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Chepelev L, Wake N, Ryan J, Althobaity W, Gupta A, Arribas E, Santiago L, Ballard DH, Wang KC, Weadock W, Ionita CN, Mitsouras D, Morris J, Matsumoto J, Christensen A, Liacouras P, Rybicki FJ, Sheikh A. Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG): guidelines for medical 3D printing and appropriateness for clinical scenarios. 3D Print Med 2018; 4:11. [PMID: 30649688 PMCID: PMC6251945 DOI: 10.1186/s41205-018-0030-y] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/19/2018] [Indexed: 02/08/2023] Open
Abstract
Medical three-dimensional (3D) printing has expanded dramatically over the past three decades with growth in both facility adoption and the variety of medical applications. Consideration for each step required to create accurate 3D printed models from medical imaging data impacts patient care and management. In this paper, a writing group representing the Radiological Society of North America Special Interest Group on 3D Printing (SIG) provides recommendations that have been vetted and voted on by the SIG active membership. This body of work includes appropriate clinical use of anatomic models 3D printed for diagnostic use in the care of patients with specific medical conditions. The recommendations provide guidance for approaches and tools in medical 3D printing, from image acquisition, segmentation of the desired anatomy intended for 3D printing, creation of a 3D-printable model, and post-processing of 3D printed anatomic models for patient care.
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Affiliation(s)
- Leonid Chepelev
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Nicole Wake
- Center for Advanced Imaging Innovation and Research (CAI2R), Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU School of Medicine, New York, NY USA
- Sackler Institute of Graduate Biomedical Sciences, NYU School of Medicine, New York, NY USA
| | | | - Waleed Althobaity
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Ashish Gupta
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Elsa Arribas
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Lumarie Santiago
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO USA
| | - Kenneth C Wang
- Baltimore VA Medical Center, University of Maryland Medical Center, Baltimore, MD USA
| | - William Weadock
- Department of Radiology and Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI USA
| | - Ciprian N Ionita
- Department of Neurosurgery, State University of New York Buffalo, Buffalo, NY USA
| | - Dimitrios Mitsouras
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | | | | | - Andy Christensen
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Peter Liacouras
- 3D Medical Applications Center, Walter Reed National Military Medical Center, Washington, DC, USA
| | - Frank J Rybicki
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Adnan Sheikh
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
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Wurm MC, Hagen J, Nkenke E, Neukam FW, Schlittenbauer T. The fitting accuracy of pre-bend reconstruction plates and their impact on the temporomandibular joint. J Craniomaxillofac Surg 2018; 47:53-59. [PMID: 30470467 DOI: 10.1016/j.jcms.2018.05.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 04/05/2018] [Accepted: 05/11/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Various causes for bone defects of the lower jaw have been described. As a result, patients often suffer from compromised aesthetics and a loss of, or reduction in, important physiological functions, such as swallowing, breathing, and speaking. A change in the shape of the lower jaw can impair the natural occlusion and leads to an atypical or modified position of the temporomandibular joint. Titanium reconstruction plates are the standard approach to jaw reconstruction, and are used for temporary bridging of a jaw defect or fixation of a bone graft. Conventionally these plates are intraoperatively adjusted to the mandible by the surgeon. Computer-aided manufacturing, computer-aided design, and rapid prototyping have gained increasing importance in the field of medicine, as they allow the production of individual models of the lower jaw, with the possibility of preoperatively bending the reconstruction plates. In this retrospective study, the accuracy of pre-bent titanium plates and their effect on the temporomandibular joint situation in comparison with intraoperatively curved plates will be discussed. MATERIALS AND METHODS Patients who attended our department for lower jaw reconstruction between March 2013 and February 2015 were included in this retrospective study. Within that time 20 patients were treated with pre-bent reconstruction plates (group 1). 20 comparable patients were selected with reconstruction and conventional intraoperative bending (group 2). To evaluate the accuracy of the plates and the condylar position, postoperative cone beam computed tomograms and computed tomograms were used to assess the bone-plate distance at 12 defined points and four angles in axial reconstruction. The results were compared, statistically evaluated, and discussed. RESULTS Regarding the maximum bone-plate distances and the sum of distances, there was a significant difference between the accuracy of the pre-bent and the conventionally bent reconstruction plates (p = 0.022, p = 0.048). Regarding the condylar position, there was no significant difference between both methods (p = 0.867). CONCLUSION The results of this study show that a better fitting accuracy can be achieved using pre-bent plates. Preparation of the plates proves to be advantageous and meaningful, especially in complex bone defects and deformations of the lower jaw. Nevertheless, concerning the position of the temporomandibular joint, no significant difference could be ascertained between the shown methods, contradicting several studies.
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Affiliation(s)
- Matthias C Wurm
- Department of Oral and Maxillofacial Surgery (Head of Department Friedrich Wilhelm Neukam, Prof., MD, DMD, PhD, Dr. h. c), Friedrich-Alexander-University Erlangen-Nuremberg, Glueckstrasse 11, 91054 Erlangen, Germany
| | - Julia Hagen
- Department of Oral and Maxillofacial Surgery (Head of Department Friedrich Wilhelm Neukam, Prof., MD, DMD, PhD, Dr. h. c), Friedrich-Alexander-University Erlangen-Nuremberg, Glueckstrasse 11, 91054 Erlangen, Germany
| | - Emeka Nkenke
- Department of Cranio-Maxillofacial and Oral Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Friedrich Wilhelm Neukam
- Department of Oral and Maxillofacial Surgery (Head of Department Friedrich Wilhelm Neukam, Prof., MD, DMD, PhD, Dr. h. c), Friedrich-Alexander-University Erlangen-Nuremberg, Glueckstrasse 11, 91054 Erlangen, Germany
| | - Tilo Schlittenbauer
- Department of Oral and Maxillofacial Surgery (Head of Department Friedrich Wilhelm Neukam, Prof., MD, DMD, PhD, Dr. h. c), Friedrich-Alexander-University Erlangen-Nuremberg, Glueckstrasse 11, 91054 Erlangen, Germany.
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Ciocca L, Mazzoni S, Marchetti C, Scotti R. The Concept of Prosthetically Guided Maxillofacial and Implant Surgery for Maxillary Reconstruction. J ORAL IMPLANTOL 2016; 42:184-8. [DOI: 10.1563/aaid-joi-d-14-00302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Leondaro Ciocca
- Section of Prosthodontics, Department of Oral Science, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Simona Mazzoni
- Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Claudio Marchetti
- Faculty of Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Roberto Scotti
- Section of Prosthodontics, Department of Oral Science, Alma Mater Studiorum University of Bologna, Bologna, Italy
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Zhang J, Xia JJ, Li J, Zhou X. Reconstruction-Based Digital Dental Occlusion of the Partially Edentulous Dentition. IEEE J Biomed Health Inform 2015; 21:201-210. [PMID: 26584502 DOI: 10.1109/jbhi.2015.2500191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Partially edentulous dentition presents a challenging problem for the surgical planning of digital dental occlusion in the field of craniomaxillofacial surgery because of the incorrect maxillomandibular distance caused by missing teeth. We propose an innovative approach called Dental Reconstruction with Symmetrical Teeth (DRST) to achieve accurate dental occlusion for the partially edentulous cases. In this DRST approach, the rigid transformation between two symmetrical teeth existing on the left and right dental model is estimated through probabilistic point registration by matching the two shapes. With the estimated transformation, the partially edentulous space can be virtually filled with the teeth in its symmetrical position. Dental alignment is performed by digital dental occlusion reestablishment algorithm with the reconstructed complete dental model. Satisfactory reconstruction and occlusion results are demonstrated with the synthetic and real partially edentulous models.
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Chan HHL, Siewerdsen JH, Vescan A, Daly MJ, Prisman E, Irish JC. 3D Rapid Prototyping for Otolaryngology-Head and Neck Surgery: Applications in Image-Guidance, Surgical Simulation and Patient-Specific Modeling. PLoS One 2015; 10:e0136370. [PMID: 26331717 PMCID: PMC4557980 DOI: 10.1371/journal.pone.0136370] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 08/03/2015] [Indexed: 01/06/2023] Open
Abstract
The aim of this study was to demonstrate the role of advanced fabrication technology across a broad spectrum of head and neck surgical procedures, including applications in endoscopic sinus surgery, skull base surgery, and maxillofacial reconstruction. The initial case studies demonstrated three applications of rapid prototyping technology are in head and neck surgery: i) a mono-material paranasal sinus phantom for endoscopy training ii) a multi-material skull base simulator and iii) 3D patient-specific mandible templates. Digital processing of these phantoms is based on real patient or cadaveric 3D images such as CT or MRI data. Three endoscopic sinus surgeons examined the realism of the endoscopist training phantom. One experienced endoscopic skull base surgeon conducted advanced sinus procedures on the high-fidelity multi-material skull base simulator. Ten patients participated in a prospective clinical study examining patient-specific modeling for mandibular reconstructive surgery. Qualitative feedback to assess the realism of the endoscopy training phantom and high-fidelity multi-material phantom was acquired. Conformance comparisons using assessments from the blinded reconstructive surgeons measured the geometric performance between intra-operative and pre-operative reconstruction mandible plates. Both the endoscopy training phantom and the high-fidelity multi-material phantom received positive feedback on the realistic structure of the phantom models. Results suggested further improvement on the soft tissue structure of the phantom models is necessary. In the patient-specific mandible template study, the pre-operative plates were judged by two blinded surgeons as providing optimal conformance in 7 out of 10 cases. No statistical differences were found in plate fabrication time and conformance, with pre-operative plating providing the advantage of reducing time spent in the operation room. The applicability of common model design and fabrication techniques across a variety of otolaryngological sub-specialties suggests an emerging role for rapid prototyping technology in surgical education, procedure simulation, and clinical practice.
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Affiliation(s)
- Harley H. L. Chan
- TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Jeffrey H. Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Allan Vescan
- Department of Otolaryngology–Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Michael J. Daly
- TECHNA Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Eitan Prisman
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia
| | - Jonathan C. Irish
- TECHNA Institute, University Health Network, Toronto, Ontario, Canada
- Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
- Department of Otolaryngology–Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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Lethaus B, Poort L, Böckmann R, Smeets R, Tolba R, Kessler P. Additive manufacturing for microvascular reconstruction of the mandible in 20 patients. J Craniomaxillofac Surg 2011; 40:43-6. [PMID: 21296586 DOI: 10.1016/j.jcms.2011.01.007] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 12/01/2010] [Accepted: 01/04/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the use of model mandibles made preoperatively by additive manufacturing, which were used to prebend reconstruction plates prior to mandibular resection and reconstruction with microvascular bony flaps. MATERIALS AND METHODS Computer Tomography (CT) or Cone Beam Tomography (CBT) scans acquired preoperatively were used to obtain DICOM data sets to produce a model of the mandible using rapid prototyping. This model was used as a template to prebend and then sterilize a 2.3 or 2.7 reconstruction plate, which was used to reconstruct the mandible with a microvascular bony flap. This technique was used in 20 consecutive patients who required mandibular resection and reconstruction because of a tumour or osteoradionecrosis. RESULTS The prebent plate was used in all patients intraoperatively without the need for any further bending. The average time to bend a plate on a nonsterile model was 0.42 h (range 0.25-0.68 h). This is felt to represent the minimum amount of time saved during the operation. Additive manufacture of the mandible prior to resection and reconstruction with a microvascular flap is a useful technique which reduces the operating time.
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Affiliation(s)
- Bernd Lethaus
- Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, P. Debyelaan, Postbus 5800, NL-6202 AZ Maastricht, The Netherlands.
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Lethaus B, Kessler P, Boeckman R, Poort LJ, Tolba R. Reconstruction of a maxillary defect with a fibula graft and titanium mesh using CAD/CAM techniques. Head Face Med 2010; 6:16. [PMID: 20642821 PMCID: PMC2917404 DOI: 10.1186/1746-160x-6-16] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 07/19/2010] [Indexed: 11/10/2022] Open
Abstract
We present a case of maxillary and orbital floor reconstruction with a microvascular fibula graft and an individualized titanium mesh. Both were planned virtually; templates were made by rapid prototyping. The postoperative computer tomography scans showed that the planned positions were achieved correctly. This case report illustrates maxillary reconstruction performed with a special template technique and demonstrates the possibilities of computer aided design/computer aided manufacturing (CAD/CAM) applications in reconstructive surgery.
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Affiliation(s)
- Bernd Lethaus
- Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, The Netherlands.
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Li JP, de Wijn JR, van Blitterswijk CA, de Groot K. The effect of scaffold architecture on properties of direct 3D fiber deposition of porous Ti6Al4V for orthopedic implants. J Biomed Mater Res A 2010; 92:33-42. [DOI: 10.1002/jbm.a.32330] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Klammert U, Böhm H, Schweitzer T, Würzler K, Gbureck U, Reuther J, Kübler A. Multi-directional Le Fort III midfacial distraction using an individual prefabricated device. J Craniomaxillofac Surg 2009; 37:210-5. [DOI: 10.1016/j.jcms.2008.11.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Revised: 11/24/2008] [Accepted: 11/28/2008] [Indexed: 11/17/2022] Open
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Siebert H, Schleier P, Beinemann J, Fried W, Zenk W, Schumann D. [Evaluation of individual ceramic implants made of Bioverit with CAD/CAM technology to reconstruct multidimensional craniofacial defects of the human skull]. ACTA ACUST UNITED AC 2006; 10:185-91. [PMID: 16685568 DOI: 10.1007/s10006-006-0687-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Restrictions in the bone structure of the craniomandibular region caused by malformation, traumata or malignant tumours are currently of interest in reconstructive oral and maxillofacial surgery. Methods of autologous bone transplantation are well established for reconstruction of those defects. The reconstruction and remodeling of contour-shaping defects is more difficult due to atrophy and resorption of free-transplantable tissues. Artificially induced harmful effects have been reported on harvesting in the donor area. Further available methods of alloplastic reconstruction are computer-assisted design and manufacturing systems (CAD/CAM). The advantages of individual design and fabrication are obvious in the manufacturing of defect-specific implants. MATERIAL AND METHODS In the present study the application of individual CAD-based reconstructed bioceramic implants made of Bioverit II was evaluated in the region of the facial skull. Clinical results, patient acceptance and the analysis of the postoperative observation period of 30 months are reviewed. RESULTS Altogether 25 individual Bioverit ceramics were implanted in the facial region. All patients were satisfied with the aesthetic results of the implantations after primary surgery. Three patients developed a need for further correction during the observation period; one implant fracture was observed. CONCLUSION Finally, it can be stated that the preoperative expenditures in time, experts, technology and fabrication of individual CAD/CAM planned and manufactured implants are justified by the following advantages: fixed volume, reduced operating time, lack of donor morbidity, easy subsequent treatment of the material and the aesthetic results achieved.
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Affiliation(s)
- H Siebert
- Klinik und Poliklinik für Mund-, Kiefer- und Geischtschirurgie/Plastische Chirurgie, Friedrich-Schilller-Universität, Jena
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Bill J, Proff P, Bayerlein T, Blens T, Gedrange T, Reuther J. Orthognathic surgery in cleft patients. J Craniomaxillofac Surg 2006; 34 Suppl 2:77-81. [PMID: 17071397 DOI: 10.1016/s1010-5182(06)60017-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Orthognathic surgery has become a standard procedure in cranio-maxillo-facial surgery during the past five decades. Based upon the elementary works by Obwegeser who introduced sagittal split ramus osteotomy in the early 1950s, this procedure has become the worldwide gold standard in mandibular orthognathic procedures by now. When devices for ensuring the centric condylar position throughout the entire surgery were introduced by Luhr in the early 1980s, modern understanding of complete functional rehabilitation in orthognathic surgery was further enhanced. Even though Le Fort I osteotomy was performed by Wassmund already in the 1920s, it took almost another 50 years until this procedure became accepted in surgery, mainly due to concerns for severe haemorrhage that may occur during surgery. Application of a compound condylar positioning device which was established to ensure and keep the exact condylar position throughout maxillary, mandibular, as well as during bimaxillary osteotomies, and to permit the targeted use of distraction devices. Among those, cleft patients also sometimes need orthognathic correction of typical micrognathia and pseudoprogenia in late adolescence or at early adult age as secondary cleft surgery procedures. In this overview, special emphasis will be placed on orthodontic treatment as well as on the technical prerequisites for the surgical procedure.
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Affiliation(s)
- Josip Bill
- Department of Oral and Maxillofacial Surgery, University of Würzburg, Germany.
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