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Slavin BV, Ehlen QT, Costello JP, Nayak VV, Bonfante EA, Benalcázar Jalkh EB, Runyan CM, Witek L, Coelho PG. 3D Printing Applications for Craniomaxillofacial Reconstruction: A Sweeping Review. ACS Biomater Sci Eng 2023; 9:6586-6609. [PMID: 37982644 PMCID: PMC11229092 DOI: 10.1021/acsbiomaterials.3c01171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
The field of craniomaxillofacial (CMF) surgery is rich in pathological diversity and broad in the ages that it treats. Moreover, the CMF skeleton is a complex confluence of sensory organs and hard and soft tissue with load-bearing demands that can change within millimeters. Computer-aided design (CAD) and additive manufacturing (AM) create extraordinary opportunities to repair the infinite array of craniomaxillofacial defects that exist because of the aforementioned circumstances. 3D printed scaffolds have the potential to serve as a comparable if not superior alternative to the "gold standard" autologous graft. In vitro and in vivo studies continue to investigate the optimal 3D printed scaffold design and composition to foster bone regeneration that is suited to the unique biological and mechanical environment of each CMF defect. Furthermore, 3D printed fixation devices serve as a patient-specific alternative to those that are available off-the-shelf with an opportunity to reduce operative time and optimize fit. Similar benefits have been found to apply to 3D printed anatomical models and surgical guides for preoperative or intraoperative use. Creation and implementation of these devices requires extensive preclinical and clinical research, novel manufacturing capabilities, and strict regulatory oversight. Researchers, manufacturers, CMF surgeons, and the United States Food and Drug Administration (FDA) are working in tandem to further the development of such technology within their respective domains, all with a mutual goal to deliver safe, effective, cost-efficient, and patient-specific CMF care. This manuscript reviews FDA regulatory status, 3D printing techniques, biomaterials, and sterilization procedures suitable for 3D printed devices of the craniomaxillofacial skeleton. It also seeks to discuss recent clinical applications, economic feasibility, and future directions of this novel technology. By reviewing the current state of 3D printing in CMF surgery, we hope to gain a better understanding of its impact and in turn identify opportunities to further the development of patient-specific surgical care.
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Affiliation(s)
- Blaire V Slavin
- University of Miami Miller School of Medicine, 1011 NW 15th St., Miami, Florida 33136, United States
| | - Quinn T Ehlen
- University of Miami Miller School of Medicine, 1011 NW 15th St., Miami, Florida 33136, United States
| | - Joseph P Costello
- University of Miami Miller School of Medicine, 1011 NW 15th St., Miami, Florida 33136, United States
| | - Vasudev Vivekanand Nayak
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, 1011 NW 15th St., Miami, Florida 33136, United States
| | - Estavam A Bonfante
- Department of Prosthodontics and Periodontology, University of Sao Paulo, Bauru School of Dentistry, Alameda Dr. Octávio Pinheiro Brisolla, Quadra 9 - Jardim Brasil, Bauru São Paulo 17012-901, Brazil
| | - Ernesto B Benalcázar Jalkh
- Department of Prosthodontics and Periodontology, University of Sao Paulo, Bauru School of Dentistry, Alameda Dr. Octávio Pinheiro Brisolla, Quadra 9 - Jardim Brasil, Bauru São Paulo 17012-901, Brazil
| | - Christopher M Runyan
- Department of Plastic and Reconstructive Surgery, Wake Forest School of Medicine, 475 Vine St, Winston-Salem, North Carolina 27101, United States
| | - Lukasz Witek
- Biomaterials Division, NYU Dentistry, 345 E. 24th St., New York, New York 10010, United States
- Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York University, 222 E 41st St., New York, New York 10017, United States
- Department of Biomedical Engineering, NYU Tandon School of Engineering, 6 MetroTech Center, Brooklyn, New York 11201, United States
| | - Paulo G Coelho
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, 1011 NW 15th St., Miami, Florida 33136, United States
- DeWitt Daughtry Family Department of Surgery, Division of Plastic Surgery, University of Miami Miller School of Medicine, 1120 NW 14th St., Miami, Florida 33136, United States
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Li Y, Liu H, Wang C, Yan R, Xiang L, Mu X, Zheng L, Liu C, Hu M. 3D printing titanium grid scaffold facilitates osteogenesis in mandibular segmental defects. NPJ Regen Med 2023; 8:38. [PMID: 37488125 PMCID: PMC10366137 DOI: 10.1038/s41536-023-00308-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 06/23/2023] [Indexed: 07/26/2023] Open
Abstract
Bone fusion of defect broken ends is the basis of the functional reconstruction of critical maxillofacial segmental bone defects. However, the currently available treatments do not easily achieve this goal. Therefore, this study aimed to fabricate 3D-printing titanium grid scaffolds, which possess sufficient pores and basic biomechanical strength to facilitate osteogenesis in order to accomplish bone fusion in mandibular segmental bone defects. The clinical trial was approved and supervised by the Medical Ethics Committee of the Chinese PLA General Hospital on March 28th, 2019 (Beijing, China. approval No. S2019-065-01), and registered in the clinical trials registry platform (registration number: ChiCTR2300072209). Titanium grid scaffolds were manufactured using selective laser melting and implanted in 20 beagle dogs with mandibular segmental defects. Half of the animals were treated with autologous bone chips and bone substances incorporated into the scaffolds; no additional filling was used for the rest of the animals. After 18 months of observation, radiological scanning and histological analysis in canine models revealed that the pores of regenerated bone were filled with titanium grid scaffolds and bone broken ends were integrated. Furthermore, three patients were treated with similar titanium grid scaffold implants in mandibular segmental defects; no mechanical complications were observed, and similar bone regeneration was observed in the reconstructed patients' mandibles in the clinic. These results demonstrated that 3D-printing titanium grid scaffolds with sufficient pores and basic biomechanical strength could facilitate bone regeneration in large-segment mandibular bone defects.
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Affiliation(s)
- Yongfeng Li
- Department of Stomatology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Huawei Liu
- Department of Stomatology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Chao Wang
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, 100083, China
| | - Rongzeng Yan
- Nanchang University Fuzhou Medical College, Fuzhou, 344000, China
| | - Lei Xiang
- Department of Stomatology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Xiaodan Mu
- Department of Stomatology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Lingling Zheng
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, 100083, China
| | - Changkui Liu
- Department of Oral and Maxillofacial Surgery, School of Stomatology, Xi'an Medical University, Xi'an, China
| | - Min Hu
- Department of Stomatology, The First Medical Center of PLA General Hospital, Beijing, China.
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Davoodi E, Montazerian H, Mirhakimi AS, Zhianmanesh M, Ibhadode O, Shahabad SI, Esmaeilizadeh R, Sarikhani E, Toorandaz S, Sarabi SA, Nasiri R, Zhu Y, Kadkhodapour J, Li B, Khademhosseini A, Toyserkani E. Additively manufactured metallic biomaterials. Bioact Mater 2022; 15:214-249. [PMID: 35386359 PMCID: PMC8941217 DOI: 10.1016/j.bioactmat.2021.12.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/17/2021] [Accepted: 12/21/2021] [Indexed: 02/06/2023] Open
Abstract
Metal additive manufacturing (AM) has led to an evolution in the design and fabrication of hard tissue substitutes, enabling personalized implants to address each patient's specific needs. In addition, internal pore architectures integrated within additively manufactured scaffolds, have provided an opportunity to further develop and engineer functional implants for better tissue integration, and long-term durability. In this review, the latest advances in different aspects of the design and manufacturing of additively manufactured metallic biomaterials are highlighted. After introducing metal AM processes, biocompatible metals adapted for integration with AM machines are presented. Then, we elaborate on the tools and approaches undertaken for the design of porous scaffold with engineered internal architecture including, topology optimization techniques, as well as unit cell patterns based on lattice networks, and triply periodic minimal surface. Here, the new possibilities brought by the functionally gradient porous structures to meet the conflicting scaffold design requirements are thoroughly discussed. Subsequently, the design constraints and physical characteristics of the additively manufactured constructs are reviewed in terms of input parameters such as design features and AM processing parameters. We assess the proposed applications of additively manufactured implants for regeneration of different tissue types and the efforts made towards their clinical translation. Finally, we conclude the review with the emerging directions and perspectives for further development of AM in the medical industry.
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Affiliation(s)
- Elham Davoodi
- Multi-Scale Additive Manufacturing (MSAM) Laboratory, Mechanical and Mechatronics Engineering Department, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada
- Department of Bioengineering, University of California, Los Angeles, California 90095, United States
- California NanoSystems Institute (CNSI), University of California, Los Angeles, California 90095, United States
- Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States
| | - Hossein Montazerian
- Department of Bioengineering, University of California, Los Angeles, California 90095, United States
- California NanoSystems Institute (CNSI), University of California, Los Angeles, California 90095, United States
- Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States
| | - Anooshe Sadat Mirhakimi
- Department of Mechanical Engineering, Isfahan University of Technology, Isfahan, Isfahan 84156-83111, Iran
| | - Masoud Zhianmanesh
- School of Biomedical Engineering, University of Sydney, Sydney, New South Wales 2006, Australia
| | - Osezua Ibhadode
- Multi-Scale Additive Manufacturing (MSAM) Laboratory, Mechanical and Mechatronics Engineering Department, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada
| | - Shahriar Imani Shahabad
- Multi-Scale Additive Manufacturing (MSAM) Laboratory, Mechanical and Mechatronics Engineering Department, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada
| | - Reza Esmaeilizadeh
- Multi-Scale Additive Manufacturing (MSAM) Laboratory, Mechanical and Mechatronics Engineering Department, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada
| | - Einollah Sarikhani
- Department of Nanoengineering, Jacobs School of Engineering, University of California, San Diego, California 92093, United States
| | - Sahar Toorandaz
- Multi-Scale Additive Manufacturing (MSAM) Laboratory, Mechanical and Mechatronics Engineering Department, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada
| | - Shima A. Sarabi
- Mechanical and Aerospace Engineering Department, University of California, Los Angeles, California 90095, United States
| | - Rohollah Nasiri
- Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States
| | - Yangzhi Zhu
- Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States
| | - Javad Kadkhodapour
- Department of Mechanical Engineering, Shahid Rajaee Teacher Training University, Tehran, Tehran 16785-163, Iran
- Institute for Materials Testing, Materials Science and Strength of Materials, University of Stuttgart, Stuttgart 70569, Germany
| | - Bingbing Li
- Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States
- Department of Manufacturing Systems Engineering and Management, California State University, Northridge, California 91330, United States
| | - Ali Khademhosseini
- Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States
| | - Ehsan Toyserkani
- Multi-Scale Additive Manufacturing (MSAM) Laboratory, Mechanical and Mechatronics Engineering Department, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada
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