scans show well-fitting implants. As implantable printable substrates are already available, we aim to advance and certify 3D-printed patient-specific implants in the near future.
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Affiliation(s)
- Stephan N Schön
- Department of Neurosurgery and Spine Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Nicolas Skalicky
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Neha Sharma
- Department of Cranio-Maxillo-Facial Surgery and 3D Print Lab, University Hospital Basel, University of Basel, Basel, Switzerland; Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Daniel W Zumofen
- Department of Surgery, Department of Neurology and Department of Radiology, Maimonides Medical Center, SUNY Downstate University, Brooklyn, New York, USA
| | - Florian M Thieringer
- Department of Cranio-Maxillo-Facial Surgery and 3D Print Lab, University Hospital Basel, University of Basel, Basel, Switzerland; Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
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9
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Zhu Y, Joralmon D, Shan W, Chen Y, Rong J, Zhao H, Xiao S, Li X. 3D printing biomimetic materials and structures for biomedical applications. Biodes Manuf 2021. [DOI: 10.1007/s42242-020-00117-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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10
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Edelmann A, Dubis M, Hellmann R. Selective Laser Melting of Patient Individualized Osteosynthesis Plates-Digital to Physical Process Chain. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E5786. [PMID: 33352930 PMCID: PMC7767064 DOI: 10.3390/ma13245786] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/13/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022]
Abstract
We report on the exemplified realization of a digital to physical process chain for a patient individualized osteosynthesis plate for the tarsal bone area. Anonymized patient-specific data of the right feet were captured by computer tomography, which were then digitally processed to generate a surface file format (standard tessellation language, STL) ready for additive manufacturing. Physical realization by selective laser melting in titanium using optimized parameter settings and post-processing by stress relief annealing results in a customized osteosynthesis plate with superior properties fulfilling medical demands. High fitting accuracy was demonstrated by applying the osteosynthesis plate to an equally good 3D printed bone model, which likewise was generated using the patient-specific computer tomography (CT) data employing selective laser sintering and polyamid 12. Proper fixation has been achieved without any further manipulation of the plate using standard screws, proving that based on CT data, individualized implants well adapted to the anatomical conditions can be accomplished without the need for additional steps, such as bending, cutting and shape trimming of precast bone plates during the surgical intervention. Beyond parameter optimization for selective laser melting, this exemplified digital to physical process chain highlights the potential of additive manufacturing for individualized osteosynthesis.
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Affiliation(s)
- André Edelmann
- Applied Laser and Photonics Group, University of Applied Sciences Aschaffenburg, 63743 Aschaffenburg, Germany; (M.D.); (R.H.)
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Sharma N, Aghlmandi S, Cao S, Kunz C, Honigmann P, Thieringer FM. Quality Characteristics and Clinical Relevance of In-House 3D-Printed Customized Polyetheretherketone (PEEK) Implants for Craniofacial Reconstruction. J Clin Med 2020; 9:jcm9092818. [PMID: 32878160 PMCID: PMC7563642 DOI: 10.3390/jcm9092818] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/13/2020] [Accepted: 08/30/2020] [Indexed: 12/11/2022] Open
Abstract
Additive manufacturing (AM) of patient-specific implants (PSIs) is gradually moving towards in-house or point-of-care (POC) manufacturing. Polyetheretherketone (PEEK) has been used in cranioplasty cases as a reliable alternative to other alloplastic materials. As only a few fused filament fabrication (FFF) printers are suitable for in-house manufacturing, the quality characteristics of the implants fabricated by FFF technology are still under investigated. This paper aimed to investigate PEEK PSIs fabricated in-house for craniofacial reconstruction, discussing the key challenges during the FFF printing process. Two exemplary cases of class III (Group 1) and class IV (Group 2) craniofacial defects were selected for the fabrication of PEEK PSIs. Taguchi’s L9 orthogonal array was selected for the following nonthermal printing process parameters, i.e., layer thickness, infill rate, number of shells, and infill pattern, and an assessment of the dimensional accuracy of the fabricated implants was made. The root mean square (RMS) values revealed higher deviations in Group 1 PSIs (0.790 mm) compared to Group 2 PSIs (0.241 mm). Horizontal lines, or the characteristic FFF stair-stepping effect, were more perceptible across the surface of Group 1 PSIs. Although Group 2 PSIs revealed no discoloration, Group 1 PSIs displayed different zones of crystallinity. These results suggest that the dimensional accuracy of PSIs were within the clinically acceptable range; however, attention must be paid towards a requirement of optimum thermal management during the printing process to fabricate implants of uniform crystallinity.
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Affiliation(s)
- Neha Sharma
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (N.S.); (S.C.); (C.K.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
| | - Soheila Aghlmandi
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, CH-4031 Basel, Switzerland;
| | - Shuaishuai Cao
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (N.S.); (S.C.); (C.K.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
| | - Christoph Kunz
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (N.S.); (S.C.); (C.K.)
| | - Philipp Honigmann
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
- Hand Surgery, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Florian M. Thieringer
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (N.S.); (S.C.); (C.K.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
- Correspondence:
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Cumulative Inaccuracies in Implementation of Additive Manufacturing Through Medical Imaging, 3D Thresholding, and 3D Modeling: A Case Study for an End-Use Implant. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10082968] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In craniomaxillofacial surgical procedures, an emerging practice adopts the preoperative virtual planning that uses medical imaging (computed tomography), 3D thresholding (segmentation), 3D modeling (digital design), and additive manufacturing (3D printing) for the procurement of an end-use implant. The objective of this case study was to evaluate the cumulative spatial inaccuracies arising from each step of the process chain when various computed tomography protocols and thresholding values were independently changed. A custom-made quality assurance instrument (Phantom) was used to evaluate the medical imaging error. A sus domesticus (domestic pig) head was analyzed to determine the 3D thresholding error. The 3D modeling error was estimated from the computer-aided design software. Finally, the end-use implant was used to evaluate the additive manufacturing error. The results were verified using accurate measurement instruments and techniques. A worst-case cumulative error of 1.7 mm (3.0%) was estimated for one boundary condition and 2.3 mm (4.1%) for two boundary conditions considering the maximum length (56.9 mm) of the end-use implant. Uncertainty from the clinical imaging to the end-use implant was 0.8 mm (1.4%). This study helps practitioners establish and corroborate surgical practices that are within the bounds of an appropriate accuracy for clinical treatment and restoration.
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13
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Computer-Aided-Design/Computer-Aided-Manufacturing Titanium Cranioplasty in a Child: Critical Appraisal. J Craniofac Surg 2019; 31:237-240. [PMID: 31714337 DOI: 10.1097/scs.0000000000005948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Large skull bone defects of the cranial vault can result from various reasons. Reconstruction of these defects is performed for protective and aesthetic reasons but is also required for adequate intracranial homeostasis. Computer-aided-design/computer-aided-manufacturing (CAD/CAM) patient-specific skull implants have become the most valuable alternative to the traditional methods of reconstruction and a growing number of publications is dealing with this topic in adults. Literature related to the application of these implants in pediatric cranioplasty is, however, still scarce.The authors present a case of a 9-year-old boy, where cranioplasty using a CAD/CAM additive manufactured titanium implant led to improvement of symptoms attributed to cerebrospinal fluid circulation problems and intracranial homeostasis disbalance. The authors further reflect on what the role of cranioplasty should be in the therapeutic treatment plan.
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Polymethyl Methacrylate in Patient-Specific Implants: Description of a New Three-Dimension Technique. J Craniofac Surg 2019; 30:408-411. [PMID: 30676441 DOI: 10.1097/scs.0000000000005148] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Polymethyl methacrylate (PMMA), an easily moldable and economical synthetic resin, has been used since the 1940s. In addition, PMMA has good mechanical properties and is one of the most biocompatible alloplastic materials currently available. The PMMA can serve as a spacer and as a delivery vehicle for antibiotics. Prior studies have indicated that no significant differences in infection rates exist between autologous and acrylic cranioplasty. Although inexpensive, the free-hand cranioplasty technique often yields unsatisfactory cosmetic results. In the present study, the application of a recently developed, economic modality for the perioperative application, and molding of PMMA to ensure a precise fit in 16 patients using computer-aided design, computer-aided manufacturing, and rapid prototyping was described.The mean defect size was 102.0 ± 26.4 cm. The mean volume of PMMA required to perform the cranioplasty procedure was 51 mL. The cost of PMMA was approximately 6 Euro (&OV0556;) per mL. The costs of fabricating the implants varied from 119.8 &OV0556; to 1632.0 &OV0556; with a mean of 326.4 &OV0556; ± 371.6. None of the implants required removal during the follow-up period.
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Javaid M, Haleem A. Additive manufacturing applications in medical cases: A literature based review. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2017.09.003] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Mohd. Javaid
- Department of Mechanical Engineering, Jamia Millia Islamia, New Delhi, India
| | - Abid Haleem
- Department of Mechanical Engineering, Jamia Millia Islamia, New Delhi, India
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Koper D, ter Laak-Poort M, Lethaus B, Yamauchi K, Moroni L, Habibovic P, Kessler P. Cranioplasty with patient-specific implants in repeatedly reconstructed cases. J Craniomaxillofac Surg 2019; 47:709-714. [DOI: 10.1016/j.jcms.2019.01.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 11/29/2018] [Accepted: 01/25/2019] [Indexed: 10/27/2022] Open
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Peel S, Eggbeer D, Burton H, Hanson H, Evans PL. Additively manufactured versus conventionally pressed cranioplasty implants: An accuracy comparison. Proc Inst Mech Eng H 2018; 232:949-961. [DOI: 10.1177/0954411918794718] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This article compared the accuracy of producing patient-specific cranioplasty implants using four different approaches. Benchmark geometry was designed to represent a cranium and a defect added simulating a craniectomy. An ‘ideal’ contour reconstruction was calculated and compared against reconstructions resulting from the four approaches –‘conventional’, ‘semi-digital’, ‘digital – non-automated’ and ‘digital – semi-automated’. The ‘conventional’ approach relied on hand carving a reconstruction, turning this into a press tool, and pressing titanium sheet. This approach is common in the UK National Health Service. The ‘semi-digital’ approach removed the hand-carving element. Both of the ‘digital’ approaches utilised additive manufacturing to produce the end-use implant. The geometries were designed using a non-specialised computer-aided design software and a semi-automated cranioplasty implant-specific computer-aided design software. It was found that all plates were clinically acceptable and that the digitally designed and additive manufacturing plates were as accurate as the conventional implants. There were no significant differences between the additive manufacturing plates designed using non-specialised computer-aided design software and those designed using the semi-automated tool. The semi-automated software and additive manufacturing production process were capable of producing cranioplasty implants of similar accuracy to multi-purpose software and additive manufacturing, and both were more accurate than handmade implants. The difference was not of clinical significance, demonstrating that the accuracy of additive manufacturing cranioplasty implants meets current best practice.
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Affiliation(s)
- Sean Peel
- PDR – International Centre for Design & Research, Cardiff Metropolitan University, Cardiff, UK
| | - Dominic Eggbeer
- PDR – International Centre for Design & Research, Cardiff Metropolitan University, Cardiff, UK
| | - Hanna Burton
- PDR – International Centre for Design & Research, Cardiff Metropolitan University, Cardiff, UK
| | - Hayley Hanson
- PDR – International Centre for Design & Research, Cardiff Metropolitan University, Cardiff, UK
| | - Peter L Evans
- Morriston Hospital, Abertawe Bro Morgannwg University Health Board, Swansea, UK
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Fabrication and Characterization of a Low Magnetic Zr-1Mo Alloy by Powder Bed Fusion Using a Fiber Laser. METALS 2017. [DOI: 10.3390/met7110501] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Homogenous scaffold-based cranial/skull implant modelling and structural analysis—unit cell algorithm-meshless approach. Med Biol Eng Comput 2017; 55:2053-2065. [DOI: 10.1007/s11517-017-1649-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 04/18/2017] [Indexed: 10/19/2022]
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Tuomi JT, Björkstrand RV, Pernu ML, Salmi MVJ, Huotilainen EI, Wolff JEH, Vallittu PK, Mäkitie AA. In vitro cytotoxicity and surface topography evaluation of additive manufacturing titanium implant materials. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:53. [PMID: 28197824 DOI: 10.1007/s10856-017-5863-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/30/2017] [Indexed: 06/06/2023]
Abstract
Custom-designed patient-specific implants and reconstruction plates are to date commonly manufactured using two different additive manufacturing (AM) technologies: direct metal laser sintering (DMLS) and electron beam melting (EBM). The purpose of this investigation was to characterize the surface structure and to assess the cytotoxicity of titanium alloys processed using DMLS and EBM technologies as the existing information on these issues is scarce. "Processed" and "polished" DMLS and EBM disks were assessed. Microscopic examination revealed titanium alloy particles and surface flaws on the processed materials. These surface flaws were subsequently removed by polishing. Surface roughness of EBM processed titanium was higher than that of DMLS processed. The cytotoxicity results of the DMLS and EBM discs were compared with a "gold standard" commercially available titanium mandible reconstruction plate. The mean cell viability for all discs was 82.6% (range, 77.4 to 89.7) and 83.3% for the control reconstruction plate. The DMLS and EBM manufactured titanium plates were non-cytotoxic both in "processed" and in "polished" forms.
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Affiliation(s)
- Jukka T Tuomi
- Department of Mechanical Engineering, School of Engineering, Aalto University, Espoo, Finland
| | - Roy V Björkstrand
- Department of Mechanical Engineering, School of Engineering, Aalto University, Espoo, Finland
| | - Mikael L Pernu
- Department of Mechanical Engineering, School of Engineering, Aalto University, Espoo, Finland
| | - Mika V J Salmi
- Department of Mechanical Engineering, School of Engineering, Aalto University, Espoo, Finland
| | - Eero I Huotilainen
- Department of Mechanical Engineering, School of Engineering, Aalto University, Espoo, Finland
| | - Jan E H Wolff
- Department of Oral and Maxillofacial Surgery/Oral Pathology and 3D Innovation Lab, VU University Medical Center, Amsterdam, The Netherlands
| | - Pekka K Vallittu
- Department of Biomaterials Science and Turku Clinical Biomaterial Centre, Welfare Division, Institute of Dentistry, University of Turku, Turku, Finland
| | - Antti A Mäkitie
- Department of Mechanical Engineering, School of Engineering, Aalto University, Espoo, Finland.
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, SE-171 76, Sweden.
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Zegers T, ter Laak-Poort M, Koper D, Lethaus B, Kessler P. The therapeutic effect of patient-specific implants in cranioplasty. J Craniomaxillofac Surg 2017; 45:82-86. [DOI: 10.1016/j.jcms.2016.10.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/10/2016] [Accepted: 10/25/2016] [Indexed: 10/20/2022] Open
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Three-dimensional printing for restoration of the donor face: A new digital technique tested and used in the first facial allotransplantation patient in Finland. J Plast Reconstr Aesthet Surg 2016; 69:1648-1652. [PMID: 27789209 DOI: 10.1016/j.bjps.2016.09.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 07/27/2016] [Accepted: 09/26/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS Prosthetic mask restoration of the donor face is essential in current facial transplant protocols. The aim was to develop a new three-dimensional (3D) printing (additive manufacturing; AM) process for the production of a donor face mask that fulfilled the requirements for facial restoration after facial harvest. MATERIALS AND METHODS A digital image of a single test person's face was obtained in a standardized setting and subjected to three different image processing techniques. These data were used for the 3D modeling and printing of a donor face mask. The process was also tested in a cadaver setting and ultimately used clinically in a donor patient after facial allograft harvest. RESULTS and Conclusions: All the three developed and tested techniques enabled the 3D printing of a custom-made face mask in a timely manner that is almost an exact replica of the donor patient's face. This technique was successfully used in a facial allotransplantation donor patient.
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Custom implant design for large cranial defects. Int J Comput Assist Radiol Surg 2016; 11:2217-2230. [DOI: 10.1007/s11548-016-1454-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/18/2016] [Indexed: 11/26/2022]
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Sotobori M, Ueki K, Ishihara Y, Moroi A, Marukawa K, Nakazawa R, Higuchi M, Iguchi R, Ikawa H, Kosaka A. Bone regeneration by periosteal elevation using conventional orthodontic wire and uHA/PLLA mesh. J Craniomaxillofac Surg 2014; 42:1742-7. [DOI: 10.1016/j.jcms.2014.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 04/12/2014] [Accepted: 06/05/2014] [Indexed: 11/25/2022] Open
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Interval cranioplasty with patient-specific implants and autogenous bone grafts--success and cost analysis. J Craniomaxillofac Surg 2014; 42:1948-51. [PMID: 25443869 DOI: 10.1016/j.jcms.2014.08.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 08/21/2014] [Accepted: 08/25/2014] [Indexed: 01/09/2023] Open
Abstract
UNLABELLED Different options exist for the reconstruction of craniectomy defects following interval cranioplasty. The standard procedure is still based on the re-implantation of autogenous bone specimen which can be stored in the abdominal wall or be cryopreserved. Alternatively patient-specific implants (PSIs) can be used. We conducted a retrospective study based on 50 consecutive patients with skull bone defects of 100 cm(2) or more being operated on by the same team of surgeons. Thirty-three patients agreed to take part in the study. Seventeen patients who underwent reconstruction with PSIs (titanium and polyether ether ketone, PEEK) (follow-up, 43 months [range, 3-93]) were compared with 16 control subjects who had autogenous bone grafts re-implanted (follow-up, 32 months [range, 5-92]). Criteria analyzed were the success and complication rates, operation time, duration of hospitalization and the treatment costs. Complication rate and the rate of reoperation were significantly lower, and the hospital stay was shorter in the PSI group. The treatment costs for reconstruction with autogenous bone were considerably lower than skull bone reconstruction based on PSIs (average costs: 10849.91 €/patient versus 15532.08 €/patient with PSI). Due to biological reasons some of the autogenous bone implants fail due to infection and resorption and the patients have to undergo another operation with implantation of a PSI in a secondary attempt. For those patients the highest overall treatment costs must be calculated (average costs: 26086.06 €/patient with secondary stage PSI versus 15532.08 €/patient with primary stage PSI). CONCLUSION High success rates and reliability of PSIs may change the treatment strategy in patients undergoing interval cranioplasty.
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Tuomi J, Paloheimo KS, Vehviläinen J, Björkstrand R, Salmi M, Huotilainen E, Kontio R, Rouse S, Gibson I, Mäkitie AA. A Novel Classification and Online Platform for Planning and Documentation of Medical Applications of Additive Manufacturing. Surg Innov 2014; 21:553-9. [DOI: 10.1177/1553350614524838] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Additive manufacturing technologies are widely used in industrial settings and now increasingly also in several areas of medicine. Various techniques and numerous types of materials are used for these applications. There is a clear need to unify and harmonize the patterns of their use worldwide. We present a 5-class system to aid planning of these applications and related scientific work as well as communication between various actors involved in this field. An online, matrix-based platform and a database were developed for planning and documentation of various solutions. This platform will help the medical community to structurally develop both research innovations and clinical applications of additive manufacturing. The online platform can be accessed through http://www.medicalam.info .
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Affiliation(s)
- Jukka Tuomi
- Aalto University, Department of Engineering Design and Production, School of Engineering, Aalto, Espoo, Finland
| | - Kaija-Stiina Paloheimo
- Aalto University, Department of Engineering Design and Production, School of Engineering, Aalto, Espoo, Finland
| | - Juho Vehviläinen
- Aalto University, Department of Engineering Design and Production, School of Engineering, Aalto, Espoo, Finland
| | - Roy Björkstrand
- Aalto University, Department of Engineering Design and Production, School of Engineering, Aalto, Espoo, Finland
| | - Mika Salmi
- Aalto University, Department of Engineering Design and Production, School of Engineering, Aalto, Espoo, Finland
| | - Eero Huotilainen
- Aalto University, Department of Engineering Design and Production, School of Engineering, Aalto, Espoo, Finland
| | - Risto Kontio
- Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | | | - Ian Gibson
- National University of Singapore, Singapore
| | - Antti A. Mäkitie
- Aalto University, Department of Engineering Design and Production, School of Engineering, Aalto, Espoo, Finland
- Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
- Karolinska Institutet, Division of ENT Diseases, CLINTEC, Stockholm, Sweden
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Huotilainen E, Jaanimets R, Valášek J, Marcián P, Salmi M, Tuomi J, Mäkitie A, Wolff J. Inaccuracies in additive manufactured medical skull models caused by the DICOM to STL conversion process. J Craniomaxillofac Surg 2013; 42:e259-65. [PMID: 24268714 DOI: 10.1016/j.jcms.2013.10.001] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 07/08/2013] [Accepted: 10/08/2013] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The process of fabricating physical medical skull models requires many steps, each of which is a potential source of geometric error. The aim of this study was to demonstrate inaccuracies and differences caused by DICOM to STL conversion in additively manufactured medical skull models. MATERIAL AND METHODS Three different institutes were requested to perform an automatic reconstruction from an identical DICOM data set of a patients undergoing tumour surgery into an STL file format using their software of preference. The acquired digitized STL data sets were assessed and compared and subsequently used to fabricate physical medical skull models. The three fabricated skull models were then scanned, and differences in the model geometries were assessed using established CAD inspection software methods. RESULTS A large variation was noted in size and anatomical geometries of the three physical skull models fabricated from an identical (or "a single") DICOM data set. CONCLUSIONS A medical skull model of the same individual can vary markedly depending on the DICOM to STL conversion software and the technical parameters used. Clinicians should be aware of this inaccuracy in certain applications.
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Affiliation(s)
- Eero Huotilainen
- BIT Research Centre, Department of Industrial Engineering and Management, School of Science and Technology, Aalto University, P.O. Box 15500, FI-00076 Helsinki, Finland
| | - Risto Jaanimets
- Oral and Maxillofacial Unit, Department of Otorhinolaryngology, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland; Medical Imaging Center, Department of Radiology, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland.
| | - Jiří Valášek
- Institute of Solid Mechanics, Mechatronics and Biomechanics, Faculty of Mechanical Engineering, Brno University of Technology, Technická 2896/2, 616 69 Brno, Czech Republic
| | - Petr Marcián
- Institute of Solid Mechanics, Mechatronics and Biomechanics, Faculty of Mechanical Engineering, Brno University of Technology, Technická 2896/2, 616 69 Brno, Czech Republic
| | - Mika Salmi
- BIT Research Centre, Department of Industrial Engineering and Management, School of Science and Technology, Aalto University, P.O. Box 15500, FI-00076 Helsinki, Finland
| | - Jukka Tuomi
- BIT Research Centre, Department of Industrial Engineering and Management, School of Science and Technology, Aalto University, P.O. Box 15500, FI-00076 Helsinki, Finland
| | - Antti Mäkitie
- BIT Research Centre, Department of Industrial Engineering and Management, School of Science and Technology, Aalto University, P.O. Box 15500, FI-00076 Helsinki, Finland; Dept. of Otolaryngology - Head & Neck Surgery, Helsinki University Hospital and University of Helsinki, P.O. Box 220, FI-00029 Helsinki, Finland
| | - Jan Wolff
- Oral and Maxillofacial Unit, Department of Otorhinolaryngology, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland; Medical Imaging Center, Department of Radiology, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland
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Aitasalo KMJ, Piitulainen JM, Rekola J, Vallittu PK. Craniofacial bone reconstruction with bioactive fiber-reinforced composite implant. Head Neck 2013; 36:722-8. [PMID: 23616383 DOI: 10.1002/hed.23370] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 01/05/2013] [Accepted: 04/11/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND A novel, bioactive, fiber-reinforced composite implant is a solution to address the shortcomings in craniofacial bone reconstruction. A longitudinal clinical investigation with a follow-up time of 4 years was conducted. METHODS A cranial bone reconstruction with the implant was performed on 12 patients. In these patients, the reasons for craniotomies resulting in craniofacial bone defects were traumatic and spontaneous intracranial bleeding as well as infections to the primary reconstruction material. The implant material consisted of a supporting fiber-reinforced framework, porous inner layers, and a bioactive glass (BG; S53P4) filling. The framework and the porous layers were made of a bisphenol-a-glycidyl methacrylate and triethyleneglycoldi-methacrylate (pBisGMA-pTEGDMA) resin matrix, which was reinforced with silanized E-glass. RESULTS In clinical examinations and skull X-rays, the implants were in original positions providing the expected functional and aesthetic outcome at all time points. CONCLUSION The implants functioned appropriately, which would provide a potential solution for craniofacial bone reconstruction in the future.
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Affiliation(s)
- Kalle M J Aitasalo
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital, Turku, Finland
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Salmi M, Paloheimo KS, Tuomi J, Ingman T, Mäkitie A. A digital process for additive manufacturing of occlusal splints: a clinical pilot study. J R Soc Interface 2013; 10:20130203. [PMID: 23614943 DOI: 10.1098/rsif.2013.0203] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of this study was to develop and evaluate a digital process for manufacturing of occlusal splints. An alginate impression was taken from the upper and lower jaws of a patient with temporomandibular disorder owing to cross bite and wear of the teeth, and then digitized using a table laser scanner. The scanned model was repaired using the 3Data Expert software, and a splint was designed with the Viscam RP software. A splint was manufactured from a biocompatible liquid photopolymer by stereolithography. The system employed in the process was SLA 350. The splint was worn nightly for six months. The patient adapted to the splint well and found it comfortable to use. The splint relieved tension in the patient's bite muscles. No sign of tooth wear or significant splint wear was detected after six months of testing. Modern digital technology enables us to manufacture clinically functional occlusal splints, which might reduce costs, dental technician working time and chair-side time. Maximum-dimensional errors of approximately 1 mm were found at thin walls and sharp corners of the splint when compared with the digital model.
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Affiliation(s)
- Mika Salmi
- Department of Industrial Engineering and Management, BIT Research Centre, Aalto University, Aalto, Finland.
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Shanjani Y, Hu Y, Toyserkani E, Grynpas M, Kandel RA, Pilliar RM. Solid freeform fabrication of porous calcium polyphosphate structures for bone substitute applications:In vivostudies. J Biomed Mater Res B Appl Biomater 2013; 101:972-80. [DOI: 10.1002/jbm.b.32905] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 01/16/2013] [Accepted: 01/17/2013] [Indexed: 11/08/2022]
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Honeybul S, Morrison DA. Skull vault destruction after rhinocerebral mucormycosis. World Neurosurg 2012; 78:553.e1-4. [PMID: 22609027 DOI: 10.1016/j.wneu.2011.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 10/25/2011] [Accepted: 12/02/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Mucormycosis is a relatively rare form of fungal infection that can be rapidly progressive. Clinical presentation depends on the anatomic area of involvement; however, the commonest form is that of rhinocerebral. CASE DESCRIPTION This is the first case of extensive and progressive destruction of the skull vault despite antifungal therapy. The patient required aggressive surgical resection to arrest the disease progression and complex reconstruction using a custom made titanium cranioplasty. CONCLUSIONS This report highlights the need for early aggressive resection for cases of mucormycosis infection where there is bony involvement.
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Affiliation(s)
- Stephen Honeybul
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Nedlands and Royal Perth Hospital, Perth, Western Australia, Australia.
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Morrison DA, Guy DT, Day RE, Lee GYF. Simultaneous repair of two large cranial defects using rapid prototyping and custom computer-designed titanium plates: a case report. Proc Inst Mech Eng H 2012; 225:1108-12. [PMID: 22292209 DOI: 10.1177/0954411911422766] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Custom titanium cranioplasty plates, manufactured by a variety of techniques, have been used to repair a range of cranial defects. The authors present a case where two relatively large, adjacent cranial defects were repaired by custom computer-designed titanium plates. The two plates were designed and fabricated simultaneously using a unique methodology. A 28-year-old woman underwent a corpus callosotomy for medically intractable epilepsy. The surgery was complicated by unexpected haemorrhage which necessitated a second craniotomy. Subsequent deep infection required the removal of bilateral bone flaps, presenting a challenge in the reconstruction of extensive, bilateral but asymmetrical cranial defects. The patient underwent a head computed tomography scan, from which a rapid-prototype model of the skull was produced. The surfaces for the missing cranial segments were generated virtually using a combination of software products and two titanium plates that followed these virtual contours were manufactured to cover the defects. The cranioplasty procedure to implant both titanium cranial plates was performed efficiently with no intra-operative complications. Intra-operatively, an excellent fit was achieved. The careful planning of the plates enhanced the relative ease with which the cranial defects were repaired with an excellent cosmetic outcome.
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Affiliation(s)
- D A Morrison
- Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, Australia.
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Martínez-Sanz E, Ossipov DA, Hilborn J, Larsson S, Jonsson KB, Varghese OP. Bone reservoir: Injectable hyaluronic acid hydrogel for minimal invasive bone augmentation. J Control Release 2011; 152:232-40. [PMID: 21315118 DOI: 10.1016/j.jconrel.2011.02.003] [Citation(s) in RCA: 153] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 01/31/2011] [Accepted: 02/01/2011] [Indexed: 11/28/2022]
Abstract
A strategy has been designed to develop hyaluronic acid (HA) hydrogel for in vivo bone augmentation using minimal invasive technique. A mild synthetic procedure was developed to prepare aldehyde modified HA by incorporating an amino-glycerol side chain via amidation reaction and selective oxidation of the pendent group. This modification, upon mixing with hydrazide modified HA formed hydrazone-crosslinked hydrogel within 30s that was stable at physiological pH. In vitro experiments showed no cytotoxicity of hydrogel with the controlled release of active bone morphogenic protein-2 (BMP-2). In vivo evaluation of this gel as a BMP-2 carrier was performed by injecting gels over the rat calvarium and showed bone formation in 8 weeks in correlation with the amount of BMP-2 loaded (0, 1 and 30μg) within the gel. Furthermore, hydrogels with 30μg of BMP-2 induced less bone formation upon subcutaneous injection in comparison with subperiosteal implantation. Histological examination showed newly formed bone with a high expression of osteocalcin, osteopontin and with angiogenic bone marrow when higher BMP-2 concentration was employed. Our result suggests that novel HA hydrogels could be used as a BMP-2 carrier and can promote bone augmentation for potential orthopedic applications.
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Affiliation(s)
- Elena Martínez-Sanz
- Departamento de Anatomía y Embriología Humana I, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
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Lethaus B, Ter Laak MP, Laeven P, Beerens M, Koper D, Poukens J, Kessler P. A treatment algorithm for patients with large skull bone defects and first results. J Craniomaxillofac Surg 2010; 39:435-40. [PMID: 21055960 DOI: 10.1016/j.jcms.2010.10.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 07/27/2010] [Accepted: 10/04/2010] [Indexed: 10/18/2022] Open
Abstract
Large skull bone defects resulting from craniotomies due to cerebral insults, trauma or tumours create functional and aesthetic disturbances to the patient. The reconstruction of large osseous defects is still challenging. A treatment algorithm is presented based on the close interaction of radiologists, computer engineers and cranio-maxillofacial surgeons. From 2004 until today twelve consecutive patients have been operated on successfully according to this treatment plan. Titanium and polyetheretherketone (PEEK) were used to manufacture the implants. The treatment algorithm is proved to be reliable. No corrections had to be performed either to the skull bone or to the implant. Short operations and hospitalization periods are essential prerequisites for treatment success and justify the high expenses.
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Affiliation(s)
- Bernd Lethaus
- Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, P. Debyelaan, NL-6202 AZ Maastricht, The Netherlands.
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Lethaus B, Tudor C, Bumiller L, Birkholz T, Wiltfang J, Kessler P. Guided bone regeneration: Dynamic procedures versus static shielding in an animal model. J Biomed Mater Res B Appl Biomater 2010; 95:126-30. [DOI: 10.1002/jbm.b.31691] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Tudor C, Bumiller L, Birkholz T, Stockmann P, Wiltfang J, Kessler P. Static and dynamic periosteal elevation: a pilot study in a pig model. Int J Oral Maxillofac Surg 2010; 39:897-903. [PMID: 20576403 DOI: 10.1016/j.ijom.2010.05.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 04/29/2010] [Accepted: 05/11/2010] [Indexed: 10/19/2022]
Abstract
The osteoinductive potential of periosteum and bone can be stimulated by elevating the periosteum in a distraction-like modus, but also by an ad-hoc elevation. This was tested and proved in an experiment in 9 Goettingen mini-pigs with elevation heights of 5, 10 and 15mm. Specially designed and perforated titanium meshes were implanted subperiosteally to compare the dynamic elevation procedure with static shielding. The cumulative results for bone formation underneath the mesh were 66% in dynamic and 67% in non-dynamic elevation. The cumulative results for mineralization of the bone regenerates in comparison with the underlying basal bone of the skull showed independently from the technique applied no difference bigger than 5%. No major difference in bone formation could be observed in this pilot study. The main advantages of dynamic periosteal elevation and static shielding are minimal invasion and morbidity. Periosteal elevation could be applied in cranio-maxillofacial surgery, in preimplantological augmentation and in reconstructive surgery of the skull; applications in other specialties may be possible.
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Affiliation(s)
- C Tudor
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
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Spetzger U, Vougioukas V, Schipper J. Materials and techniques for osseous skull reconstruction. MINIM INVASIV THER 2010; 19:110-21. [DOI: 10.3109/13645701003644087] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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