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Kveller C, Jakobsen AM, Larsen NH, Lindhardt JL, Baad-Hansen T. First experiences of a hospital-based 3D printing facility - an analytical observational study. BMC Health Serv Res 2024; 24:28. [PMID: 38178068 PMCID: PMC10768152 DOI: 10.1186/s12913-023-10511-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024] Open
Abstract
PURPOSE To identify the clinical impact and potential benefits of in-house 3D-printed objects through a questionnaire, focusing on three principal areas: patient education; interdisciplinary cooperation; preoperative planning and perioperative execution. MATERIALS AND METHODS Questionnaires were sent from January 2021 to August 2022. Participants were directed to rate on a scale from 1 to 10. RESULTS The response rate was 43%. The results of the rated questions are averages. 84% reported using 3D-printed objects in informing the patient about their condition/procedure. Clinician-reported improvement in patient understanding of their procedure/disease was 8.1. The importance of in-house placement was rated 9.2. 96% reported using the 3D model to confer with colleagues. Delay in treatment due to 3D printing lead-time was 1.8. The degree with which preoperative planning was altered was 6.9. The improvement in clinician perceived preoperative confidence was 8.3. The degree with which the scope of the procedure was affected, in regard to invasiveness, was 5.6, wherein a score of 5 is taken to mean unchanged. Reduction in surgical duration was rated 5.7. CONCLUSION Clinicians report the utilization of 3D printing in surgical specialties improves procedures pre- and intraoperatively, has a potential for increasing patient engagement and insight, and in-house location of a 3D printing center results in improved interdisciplinary cooperation and allows broader access with only minimal delay in treatment due to lead-time.
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Affiliation(s)
- Christian Kveller
- Department of Orthopedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark.
| | - Anders M Jakobsen
- Department of Plastic and Breast Surgery, 3D Innovation, Aarhus University Hospital, Aarhus, Denmark
| | - Nicoline H Larsen
- Department of Dentistry, Section for Oral and Maxillofacial Surgery, Aarhus University, Aarhus, Denmark
| | - Joakim L Lindhardt
- Department of Plastic and Breast Surgery, 3D Innovation, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Baad-Hansen
- Department of Orthopedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
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Chiu YW, Chen PY, Chen YL, Peng CY, Lu MY, Chen YT, Yang CC. Use of reconstruction plates prebent on three-dimensional models to reduce the complications of mandibular reconstruction. J Dent Sci 2024; 19:473-478. [PMID: 38303842 PMCID: PMC10829746 DOI: 10.1016/j.jds.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 09/01/2023] [Indexed: 02/03/2024] Open
Abstract
Background/purpose Though the gold standard method for mandible reconstruction of the defect from segmental mandibulectomy is by osseous flap or graft, using reconstruction plates is still indicated in some cases. Traditionally, the plate is bended immediately after the segmental mandibulectomy by freehand. However, it's difficult to fit well to the original position of mandible, which may result in more complications. This study therefore aimed to investigate whether using prebent plates on computer-aided 3D printing models could reduce the complication rate. Materials and methods Patients who received mandible reconstruction by reconstruction plate from 2018 to 2022 were enrolled and evaluated in this study. The data, including demographics, indications for surgery, pre-existed preoperative and postoperative therapies, classification of defects, and postoperative outcomes were collected and analyzed. Results A total of 52 patients were enrolled in our study. The prebent group exhibited a significantly lower complication rate than that of the immediately bent group (P = 0.012). Other risk factors of plate complications included postoperative adjuvant radiotherapy (P = 0.017) and previous surgery (P = 0.047). The complication-free survival rate was also better in the prebent group in a 3-year follow-up period (P = 0.012). Conclusion Prebent plates on computer-aided printing models proved to be an effective approach to reduce the complications for mandibular reconstruction in segmental mandibulectomy.
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Affiliation(s)
- Yu-Wei Chiu
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- College of Oral Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Pei-Yin Chen
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- College of Oral Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yen-Lin Chen
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- College of Oral Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chih-Yu Peng
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- College of Oral Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Ming-Yi Lu
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- College of Oral Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yi-Tzu Chen
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- College of Oral Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Cheng-Chieh Yang
- Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Stomatology, Oral & Maxillofacial Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
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Betancourt MC, Araújo C, Marín S, Buriticá W. The Quantitative Impact of Using 3D Printed Anatomical Models for Surgical Planning Optimization: Literature Review. 3D PRINTING AND ADDITIVE MANUFACTURING 2023; 10:1130-1139. [PMID: 37886412 PMCID: PMC10599434 DOI: 10.1089/3dp.2021.0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
3D printing has entered the medical field as a visualization tool that allows the manufacture of three-dimensional (3D) models that physically represent the anatomy of a patient in need of analysis to improve surgical results. This article analyzes the literature around reported study cases that make use of anatomical models for their surgical processes' planning, focusing on obtaining the quantitative results of each one of them. A search of case studies was carried out in the main medical databases such as PubMed, ScienceDirect, SpringerLink, among others; to obtain the most relevant results of the 56 selected articles, the information of each study was analyzed and categorized. These articles presented figures and data about the benefits that are considered more representative to measure the positive impact of this technology. These benefits are summarized in variables such as the decrease in surgical time, greater accuracy in the diagnosis of pathology, blood loss reduction, and decreasing operating room costs; owed to an improvement in the surgery planning. It was found that in all the cases analyzed there was an improvement in the surgical results related to these variables, which were summarized in macro figures that combine this improvement quantitatively. In the analyzed studies, it was evident that there is great potential in the use of 3D printing for presurgical planning, being as the results of these analyzed interventions were better when using this technology. In addition, it was found that the results obtained initially, before applying the inclusion and exclusion criteria, were mostly of a qualitative nature; expressing the perception of researchers regarding the positive use of this tool in the field and evidencing an opportunity for this research to focus on concrete and technical information to show in numerical terms the effectiveness of this tool, to demonstrate the cost-benefit that it has for the field.
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The Precision of Different Types of Plates Fabricated With a Computer-Aided Design and Manufacturing System in Mandibular Reconstruction With Fibular-Free Flaps. J Craniofac Surg 2023; 34:187-197. [PMID: 36168132 DOI: 10.1097/scs.0000000000009037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/27/2022] [Indexed: 01/11/2023] Open
Abstract
Computer-assisted surgery (CAS) has been introduced to mandible reconstruction with fibular-free flap in cutting guide placement. When CAS cooperates with different plate fixations, the results show various degrees of errors by which this study aimed to evaluate. Mock surgeries were conducted in 3D-printed mandibles with 2 types of defects, limited or extensive, reconstructed from 2 ameloblastoma patients. Three types of fixations, miniplate, manually bending reconstruction plate, and patient-specific plate, are tested, each of which was performed 3 times in each type of defect, adding up to 18 surgeries. One with the least errors was selected and applied to patients whose 3D-printed mandibles were derived. Finally, in vivo errors were compared with the mock. In limited defect, average errors show no statistical significance among all types. In extensive defect, patient-specific plate had a significantly lower average condylar error than manually bending reconstruction plate and miniplate (8.09±2.52 mm vs. 25.49±2.72 and 23.13±13.54 mm, respectively). When patient-specific plate was applied in vivo , the errors were not significantly different from the mock. Patient-specific plates that cooperated with CAS showed the least errors. Nevertheless, manually bent reconstruction plates and miniplates could be applied in limited defects with caution.
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Truscott A, Zamani R, Akrami M. Comparing the use of conventional and three-dimensional printing (3DP) in mandibular reconstruction. Biomed Eng Online 2022; 21:18. [PMID: 35305669 PMCID: PMC8934485 DOI: 10.1186/s12938-022-00989-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 03/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background There are a number of clinical disorders that require mandibular reconstruction (MR). Novel three-dimensional (3D) printing technology enables reconstructions to be more accurate and beneficial to the patient. However, there is currently no evidence identifying which techniques are better suited for MR, based on the type of clinical disorder the patient has. In this study, we aim to compare 3D techniques with conventional techniques to identify how best to reconstruct the mandible based on the clinical cause that necessitates the reconstructive procedure: cancerous or benign tumours, clinical disorders, infection or disease and trauma or injury. Methods PubMed, Scopus, Embase and Medline were searched to identify relevant papers that outline the clinical differences between 3D and conventional techniques in MR. Data were evaluated to provide a clear outline of suitable techniques for surgery. Results 20 of 2749 papers met inclusion criteria. These papers were grouped based on the clinical causes that required MR into four categories: malignant or benign tumour resection; mandibular trauma/injury and other clinical disorders. Conclusions The majority of researchers favoured 3D techniques in MR. However, due to a lack of standardised reporting in these studies it was not possible to determine which specific techniques were better for which clinical presentations.
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Turek P, Pakla P, Budzik G, Lewandowski B, Przeszłowski Ł, Dziubek T, Wolski S, Frańczak J. Procedure Increasing the Accuracy of Modelling and the Manufacturing of Surgical Templates with the Use of 3D Printing Techniques, Applied in Planning the Procedures of Reconstruction of the Mandible. J Clin Med 2021; 10:jcm10235525. [PMID: 34884227 PMCID: PMC8658254 DOI: 10.3390/jcm10235525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 12/19/2022] Open
Abstract
The application of anatomical models and surgical templates in maxillofacial surgery allows, among other benefits, the increase of precision and the shortening of the operation time. Insufficiently precise anastomosis of the broken parts of the mandible may adversely affect the functioning of this organ. Applying the modern mechanical engineering methods, including computer-aided design methods (CAD), reverse engineering (RE), and rapid prototyping (RP), a procedure used to shorten the data processing time and increase the accuracy of modelling anatomical structures and the surgical templates with the use of 3D printing techniques was developed. The basis for developing and testing this procedure was the medical imaging data DICOM of patients treated at the Maxillofacial Surgery Clinic of the Fryderyk Chopin Provincial Clinical Hospital in Rzeszów. The patients were operated on because of malignant tumours of the floor of the oral cavity and the necrosis of the mandibular corpus, requiring an extensive resection of the soft tissues and resection of the mandible. Familiarity with and the implementation of the developed procedure allowed doctors to plan the operation precisely and prepare the surgical templates and tools in terms of the expected accuracy of the procedures. The models obtained based on this procedure shortened the operation time and increased the accuracy of performance, which accelerated the patient’s rehabilitation in the further course of events.
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Affiliation(s)
- Paweł Turek
- Faculty of Mechanical Engineering and Aeronautics, Rzeszów University of Technology, 35-959 Rzeszów, Poland; (G.B.); (Ł.P.); (T.D.)
- Correspondence:
| | - Paweł Pakla
- Department of Maxillofacial Surgery, Fryderyk Chopin Clinical Voivodeship Hospital No.1 in Rzeszów, 35-055 Rzeszów, Poland; (P.P.); (B.L.); (J.F.)
| | - Grzegorz Budzik
- Faculty of Mechanical Engineering and Aeronautics, Rzeszów University of Technology, 35-959 Rzeszów, Poland; (G.B.); (Ł.P.); (T.D.)
| | - Bogumił Lewandowski
- Department of Maxillofacial Surgery, Fryderyk Chopin Clinical Voivodeship Hospital No.1 in Rzeszów, 35-055 Rzeszów, Poland; (P.P.); (B.L.); (J.F.)
- Collegium Medicum, University of Rzeszów, 35-315 Rzeszów, Poland
| | - Łukasz Przeszłowski
- Faculty of Mechanical Engineering and Aeronautics, Rzeszów University of Technology, 35-959 Rzeszów, Poland; (G.B.); (Ł.P.); (T.D.)
| | - Tomasz Dziubek
- Faculty of Mechanical Engineering and Aeronautics, Rzeszów University of Technology, 35-959 Rzeszów, Poland; (G.B.); (Ł.P.); (T.D.)
| | - Sławomir Wolski
- Faculty of Mathematics and Applied Physics, Rzeszów University of Technology, 35-959 Rzeszów, Poland;
| | - Jan Frańczak
- Department of Maxillofacial Surgery, Fryderyk Chopin Clinical Voivodeship Hospital No.1 in Rzeszów, 35-055 Rzeszów, Poland; (P.P.); (B.L.); (J.F.)
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Latimer JM, Maekawa S, Yao Y, Wu DT, Chen M, Giannobile WV. Regenerative Medicine Technologies to Treat Dental, Oral, and Craniofacial Defects. Front Bioeng Biotechnol 2021; 9:704048. [PMID: 34422781 PMCID: PMC8378232 DOI: 10.3389/fbioe.2021.704048] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/29/2021] [Indexed: 01/10/2023] Open
Abstract
Additive manufacturing (AM) is the automated production of three-dimensional (3D) structures through successive layer-by-layer deposition of materials directed by computer-aided-design (CAD) software. While current clinical procedures that aim to reconstruct hard and soft tissue defects resulting from periodontal disease, congenital or acquired pathology, and maxillofacial trauma often utilize mass-produced biomaterials created for a variety of surgical indications, AM represents a paradigm shift in manufacturing at the individual patient level. Computer-aided systems employ algorithms to design customized, image-based scaffolds with high external shape complexity and spatial patterning of internal architecture guided by topology optimization. 3D bioprinting and surface modification techniques further enhance scaffold functionalization and osteogenic potential through the incorporation of viable cells, bioactive molecules, biomimetic materials and vectors for transgene expression within the layered architecture. These computational design features enable fabrication of tissue engineering constructs with highly tailored mechanical, structural, and biochemical properties for bone. This review examines key properties of scaffold design, bioresorbable bone scaffolds produced by AM processes, and clinical applications of these regenerative technologies. AM is transforming the field of personalized dental medicine and has great potential to improve regenerative outcomes in patient care.
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Affiliation(s)
- Jessica M Latimer
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, United States
| | - Shogo Maekawa
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, United States.,Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yao Yao
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, United States.,Biointerfaces Institute, University of Michigan, Ann Arbor, MI, United States
| | - David T Wu
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, United States.,Laboratory for Cell and Tissue Engineering, Harvard John A. Paulson School of Engineering and Applied Sciences, Boston, MA, United States.,Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, United States
| | - Michael Chen
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, United States
| | - William V Giannobile
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, United States
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Estimating the Accuracy of Mandible Anatomical Models Manufactured Using Material Extrusion Methods. Polymers (Basel) 2021; 13:polym13142271. [PMID: 34301029 PMCID: PMC8309312 DOI: 10.3390/polym13142271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 06/28/2021] [Accepted: 07/07/2021] [Indexed: 01/20/2023] Open
Abstract
The development of new solutions in craniofacial surgery brings the need to increase the accuracy of 3D printing models. The accuracy of the manufactured models is most often verified using optical coordinate measuring systems. However, so far, no decision has been taken regarding which type of system would allow for a reliable estimation of the geometrical accuracy of the anatomical models. Three types of optical measurement systems (Atos III Triple Scan, articulated arm (MCA-II) with a laser head (MMD × 100), and Benchtop CT160Xi) were used to verify the accuracy of 12 polymer anatomical models of the left side of the mandible. The models were manufactured using fused deposition modeling (FDM), melted and extruded modeling (MEM), and fused filament fabrication (FFF) techniques. The obtained results indicate that the Atos III Triple Scan allows for the most accurate estimation of errors in model manufacturing. Using the FDM technique obtained the best accuracy in models manufactured (0.008 ± 0.118 mm for ABS0-M30 and 0.016 ± 0.178 mm for PC-10 material). A very similar value of the standard deviation of PLA and PET material was observed (about 0.180 mm). The worst results were observed in the MEM technique (0.012 mm ± 0.308 mm). The knowledge regarding the precisely evaluated errors in manufactured models within the mandibular area will help in the controlled preparation of templates regarding the expected accuracy of surgical operations.
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Montero J, Becerro A, Pardal-Peláez B, Quispe-López N, Blanco JF, Gómez-Polo C. Main 3D Manufacturing Techniques for Customized Bone Substitutes. A Systematic Review. MATERIALS 2021; 14:ma14102524. [PMID: 34066290 PMCID: PMC8152095 DOI: 10.3390/ma14102524] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/01/2021] [Accepted: 05/09/2021] [Indexed: 12/12/2022]
Abstract
Clinicians should be aware of the main methods and materials to face the challenge of bone shortage by manufacturing customized grafts, in order to repair defects. This study aims to carry out a bibliographic review of the existing methods to manufacture customized bone scaffolds through 3D technology and to identify their current situation based on the published papers. A literature search was carried out using "3D scaffold", "bone regeneration", "robocasting" and "3D printing" as descriptors. This search strategy was performed on PubMed (MEDLINE), Scopus and Cochrane Library, but also by hand search in relevant journals and throughout the selected papers. All the papers focusing on techniques for manufacturing customized bone scaffolds were reviewed. The 62 articles identified described 14 techniques (4 subtraction + 10 addition techniques). Scaffold fabrication techniques can be also be classified according to the time at which they are developed, into Conventional techniques and Solid Freeform Fabrication techniques. The conventional techniques are unable to control the architecture of the pore and the pore interconnection. However, current Solid Freeform Fabrication techniques allow individualizing and generating complex geometries of porosity. To conclude, currently SLA (Stereolithography), Robocasting and FDM (Fused deposition modeling) are promising options in customized bone regeneration.
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Zeller AN, Neuhaus MT, Weissbach LVM, Rana M, Dhawan A, Eckstein FM, Gellrich NC, Zimmerer RM. Patient-Specific Mandibular Reconstruction Plates Increase Accuracy and Long-Term Stability in Immediate Alloplastic Reconstruction of Segmental Mandibular Defects. J Maxillofac Oral Surg 2020; 19:609-615. [PMID: 33071511 PMCID: PMC7524954 DOI: 10.1007/s12663-019-01323-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 12/18/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim of the current study was to evaluate potential differences in the accuracy of mandibular reconstruction and long-term stability, with respect to different reconstructive procedures. METHODS In total, 42 patients who had undergone primary segmental mandibular resection with immediate alloplastic reconstruction, with either manually pre-bent or patient-specific mandibular reconstruction plates (PSMRP), were included in this study. Mandibular dimensions, in terms of six clinically relevant distances (capitulum [most lateral points], capitulum [most medial points], incisura [most caudal points], mandibular foramina, coronoid process [most cranial points], dorsal tip of the mandible closest to the gonion point) determined from tomographic images, were compared prior to, and after surgery. RESULTS Dimensional alterations were significantly more often found when conventionally bent titanium reconstruction plates were used. These occurred in the area of the coronoid process (p = 0.014). Plate fractures were significantly (p = 0.022) more often found within the manually pre-bent group than within the PSMRP group (17%/0%). CONCLUSION The results suggest that the use of PSMRP may prevent rotation of the proximal mandibular segment, thus avoiding functional impairment. In addition, the use of PSMRP may potentially enhance the long-term stability of alloplastic reconstructions.
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Affiliation(s)
- A. N. Zeller
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - M. T. Neuhaus
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - L. V. M. Weissbach
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - M. Rana
- Department of Oral and Maxillofacial Surgery, University Hospital Duesseldorf, Düsseldorf, Germany
| | - A. Dhawan
- Sri Guru Ram Das Institute of Dental Sciences and Research, Amritsar, India
| | - F. M. Eckstein
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - N. C. Gellrich
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - R. M. Zimmerer
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
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Retrospective analysis of complications in 190 mandibular resections and simultaneous reconstructions with free fibula flap, iliac crest flap or reconstruction plate: a comparative single centre study. Clin Oral Investig 2020; 25:2905-2914. [PMID: 33025147 PMCID: PMC8060197 DOI: 10.1007/s00784-020-03607-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/25/2020] [Indexed: 11/30/2022]
Abstract
Objectives The purpose of this study was to evaluate the incidence of complications following mandibular reconstruction and to analyse possible contributing factors. Materials and methods Clinical data and computed tomography scans of all patients who needed a mandibular reconstruction with a reconstruction plate, free fibula flap (FFF) or iliac crest (DCIA) flap between August 2010 and August 2015 were retrospectively analysed. Results One hundred and ninety patients were enrolled, encompassing 77 reconstructions with reconstruction plate, 89 reconstructions with FFF and 24 reconstructions with DCIA flaps. Cutaneous perforation was most frequently detected in the plate subgroup within the early interval and overall (each p = 0.004). Low body mass index (BMI) and total radiation dosage were the most relevant risk factors for the development of analysed complications. Conclusions Microvascular bone flaps have overall less skin perforation than reconstruction plates. BMI and expected total radiation dosage have to be respected in choice of reconstructive technique. Clinical relevance A treatment algorithm for mandibular reconstructions on the basis of our results is presented. Electronic supplementary material The online version of this article (10.1007/s00784-020-03607-8) contains supplementary material, which is available to authorized users.
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Ballard DH, Mills P, Duszak R, Weisman JA, Rybicki FJ, Woodard PK. Medical 3D Printing Cost-Savings in Orthopedic and Maxillofacial Surgery: Cost Analysis of Operating Room Time Saved with 3D Printed Anatomic Models and Surgical Guides. Acad Radiol 2020; 27:1103-1113. [PMID: 31542197 DOI: 10.1016/j.acra.2019.08.011] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/20/2019] [Accepted: 08/26/2019] [Indexed: 12/16/2022]
Abstract
RATIONALE AND OBJECTIVE Three-dimensional (3D) printed anatomic models and surgical guides have been shown to reduce operative time. The purpose of this study was to generate an economic analysis of the cost-saving potential of 3D printed anatomic models and surgical guides in orthopedic and maxillofacial surgical applications. MATERIALS AND METHODS A targeted literature search identified operating room cost-per-minute and studies that quantified time saved using 3D printed constructs. Studies that reported operative time differences due to 3D printed anatomic models or surgical guides were reviewed and cataloged. A mean of $62 per operating room minute (range of $22-$133 per minute) was used as the reference standard for operating room time cost. Different financial scenarios were modeled with the provided cost-per-minute of operating room time (using high, mean, and low values) and mean time saved using 3D printed constructs. RESULTS Seven studies using 3D printed anatomic models in surgical care demonstrated a mean 62 minutes ($3720/case saved from reduced time) of time saved, and 25 studies of 3D printed surgical guides demonstrated a mean 23 minutes time saved ($1488/case saved from reduced time). An estimated 63 models or guides per year (or 1.2/week) were predicted to be the minimum number to breakeven and account for annual fixed costs. CONCLUSION Based on the literature-based financial analyses, medical 3D printing appears to reduce operating room costs secondary to shortening procedure times. While resource-intensive, 3D printed constructs used in patients' operative care provides considerable downstream value to health systems.
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Affiliation(s)
- David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110.
| | | | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Jeffery A Weisman
- University of Illinois at Chicago Occupational Medicine, Chicago, Illinois
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110
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Design and Fabrication of Implants for Mandibular and Craniofacial Defects Using Different Medical-Additive Manufacturing Technologies: A Review. Ann Biomed Eng 2020; 48:2285-2300. [PMID: 32691264 DOI: 10.1007/s10439-020-02567-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022]
Abstract
Mandibular and craniofacial bone defects can be caused by trauma, inflammatory disease, and benign or malignant tumors. Patients with bone defects suffer from problems with aesthetics, speech, and mastication, resulting in the need for implants. Conventional methods do not always provide satisfactory results. Most of the techniques proposed by researchers in the field of biomedical engineering use reverse engineering, computer-aided design (CAD), and additive manufacturing (AM), whose implementation can improve the outcomes of reconstructive surgeries. Several literature reviews on this particular topic have been conducted. However, they provide mostly overviews of AM technologies for general biomedical devices. This paper summarizes the use of existing medical AM techniques for the design and fabrication of mandibular and craniofacial implants, and then discusses their advantages and disadvantages in terms of accuracy, costs, energy consumption, and production rate. The aim of this study is to present a comparative review of the most commonly used AM technologies to aid researchers in selecting the best possible AM technologies for medical use. Studies included in this review contain CAD designs of mandibular or cranial implants, as well as their fabrication using AM technologies. Special attention is paid to PolyJet technology, because of its high accuracy, and economical efficiency.
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Dentistry 4.0 Concept in the Design and Manufacturing of Prosthetic Dental Restorations. Processes (Basel) 2020. [DOI: 10.3390/pr8050525] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The paper is a comprehensive but compact review of the literature on the state of illnesses of the human stomatognathic system, related consequences in the form of dental deficiencies, and the resulting need for prosthetic treatment. Types of prosthetic restorations, including implants, as well as new classes of implantable devices called implant-scaffolds with a porous part integrated with a solid core, as well as biological engineering materials with the use of living cells, have been characterized. A review of works on current trends in the technical development of dental prosthetics aiding, called Dentistry 4.0, analogous to the concept of the highest stage of Industry 4.0 of the industrial revolution, has been presented. Authors’ own augmented holistic model of Industry 4.0 has been developed and presented. The studies on the significance of cone-beam computed tomography (CBCT) in planning prosthetic treatment, as well as in the design and manufacture of prosthetic restorations, have been described. The presented and fully digital approach is a radical turnaround in both clinical procedures and the technologies of implant preparation using computer-aided design and manufacturing methods (CAD/CAM) and additive manufacturing (AM) technologies, including selective laser sintering (SLS). The authors’ research illustrates the practical application of the Dentistry 4.0 approach for several types of prosthetic restorations. The development process of the modern approach is being observed all over the world. The use of the principles of the augmented holistic model of Industry 4.0 in advanced dental engineering indicates a change in the traditional relationship between a dentist and a dental engineer. The overall conclusion demonstrates that it is inevitable and extremely beneficial to implement the idea of Dentistry 4.0 following the assumptions of the authors’ own, holistic Industry 4.0 model.
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Modabber A, Rauen A, Ayoub N, Möhlhenrich SC, Peters F, Kniha K, Hölzle F, Raith S. Evaluation of a novel algorithm for automating virtual surgical planning in mandibular reconstruction using fibula flaps. J Craniomaxillofac Surg 2019; 47:1378-1386. [DOI: 10.1016/j.jcms.2019.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/03/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022] Open
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16
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Lerebours A, Marin F, Bouvier S, Egles C, Masquelet AC, Rassineux A. A voxel-based method for designing a numerical biomechanical model patient-specific with an anatomical functional approach adapted to additive manufacturing. Comput Methods Biomech Biomed Engin 2019; 22:304-312. [DOI: 10.1080/10255842.2018.1552684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Augustin Lerebours
- Centre de recherche de Royallieu, Sorbonne Universités, Université de technologie de Compiègne, CNRS, FRE-2012 Roberval, Compiègne cedex, France
| | - Frederic Marin
- Centre de recherche Royallieu, Sorbonne Universités, Université de technologie de Compiègne, CNRS, UMR 7338 BioMécanique et BioIngénierie (BMBI), Compiègne cedex, France
| | - Salima Bouvier
- Centre de recherche de Royallieu, Sorbonne Universités, Université de technologie de Compiègne, CNRS, FRE-2012 Roberval, Compiègne cedex, France
| | - Christophe Egles
- Centre de recherche Royallieu, Sorbonne Universités, Université de technologie de Compiègne, CNRS, UMR 7338 BioMécanique et BioIngénierie (BMBI), Compiègne cedex, France
| | | | - Alain Rassineux
- Centre de recherche de Royallieu, Sorbonne Universités, Université de technologie de Compiègne, CNRS, FRE-2012 Roberval, Compiègne cedex, France
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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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McCann AC, Shnayder Y, Przylecki WH, Kakarala K, Nazir N, Girod DA, Andrews BT. Comparison of Modern Rigid Fixation Plating Outcomes for Segmental Mandibular Microvascular Reconstruction. Laryngoscope 2018; 129:1081-1086. [PMID: 30284278 DOI: 10.1002/lary.27406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS New advances in osseous microvascular mandibular rigid fixation are being employed at many institutions. These include standardized prebent/preformed reconstruction plates as well as computer-aided design/computer-aided manufacturing (CAD/CAM) custom plates that are patient specific. Our goal was to assess and compare the outcomes of both of these new technologies when utilized for mandibular microvascular reconstruction. STUDY DESIGN Retrospective chart review. METHODS Subjects were categorized into two groups according to their mandibular rigid fixation technique: group 1 = prebent/preformed plates and group 2 = CAD/CAM custom plates. Primary outcome measures were 1) perioperative complications (defined as deep tissue infection, wound dehiscence resulting in bone exposure, and/or plate exposure) and 2) reoperation rates for mandibular hardware failure/explantation. Statistical analysis consisted of χ2 , Fisher exact test, and multivariable regression models. RESULTS A total of 142 subjects underwent microvascular mandibular reconstruction in a 6-year period. Eighty-nine subjects utilized prebent/preformed plates, and 53 employed CAD/CAM custom plates. Perioperative complications occurred in 32 of 89 (35.9%) subjects with prebent/preformed plates and 11 of 53 (20.7%) subjects using CAD/CAM custom plates. Reoperation requiring hardware explantation occurred in 18 of 89 (20.2%) subjects and three of 53 (5.6%) using CAD/CAM custom plates. Statistical comparison of perioperative complications between the two groups approached significance (P = .0556), and the rate of reoperation was significant favoring CAD/CAM implants (P = .0180). CONCLUSIONS In our experience, CAD/CAM custom plates utilized for rigid fixation during microvascular mandibular reconstruction demonstrated fewer complications and statistically lower reoperation rates when compared with prebent/preformed plates. LEVEL OF EVIDENCE 2c Laryngoscope, 129:1081-1086, 2019.
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Affiliation(s)
- Adam C McCann
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Yelizaveta Shnayder
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Wojciech H Przylecki
- Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Kiran Kakarala
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Niaman Nazir
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Douglas A Girod
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Brian T Andrews
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, U.S.A.,Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
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van Baar GJC, Forouzanfar T, Liberton NPTJ, Winters HAH, Leusink FKJ. Accuracy of computer-assisted surgery in mandibular reconstruction: A systematic review. Oral Oncol 2018; 84:52-60. [PMID: 30115476 DOI: 10.1016/j.oraloncology.2018.07.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/29/2018] [Accepted: 07/10/2018] [Indexed: 11/18/2022]
Abstract
Computer-assisted surgery (CAS) for mandibular reconstruction was developed to improve conventional treatment methods. In the past years, many different software programs have entered the market, offering numerous approaches for preoperative planning and postoperative evaluation of the CAS process of mandibular reconstruction. In this systematic review, we reviewed planning and evaluation methods in studies that quantitatively assessed accuracy of mandibular reconstruction performed with CAS. We included 42 studies describing 413 mandibular reconstructions planned and evaluated using CAS. The commonest software was Proplan/Surgicase CMF (55%). In most cases, the postoperative virtual 3-dimensional model was compared to the preoperative 3-dimensional model, revised to the virtual plan (64%). The commonest landmark for accuracy measurements was the condyle (54%). Accuracy deviations ranged between 0 mm and 12.5 mm and between 0.9° and 17.5°. Because of a lack of uniformity in planning (e.g., image acquisition, mandibular resection size) and evaluation methodologies, the ability to compare postoperative outcomes was limited; meta-analysis was not performed. A practical and simple guideline for standardizing planning and evaluation methods needs to be considered to allow valid comparisons of postoperative results and facilitate meta-analysis in the future.
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Affiliation(s)
- Gustaaf J C van Baar
- Department of Oral and Maxillofacial Surgery/Oral Pathology & 3D Innovation Lab, VU University Medical Centre/Academic Centre for Dentistry Amsterdam (ACTA), De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Tymour Forouzanfar
- Department of Oral and Maxillofacial Surgery/Oral Pathology & 3D Innovation Lab, VU University Medical Centre/Academic Centre for Dentistry Amsterdam (ACTA), De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Niels P T J Liberton
- Department of Oral and Maxillofacial Surgery/Oral Pathology & 3D Innovation Lab, VU University Medical Centre/Academic Centre for Dentistry Amsterdam (ACTA), De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Henri A H Winters
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Frank K J Leusink
- Department of Oral and Maxillofacial Surgery/Oral Pathology & 3D Innovation Lab, VU University Medical Centre/Academic Centre for Dentistry Amsterdam (ACTA), De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
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20
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Clinical experience with a novel structure designed bridging plate system for segmental mandibular reconstruction: The TriLock bridging plate. J Craniomaxillofac Surg 2018; 46:1679-1690. [DOI: 10.1016/j.jcms.2018.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 06/05/2018] [Accepted: 07/02/2018] [Indexed: 11/17/2022] Open
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21
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Sinha P, Skolnick G, Patel KB, Branham GH, Chi JJ. A 3-Dimensional-Printed Short-Segment Template Prototype for Mandibular Fracture Repair. JAMA FACIAL PLAST SU 2018; 20:373-380. [PMID: 29710318 PMCID: PMC6233625 DOI: 10.1001/jamafacial.2018.0238] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 02/13/2018] [Indexed: 11/14/2022]
Abstract
IMPORTANCE After reduction of complex mandibular fractures, contouring of the fracture plates to fixate the reduced mandibular segments can be time-consuming. OBJECTIVE To explore the potential application of a 3-dimensional (3-D)-printed short-segment mandibular template in the management of complex mandibular fractures. DESIGN, SETTING, AND PARTICIPANTS A feasibility study was performed at a tertiary academic center using maxillofacial computed tomography data of 3 patients with comminuted mandibular fractures who required preoperative planning with a perfected complete mandible model. INTERVENTIONS Thresholding, segmentation, and realignment of the fractured mandible were performed based on computed tomography data. Each reduced mandible design was divided to create 3-D templates for 6 fracture sites: right and left angle, body, and symphyseal/parasymphyseal. Sessions were conducted with junior otolaryngology and plastic surgery residents, during which mandibular fracture plates were contoured in a "preoperative" setting against the 3-D-printed short-segment templates, and an "intraoperative" setting against the previously manufactured, complete mandible model. The previously manufactured, complete model served as a surrogate for the intraoperative mandible with the fracture site reduced. MAIN OUTCOMES AND MEASURES The time for 3-D template printing, the "preoperative" (measure of the time consumed preoperatively), and "intraoperative" (measure of the time saved intraoperatively) times were recorded. Comparisons were made for cost estimates between a complete model and the 3-D-printed short-segment template. The operating room charge equivalent of the intraoperative time was also calculated. RESULTS Of the 3 patients whose data were used, 1 was a teenager and 2 were young adults. The total time for 3-D modeling and printing per short-segment template was less than 3 hours. The median (range) intraoperative time saved by precontouring the fracture plates was 7 (1-14), 5 (1-30), and 7 (2-15) minutes, and the operating room charge equivalents were $350.35 ($50.05-$700.70), $250 ($50.05-$1501.50), and $350.35 ($100.10-$750.75) for the angle, body, and symphyseal/parasymphyseal segments, respectively. The total cost for a single 3-D-printed template was less than $20, while that for a perfected complete model was approximately $2200. CONCLUSIONS AND RELEVANCE We demonstrate that patient- and site-specific 3-D-printed short-segment templates can be created within the timeframe required for mandibular fracture repair. These novel 3-D-printed templates also demonstrate cost efficiency in the preoperative planning for complex mandibular fracture management compared with perfected models and facilitate plate contouring in a similar fashion. Estimation of reduced operative room cost and time with the application of these short-segment templates warrants studies in actual patient care. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Parul Sinha
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Gary Skolnick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Kamlesh B. Patel
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Gregory H. Branham
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - John J. Chi
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
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22
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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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Canzi P, Magnetto M, Marconi S, Morbini P, Mauramati S, Aprile F, Avato I, Auricchio F, Benazzo M. New frontiers and emerging applications of 3D printing in ENT surgery: a systematic review of the literature. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2018; 38:286-303. [PMID: 30197421 PMCID: PMC6146580 DOI: 10.14639/0392-100x-1984] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 05/14/2018] [Indexed: 12/22/2022]
Abstract
3D printing systems have revolutionised prototyping in the industrial field by lowering production time from days to hours and costs from thousands to just a few dollars. Today, 3D printers are no more confined to prototyping, but are increasingly employed in medical disciplines with fascinating results, even in many aspects of otorhinolaryngology. All publications on ENT surgery, sourced through updated electronic databases (PubMed, MEDLINE, EMBASE) and published up to March 2017, were examined according to PRISMA guidelines. Overall, 121 studies fulfilled specific inclusion criteria and were included in our systematic review. Studies were classified according to the specific field of application (otologic, rhinologic, head and neck) and area of interest (surgical and preclinical education, customised surgical planning, tissue engineering and implantable prosthesis). Technological aspects, clinical implications and limits of 3D printing processes are discussed focusing on current benefits and future perspectives.
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Affiliation(s)
- P. Canzi
- Department of Otorhinolaryngology, University of Pavia, Foundation IRCCS Policlinico “San Matteo”, Pavia, Italy
| | - M. Magnetto
- Department of Otorhinolaryngology, University of Pavia, Foundation IRCCS Policlinico “San Matteo”, Pavia, Italy
| | - S. Marconi
- Department of Civil Engineering and Architecture, University of Pavia, Italy
| | - P. Morbini
- Department of Pathology, University of Pavia, Foundation IRCCS Policlinico S. Matteo, Pavia, Italy
| | - S. Mauramati
- Department of Otorhinolaryngology, University of Pavia, Foundation IRCCS Policlinico “San Matteo”, Pavia, Italy
| | - F. Aprile
- Department of Otorhinolaryngology, University of Pavia, Foundation IRCCS Policlinico “San Matteo”, Pavia, Italy
| | - I. Avato
- Department of Otorhinolaryngology, University of Pavia, Foundation IRCCS Policlinico “San Matteo”, Pavia, Italy
- PhD in Experimental Medicine, University of Pavia, Italy
| | - F. Auricchio
- Department of Civil Engineering and Architecture, University of Pavia, Italy
| | - M. Benazzo
- Department of Otorhinolaryngology, University of Pavia, Foundation IRCCS Policlinico “San Matteo”, Pavia, Italy
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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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25
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Arce K, Waris S, Alexander AE, Ettinger KS. Novel Patient-Specific 3-Dimensional Printed Fixation Tray for Mandibular Reconstruction With Fibular Free Flaps. J Oral Maxillofac Surg 2018; 76:2211-2219. [PMID: 29802815 DOI: 10.1016/j.joms.2018.04.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 10/17/2022]
Abstract
Segmental mandibular defects secondary to infectious, traumatic, and pathologic conditions can be debilitating because of their impact on function and facial esthetics. Several reconstructive techniques are available, with vascularized flaps commonly used for the reconstruction of large bony or composite segmental defects. The free fibular flap for mandibular reconstruction is well documented and remains a commonly used flap because of its bone length, versatility, distant location from the head and neck region that allows for a 2-team approach, and ability to simultaneously place endosseous implants. Virtual surgical planning (VSP) and guided resection and reconstruction of maxillofacial defects have facilitated complex 3-dimensional (3D) reconstruction. The accuracy and fidelity of VSP are dependent on the intraoperative execution of the VSP, with computer-aided design and computer-aided modeling of patient-specific cutting guides and hardware providing a template for its execution. The goal of this report is to describe the authors' experience with the use of a novel 3D printed fixation tray designed from the VSP data. It provides dual functionality by aiding in alignment and stabilization of the fibular segments and concomitantly providing patient-specific anatomic references for indexing of bony and soft tissue components. This tray enables rapid ex vivo configuration of the fibula segment(s) with the reconstruction bar relative to the native mandibular segments and allows the compiled construct to be transferred to the head and neck for insetting as a precisely configured single unit.
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Affiliation(s)
- Kevin Arce
- Assistant Professor of Surgery and Program Director, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN.
| | - Samir Waris
- Resident, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN
| | - Amy E Alexander
- Biomedical Engineer, Biomechanics Research, Anatomical Modeling Laboratory, Mayo Clinic, Rochester, MN
| | - Kyle S Ettinger
- Mayo Clinic Scholar, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN; Head and Neck Oncologic Surgery and Microvascular Reconstruction Fellow, Division of Head and Neck Surgery, Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL
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Ettinger KS, Alexander AE, Arce K. Computed Tomographic Angiography Perforator Localization for Virtual Surgical Planning of Osteocutaneous Fibular Free Flaps in Head and Neck Reconstruction. J Oral Maxillofac Surg 2018; 76:2220-2230. [PMID: 29730061 DOI: 10.1016/j.joms.2018.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 04/03/2018] [Accepted: 04/03/2018] [Indexed: 11/30/2022]
Abstract
Virtual surgical planning (VSP), computer-aided design and computer-aided modeling, and 3-dimensional printing are 3 distinct technologies that have become increasingly employed in head and neck oncology and microvascular reconstruction. Although each of these technologies have long been utilized for treatment planning in other surgical disciplines such as craniofacial surgery, trauma surgery, temporomandibular joint surgery, and orthognathic surgery, its widespread use in head and neck reconstructive surgery remains a much more recent advent. In response to the growing trend of VSP being used for the planning of fibular free flaps in head and neck reconstruction, some surgeons have questioned the technology's implementation based upon its perceived inadequacy in addressing other reconstructive considerations beyond hard tissue anatomy. Detractors of VSP for head and neck reconstruction highlight its lack of capability in accounting for multiple reconstructive factors, such as recipient vessel selection, vascular pedicle reach, need for dead space obliteration, and skin paddle perforator location. It is with this premise in mind that we report a simple technique for anatomically localizing peroneal artery perforators during VSP for osteocutaneous fibular free flaps in which both bone and a soft tissue skin paddle are required for ablative reconstruction. The technique allows for anatomic perforator localization during the VSP session based solely upon data existent within the preoperative computed tomographic angiography (CTA) and it does not require any modifications to preoperative clinical workflows. It is the authors' presumption that many surgeons in the field are unaware of this planning capability within the context of modern VSP for head and neck reconstruction. The primary purpose of this manuscript is to introduce and further familiarize surgeons with the technique of CTA perforator localization as a method of improving intraoperative fidelity for VSP of osteocutaneous fibular free flaps.
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Affiliation(s)
- Kyle S Ettinger
- Mayo Clinic Scholar, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN; Head and Neck Oncologic Surgery and Microvascular Reconstruction Fellow, Department of Oral and Maxillofacial Surgery, Division of Head and Neck Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL.
| | - Amy E Alexander
- Biomedical Engineer, Anatomic Modeling Lab, Mayo Clinic, Rochester, MN
| | - Kevin Arce
- Assistant Professor of Surgery and Program Director, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN
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Berrone M, Crosetti E, Tos PL, Pentenero M, Succo G. Fibular osteofasciocutaneous flap in computer-assisted mandibular reconstruction: technical aspects in oral malignancies. ACTA OTORHINOLARYNGOLOGICA ITALICA 2018; 36:469-478. [PMID: 28177329 PMCID: PMC5317125 DOI: 10.14639/0392-100x-1282] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 06/13/2016] [Indexed: 12/23/2022]
Abstract
Virtual surgical planning technology in head and neck surgery is witnessing strong growth. In the literature, the validity of the method from the point of view of accuracy and clinical utility has been widely documented, especially for bone modelling. To date, however, with its increased use in head and neck oncology, and consequently the increased need for bone and soft tissue reconstruction, is important to carry out the virtual programme considering not only bone reconstruction but also all aspects related to the reconstruction of soft tissue using composite flaps. We describe our approach to virtual planning in the case of composite flaps. The study reports six consecutive patients with malignant disease requiring mandibular bone and soft tissue reconstruction using fibular osteocutaneous flaps. In all six patients, the resection and reconstruction were planned virtually focusing on the position of cutaneous perforator vessels in order to schedule fibula cutting guides. There were no complications in all six cases. The technique described allowed us to schedule composite fibula flaps in mandibular reconstruction virtually with good accuracy of the position of the bone segment in relation to the cutaneous paddle, important for soft tissue reconstruction. Despite the limited number of cases, the preliminary results of the study suggest that this protocol is useful in virtual programmes using composite flaps in mandibular reconstruction. Further investigations are needed.
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Affiliation(s)
- M Berrone
- Department of Oncology, Phd Program in Experimental Medicine and Therapy, University of Turin, Italy
| | - E Crosetti
- FPO IRCSS, Candiolo Cancer Institute, Head & Neck Oncology Unit, Candiolo, Turin, Italy
| | - P L Tos
- Microsurgery Unit, Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Center CTO, Turin, Italy
| | - M Pentenero
- Department of Oncology, Oral Medicine and Oral Oncology Unit, University of Turin, Italy
| | - G Succo
- Department of Oncology, Otolaryngology Unit, University of Turin, Italy
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Raith S, Rauen A, Möhlhenrich SC, Ayoub N, Peters F, Steiner T, Hölzle F, Modabber A. Introduction of an algorithm for planning of autologous fibular transfer in mandibular reconstruction based on individual bone curvatures. Int J Med Robot 2018; 14. [PMID: 29423929 DOI: 10.1002/rcs.1894] [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: 03/21/2017] [Revised: 12/20/2017] [Accepted: 12/30/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND Reconstruction of the mandible with autologous transplants is a challenging task and current computer-aided surgical planning remains cumbersome. Thus, the aim of the present study was to create an automated computational approach for this procedure. METHODS The developed algorithm is based on curves following characteristic anatomical features. Geometrical data from a physiological mandible and a fibula were used to generate six different defects, and geometrical accordance was investigated to demonstrate the applicability of the method with different reconstruction parameters (n = 309). RESULTS The method proved to be applicable, it recognized given clinical constraints and the values of accordance could be used to quantify the success of reconstructions. CONCLUSIONS With the present approach, the complex three-dimensional task of mandibular reconstruction was simplified, and thus it allows implementation in clinical routine. The computational planning that is proposed may be used to design cutting guides or as geometrical input data for real-time navigated surgery.
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Affiliation(s)
- Stefan Raith
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Alexandra Rauen
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Stephan Christian Möhlhenrich
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University Hospital, Aachen, Germany.,Department of Orthodontics, RWTH Aachen University Hospital, Aachen, Germany
| | - Nassim Ayoub
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Florian Peters
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Timm Steiner
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Ali Modabber
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University Hospital, Aachen, Germany
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Three-dimensional printing modeling: application in maxillofacial and hand fractures and resident training. EUROPEAN JOURNAL OF PLASTIC SURGERY 2017. [DOI: 10.1007/s00238-017-1373-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Konakondla S, Brimley CJ, Sublett JM, Stefanowicz E, Flora S, Mongelluzzo G, Schirmer CM. Multimodality 3D Superposition and Automated Whole Brain Tractography: Comprehensive Printing of the Functional Brain. Cureus 2017; 9:e1731. [PMID: 29201580 PMCID: PMC5707174 DOI: 10.7759/cureus.1731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Whole brain tractography using diffusion tensor imaging (DTI) sequences can be used to map cerebral connectivity; however, this can be time-consuming due to the manual component of image manipulation required, calling for the need for a standardized, automated, and accurate fiber tracking protocol with automatic whole brain tractography (AWBT). Interpreting conventional two-dimensional (2D) images, such as computed tomography (CT) and magnetic resonance imaging (MRI), as an intraoperative three-dimensional (3D) environment is a difficult task with recognized inter-operator variability. Three-dimensional printing in neurosurgery has gained significant traction in the past decade, and as software, equipment, and practices become more refined, trainee education, surgical skills, research endeavors, innovation, patient education, and outcomes via valued care is projected to improve. We describe a novel multimodality 3D superposition (MMTS) technique, which fuses multiple imaging sequences alongside cerebral tractography into one patient-specific 3D printed model. Inferences on cost and improved outcomes fueled by encouraging patient engagement are explored.
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Affiliation(s)
- Sanjay Konakondla
- Neurosurgery Department, Neuroscience Institute, Geisinger Health System
| | - Cameron J Brimley
- Neurosurgery Department, Neuroscience Institute, Geisinger Health System
| | | | | | - Sarah Flora
- Department of Radiology and Neuroradiology, Geisinger Health System
| | - Gino Mongelluzzo
- Department of Radiology and Neuroradiology, Geisinger Health System
| | - Clemens M Schirmer
- Neurosurgery Department, Neuroscience Institute, Geisinger Health System
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31
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Duttenhoefer F, Probst FA, Vach K, Cornelius CP, Zens M, Schmelzeisen R, Metzger MC. Clinical analysis of MatrixMANDIBLE Preformed Reconstruction Plate design. J Craniomaxillofac Surg 2017; 45:1521-1525. [DOI: 10.1016/j.jcms.2017.05.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 05/04/2017] [Accepted: 05/29/2017] [Indexed: 11/17/2022] Open
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Hirsch JD, Vincent RL, Eisenman DJ. Surgical reconstruction of the ossicular chain with custom 3D printed ossicular prosthesis. 3D Print Med 2017; 3:7. [PMID: 29782607 PMCID: PMC5954796 DOI: 10.1186/s41205-017-0015-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 07/07/2017] [Indexed: 11/16/2022] Open
Abstract
Background Conductive hearing loss due to ossicular abnormalities occurs from many causes, including trauma, infection, cholesteatoma, surgery and congenital anomalies. Surgical reconstruction of the ossicular chain is a well-established procedure for repair of ossicular defects, but is still plagued by high failure rates. Underlying disease and proper sizing of prostheses are two challenges that lead to component failure. Three-dimensional (3D) printing has been used successfully to solve a number of medical prosthesis problems. Custom 3D printing an individualized ossicular prosthesis would be a potential solution for the wide range of anatomic variation encountered in the pathological middle ear, and could decrease the rate of post-operative prosthesis displacement by increasing the likelihood of a proper fit, in addition to decreasing surgical time. In this study, the incus was removed from three formalin-fixed cadaveric human temporal bones with no macro- or microscopic evidence of pathology. Imaging of the cadaveric bone was obtained using a standard temporal bone CT protocol. A custom prosthesis for each cadaveric human temporal bone was designed using the Mimics Innovation Suite software (Materialise, Belgium) and fabricated on a Form2 3D printer (FormLabs, Somerville, Massachusetts). Four surgeons then performed insertion of each prosthesis into each middle ear, blinded to the bone from and for which each was designed. The surgeons were asked to match each prosthesis to its correct parent bone. Results Each prosthesis had unique measurements. Each of the four surgeons was able to correctly match the prosthesis model to its intended temporal bone. The chances of this occurring randomly are 1:1296. Conclusions A custom 3D printed ossicular prosthesis is a viable solution for conductive hearing loss due to ossicular chain defects. Commercially available CT scanners can detect significant anatomic differences in normal human middle ear ossicles. These differences can be accurately represented with current 3D printing technology and, more significantly, surgeons can detect these differences.
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Affiliation(s)
- Jeffrey D Hirsch
- 1Department of Diagnostic Radiology, University of Maryland School of Medicine, Baltimore, USA
| | - Richard L Vincent
- 2Department of Otorhinolaryngology - Head & Neck Surgery, University of Maryland School of Medicine, Baltimore, USA
| | - David J Eisenman
- 2Department of Otorhinolaryngology - Head & Neck Surgery, University of Maryland School of Medicine, Baltimore, USA
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Wang L, Liu K, Shao Z, Shang ZJ. Management of the condyle following the resection of tumours of the mandible. Int J Oral Maxillofac Surg 2017; 46:1252-1256. [PMID: 28688540 DOI: 10.1016/j.ijom.2017.04.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 03/30/2017] [Accepted: 04/26/2017] [Indexed: 11/26/2022]
Abstract
The aim of this study was to assess the management of the condyle during the restoration of mandibular defects following tumour resection. A total of 41 patients who underwent simultaneous tumour resection and reconstruction with vascularized iliac myocutaneous flaps for mandibular defects, from September 2010 to October 2014, were included. These patients were divided into three groups: group 1, condyle preserved; group 2, condyle sacrificed; group 3, condyle frozen. Patients were followed up at 1, 3, 6, and 12 months for the evaluation of appearance, occlusion, and speech. The TMJ disability index (DI) and craniomandibular index (CMI) differed significantly according to the method of management, as well as the position and morphology of the reconstructed condyle (P<0.01); however, no statistically significant difference in mandible movement was observed between the groups. The DI and CMI values were significantly lower in group 1 patients compared to group 2 and group 3 patients. The results showed that TMJ function in group 1 patients was superior to that in group 2 and group 3 patients, and that function in group 3 patients was better than that in group 2 patients. In conclusion, the condyle should be preserved when benign mandibular lesions are situated near the condyle, as preservation has a positive effect on TMJ function and mandible movement.
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Affiliation(s)
- L Wang
- Jiangsu Key Laboratory of Oral Diseases, and Department of Oral and Maxillofacial Surgery-Head and Neck Oncology, Affiliated Hospital of Stomatology, Nanjing Medical University, Jiangsu, China
| | - K Liu
- Department of Oral and Maxillofacial Surgery-Head and Neck Oncology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Z Shao
- Department of Oral and Maxillofacial Surgery-Head and Neck Oncology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Z-J Shang
- Jiangsu Key Laboratory of Oral Diseases, and Department of Oral and Maxillofacial Surgery-Head and Neck Oncology, Affiliated Hospital of Stomatology, Nanjing Medical University, Jiangsu, China.
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Thompson A, McNally D, Maskery I, Leach RK. X-ray computed tomography and additive manufacturing in medicine: a review. INTERNATIONAL JOURNAL OF METROLOGY AND QUALITY ENGINEERING 2017. [DOI: 10.1051/ijmqe/2017015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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35
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Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years. Br J Oral Maxillofac Surg 2017; 55:113-126. [DOI: 10.1016/j.bjoms.2016.12.010] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 12/02/2016] [Indexed: 11/19/2022]
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36
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Ripley B, Levin D, Kelil T, Hermsen JL, Kim S, Maki JH, Wilson GJ. 3D printing from MRI Data: Harnessing strengths and minimizing weaknesses. J Magn Reson Imaging 2016; 45:635-645. [PMID: 27875009 DOI: 10.1002/jmri.25526] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/27/2016] [Accepted: 09/27/2016] [Indexed: 01/17/2023] Open
Abstract
3D printing facilitates the creation of accurate physical models of patient-specific anatomy from medical imaging datasets. While the majority of models to date are created from computed tomography (CT) data, there is increasing interest in creating models from other datasets, such as ultrasound and magnetic resonance imaging (MRI). MRI, in particular, holds great potential for 3D printing, given its excellent tissue characterization and lack of ionizing radiation. There are, however, challenges to 3D printing from MRI data as well. Here we review the basics of 3D printing, explore the current strengths and weaknesses of printing from MRI data as they pertain to model accuracy, and discuss considerations in the design of MRI sequences for 3D printing. Finally, we explore the future of 3D printing and MRI, including creative applications and new materials. LEVEL OF EVIDENCE 5 J. Magn. Reson. Imaging 2017;45:635-645.
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Affiliation(s)
- Beth Ripley
- Department of Radiology, University of Washington, Seattle, Washington, USA.,Department of Radiology, VA Puget Sound Health Care System, Seattle WA 98108
| | - Dmitry Levin
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Tatiana Kelil
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua L Hermsen
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Sooah Kim
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Jeffrey H Maki
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Gregory J Wilson
- Department of Radiology, University of Washington, Seattle, Washington, USA
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Tack P, Victor J, Gemmel P, Annemans L. 3D-printing techniques in a medical setting: a systematic literature review. Biomed Eng Online 2016; 15:115. [PMID: 27769304 PMCID: PMC5073919 DOI: 10.1186/s12938-016-0236-4] [Citation(s) in RCA: 535] [Impact Index Per Article: 66.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 10/09/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Three-dimensional (3D) printing has numerous applications and has gained much interest in the medical world. The constantly improving quality of 3D-printing applications has contributed to their increased use on patients. This paper summarizes the literature on surgical 3D-printing applications used on patients, with a focus on reported clinical and economic outcomes. METHODS Three major literature databases were screened for case series (more than three cases described in the same study) and trials of surgical applications of 3D printing in humans. RESULTS 227 surgical papers were analyzed and summarized using an evidence table. The papers described the use of 3D printing for surgical guides, anatomical models, and custom implants. 3D printing is used in multiple surgical domains, such as orthopedics, maxillofacial surgery, cranial surgery, and spinal surgery. In general, the advantages of 3D-printed parts are said to include reduced surgical time, improved medical outcome, and decreased radiation exposure. The costs of printing and additional scans generally increase the overall cost of the procedure. CONCLUSION 3D printing is well integrated in surgical practice and research. Applications vary from anatomical models mainly intended for surgical planning to surgical guides and implants. Our research suggests that there are several advantages to 3D-printed applications, but that further research is needed to determine whether the increased intervention costs can be balanced with the observable advantages of this new technology. There is a need for a formal cost-effectiveness analysis.
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Affiliation(s)
- Philip Tack
- Department of Public Health, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Jan Victor
- Ghent University Hospital, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Paul Gemmel
- Departement of Economics & Business Administration, Ghent University, Tweekerkenstraat 2, 9000, Ghent, Belgium
| | - Lieven Annemans
- Department of Public Health, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
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Matsumoto JS, Morris JM, Foley TA, Williamson EE, Leng S, McGee KP, Kuhlmann JL, Nesberg LE, Vrtiska TJ. Three-dimensional Physical Modeling: Applications and Experience at Mayo Clinic. Radiographics 2016; 35:1989-2006. [PMID: 26562234 DOI: 10.1148/rg.2015140260] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Radiologists will be at the center of the rapid technologic expansion of three-dimensional (3D) printing of medical models, as accurate models depend on well-planned, high-quality imaging studies. This article outlines the available technology and the processes necessary to create 3D models from the radiologist's perspective. We review the published medical literature regarding the use of 3D models in various surgical practices and share our experience in creating a hospital-based three-dimensional printing laboratory to aid in the planning of complex surgeries.
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Affiliation(s)
- Jane S Matsumoto
- From the Division of Pediatric Radiology, Department of Radiology (J.S.M.); Division of Neuroradiology, Department of Radiology (J.M.M.); Division of Cardiovascular Radiology, Department of Radiology (T.A.F., E.E.W., T.J.V.); Division of Abdominal Imaging, Department of Radiology (E.E.W., T.J.V.); Division of Medical Physics, Department of Radiology (S.L., K.P.M.); Division of Engineering (J.L.K.); and Department of Radiology (L.E.N.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Jonathan M Morris
- From the Division of Pediatric Radiology, Department of Radiology (J.S.M.); Division of Neuroradiology, Department of Radiology (J.M.M.); Division of Cardiovascular Radiology, Department of Radiology (T.A.F., E.E.W., T.J.V.); Division of Abdominal Imaging, Department of Radiology (E.E.W., T.J.V.); Division of Medical Physics, Department of Radiology (S.L., K.P.M.); Division of Engineering (J.L.K.); and Department of Radiology (L.E.N.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Thomas A Foley
- From the Division of Pediatric Radiology, Department of Radiology (J.S.M.); Division of Neuroradiology, Department of Radiology (J.M.M.); Division of Cardiovascular Radiology, Department of Radiology (T.A.F., E.E.W., T.J.V.); Division of Abdominal Imaging, Department of Radiology (E.E.W., T.J.V.); Division of Medical Physics, Department of Radiology (S.L., K.P.M.); Division of Engineering (J.L.K.); and Department of Radiology (L.E.N.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Eric E Williamson
- From the Division of Pediatric Radiology, Department of Radiology (J.S.M.); Division of Neuroradiology, Department of Radiology (J.M.M.); Division of Cardiovascular Radiology, Department of Radiology (T.A.F., E.E.W., T.J.V.); Division of Abdominal Imaging, Department of Radiology (E.E.W., T.J.V.); Division of Medical Physics, Department of Radiology (S.L., K.P.M.); Division of Engineering (J.L.K.); and Department of Radiology (L.E.N.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Shuai Leng
- From the Division of Pediatric Radiology, Department of Radiology (J.S.M.); Division of Neuroradiology, Department of Radiology (J.M.M.); Division of Cardiovascular Radiology, Department of Radiology (T.A.F., E.E.W., T.J.V.); Division of Abdominal Imaging, Department of Radiology (E.E.W., T.J.V.); Division of Medical Physics, Department of Radiology (S.L., K.P.M.); Division of Engineering (J.L.K.); and Department of Radiology (L.E.N.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Kiaran P McGee
- From the Division of Pediatric Radiology, Department of Radiology (J.S.M.); Division of Neuroradiology, Department of Radiology (J.M.M.); Division of Cardiovascular Radiology, Department of Radiology (T.A.F., E.E.W., T.J.V.); Division of Abdominal Imaging, Department of Radiology (E.E.W., T.J.V.); Division of Medical Physics, Department of Radiology (S.L., K.P.M.); Division of Engineering (J.L.K.); and Department of Radiology (L.E.N.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Joel L Kuhlmann
- From the Division of Pediatric Radiology, Department of Radiology (J.S.M.); Division of Neuroradiology, Department of Radiology (J.M.M.); Division of Cardiovascular Radiology, Department of Radiology (T.A.F., E.E.W., T.J.V.); Division of Abdominal Imaging, Department of Radiology (E.E.W., T.J.V.); Division of Medical Physics, Department of Radiology (S.L., K.P.M.); Division of Engineering (J.L.K.); and Department of Radiology (L.E.N.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Linda E Nesberg
- From the Division of Pediatric Radiology, Department of Radiology (J.S.M.); Division of Neuroradiology, Department of Radiology (J.M.M.); Division of Cardiovascular Radiology, Department of Radiology (T.A.F., E.E.W., T.J.V.); Division of Abdominal Imaging, Department of Radiology (E.E.W., T.J.V.); Division of Medical Physics, Department of Radiology (S.L., K.P.M.); Division of Engineering (J.L.K.); and Department of Radiology (L.E.N.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Terri J Vrtiska
- From the Division of Pediatric Radiology, Department of Radiology (J.S.M.); Division of Neuroradiology, Department of Radiology (J.M.M.); Division of Cardiovascular Radiology, Department of Radiology (T.A.F., E.E.W., T.J.V.); Division of Abdominal Imaging, Department of Radiology (E.E.W., T.J.V.); Division of Medical Physics, Department of Radiology (S.L., K.P.M.); Division of Engineering (J.L.K.); and Department of Radiology (L.E.N.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905
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Abstract
PURPOSE OF REVIEW Multiple disease processes, including neoplasia, trauma, and medication side-effects, necessitate segmental resection and subsequent reconstruction of the mandible. As surgical techniques have advanced, several technologies have been developed with the potential to significantly transform a surgeon's approach to the restoration of mandibular continuity. The purpose of this review is to highlight many of these relatively newer tools and discuss their evolving role in mandibular reconstruction. RECENT FINDINGS Several contemporary studies have documented the application of different approaches and modifications to mandibular reconstruction - including computer-aided design or computer-aided modeling, contemporary plating systems, osseointegrated implants, and various modifications to existing osseocutaneous free tissue transfer options - and have reported relatively high success rates. SUMMARY In discussing these reports, we present a survey of current and developing technologies in the field of mandibular reconstruction and aim to provide sufficient context for the gradual integration of these techniques into practice.
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Mulford JS, Babazadeh S, Mackay N. Three-dimensional printing in orthopaedic surgery: review of current and future applications. ANZ J Surg 2016; 86:648-53. [PMID: 27071485 DOI: 10.1111/ans.13533] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/29/2016] [Accepted: 02/16/2016] [Indexed: 01/01/2023]
Abstract
Three-dimensional (3D) printing is a rapidly evolving technology with the potential for significant contributions to surgical practice. There are many current applications for 3D printing technology with future applications being explored. This technology has applications in preoperative planning, education, custom manufacturing (implants, prosthetics and surgical guides) and exciting potential for biological applications. This article reviews the current and future applications of 3D technology in orthopaedic surgery.
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Affiliation(s)
- Jonathan S Mulford
- Department of Orthopaedics, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Sina Babazadeh
- Department of Orthopaedics, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Neil Mackay
- Department of Orthopaedics, Launceston General Hospital, Launceston, Tasmania, Australia
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Ow A, Tan W, Pienkowski L. Mandibular Reconstruction Using a Custom-Made Titanium Prosthesis: A Case Report on the Use of Virtual Surgical Planning and Computer-Aided Design/Computer-Aided Manufacturing. Craniomaxillofac Trauma Reconstr 2016; 9:246-50. [PMID: 27516841 DOI: 10.1055/s-0036-1581060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 08/23/2015] [Indexed: 10/22/2022] Open
Abstract
The use of virtual surgical planning and computer-aided design/computer-aided manufacturing has been reported to enhance the planning for the reconstruction of mandibular continuity defects. This case report illustrates the use of this technology in the fabrication of a custom-made titanium prosthesis to restore a segmental mandibular defect. The design specifications and sequence of the custom-made titanium prosthesis are discussed. Although successful in this case, there are limitations in its application and case selection is of vital importance.
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Affiliation(s)
- Andrew Ow
- Discipline of Oral and Maxillofacial Surgery, Jurong Health Services, Singapore, Singapore
| | - Winston Tan
- Discipline of Oral and Maxillofacial Surgery, Jurong Health Services, Singapore, Singapore
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Thor A. Preoperative Planning of Virtual Osteotomies Followed by Fabrication of Patient Specific Reconstruction Plate for Secondary Correction and Fixation of Displaced Bilateral Mandibular Body Fracture. Craniomaxillofac Trauma Reconstr 2016; 9:188-94. [PMID: 27162581 DOI: 10.1055/s-0036-1572492] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
This paper describes the course of treatment of a severely diplaced bilateral mandibular body fracture, where the first osteosynthesis failed. The subject developed an open bite due to a posterior rotation of the distal part of the mandible and anterior rotation of the proximal parts of the mandible. This situation was evaluated with CBCT and the facial skeleton was segmented using computer software. Correct occlusion was virtually established by bilateral virtual osteotomies in the fracture areas of the mandible. After segmentation, the mandible was virtually rotated back into position and the open bite was closed. A patient specific mandibular reconstruction plate was outlined and fabricated from the new virtual situation and the plate was thereafter installed utilizing the preoperative plan. Osteotomy- and drill-guides was used and thus simplified the surgery resulting in uneventful healing. Virtual planning and patient specific implants and guides were valuable in this case of secondary reconstructive trauma surgery.
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Affiliation(s)
- Andreas Thor
- Department for Surgical Sciences, Plastic and Oral & Maxillofacial Surgery, Uppsala University, Uppsala, Sweden
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Martelli N, Serrano C, van den Brink H, Pineau J, Prognon P, Borget I, El Batti S. Advantages and disadvantages of 3-dimensional printing in surgery: A systematic review. Surgery 2016; 159:1485-1500. [PMID: 26832986 DOI: 10.1016/j.surg.2015.12.017] [Citation(s) in RCA: 328] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/02/2015] [Accepted: 12/11/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND Three-dimensional (3D) printing is becoming increasingly important in medicine and especially in surgery. The aim of the present work was to identify the advantages and disadvantages of 3D printing applied in surgery. METHODS We conducted a systematic review of articles on 3D printing applications in surgery published between 2005 and 2015 and identified using a PubMed and EMBASE search. Studies dealing with bioprinting, dentistry, and limb prosthesis or those not conducted in a hospital setting were excluded. RESULTS A total of 158 studies met the inclusion criteria. Three-dimensional printing was used to produce anatomic models (n = 113, 71.5%), surgical guides and templates (n = 40, 25.3%), implants (n = 15, 9.5%) and molds (n = 10, 6.3%), and primarily in maxillofacial (n = 79, 50.0%) and orthopedic (n = 39, 24.7%) operations. The main advantages reported were the possibilities for preoperative planning (n = 77, 48.7%), the accuracy of the process used (n = 53, 33.5%), and the time saved in the operating room (n = 52, 32.9%); 34 studies (21.5%) stressed that the accuracy was not satisfactory. The time needed to prepare the object (n = 31, 19.6%) and the additional costs (n = 30, 19.0%) were also seen as important limitations for routine use of 3D printing. CONCLUSION The additional cost and the time needed to produce devices by current 3D technology still limit its widespread use in hospitals. The development of guidelines to improve the reporting of experience with 3D printing in surgery is highly desirable.
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Affiliation(s)
- Nicolas Martelli
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France; University Paris-Sud, GRADES, Faculty of Pharmacy, Châtenay-Malabry, France.
| | - Carole Serrano
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
| | | | - Judith Pineau
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
| | - Patrice Prognon
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
| | - Isabelle Borget
- University Paris-Sud, GRADES, Faculty of Pharmacy, Châtenay-Malabry, France; Department of Health Economics, Gustave Roussy Institute, Villejuif, France
| | - Salma El Batti
- Department of Cardiac and Vascular Surgery, Georges Pompidou European Hospital, Paris, France; URDIA - Unité de Recherche en Développement, Imagerie et Anatomie - EA 4465, Université Paris Descartes, Paris, France
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O’Brien EK, Wayne DB, Barsness KA, McGaghie WC, Barsuk JH. Use of 3D Printing for Medical Education Models in Transplantation Medicine: a Critical Review. CURRENT TRANSPLANTATION REPORTS 2016. [DOI: 10.1007/s40472-016-0088-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
3D biomaterial printing has emerged as a potentially revolutionary technology, promising to transform both research and medical therapeutics. Although there has been recent progress in the field, on-demand fabrication of functional and transplantable tissues and organs is still a distant reality. To advance to this point, there are two major technical challenges that must be overcome. The first is expanding upon the limited variety of available 3D printable biomaterials (biomaterial inks), which currently do not adequately represent the physical, chemical, and biological complexity and diversity of tissues and organs within the human body. Newly developed biomaterial inks and the resulting 3D printed constructs must meet numerous interdependent requirements, including those that lead to optimal printing, structural, and biological outcomes. The second challenge is developing and implementing comprehensive biomaterial ink and printed structure characterization combined with in vitro and in vivo tissue- and organ-specific evaluation. This perspective outlines considerations for addressing these technical hurdles that, once overcome, will facilitate rapid advancement of 3D biomaterial printing as an indispensable tool for both investigating complex tissue and organ morphogenesis and for developing functional devices for a variety of diagnostic and regenerative medicine applications.
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Affiliation(s)
- Adam E Jakus
- Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA. Simpson Querrey Institute for BioNanotechnology, Northwestern University, Chicago, IL 60611, USA
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Brown JS, Barry C, Ho M, Shaw R. A new classification for mandibular defects after oncological resection. Lancet Oncol 2016; 17:e23-30. [DOI: 10.1016/s1470-2045(15)00310-1] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 08/26/2015] [Accepted: 09/03/2015] [Indexed: 10/22/2022]
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Suomalainen A, Stoor P, Mesimäki K, Kontio RK. Rapid prototyping modelling in oral and maxillofacial surgery: A two year retrospective study. J Clin Exp Dent 2015; 7:e605-12. [PMID: 26644837 PMCID: PMC4663063 DOI: 10.4317/jced.52556] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 09/05/2015] [Indexed: 11/09/2022] Open
Abstract
Background The use of rapid prototyping (RP) models in medicine to construct bony models is increasing. Material and Methods The aim of the study was to evaluate retrospectively the indication for the use of RP models in oral and maxillofacial surgery at Helsinki University Central Hospital during 2009-2010. Also, the used computed tomography (CT) examination – multislice CT (MSCT) or cone beam CT (CBCT) - method was evaluated. Results In total 114 RP models were fabricated for 102 patients. The mean age of the patients at the time of the production of the model was 50.4 years. The indications for the modelling included malignant lesions (29%), secondary reconstruction (25%), prosthodontic treatment (22%), orthognathic surgery or asymmetry (13%), benign lesions (8%), and TMJ disorders (4%). MSCT examination was used in 92 and CBCT examination in 22 cases. Most of the models (75%) were conventional hard tissue models. Models with colored tumour or other structure(s) of interest were ordered in 24%. Two out of the 114 models were soft tissue models. Conclusions The main benefit of the models was in treatment planning and in connection with the production of pre-bent plates or custom made implants. The RP models both facilitate and improve treatment planning and intraoperative efficiency. Key words:Rapid prototyping, radiology, computed tomography, cone beam computed tomography.
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Affiliation(s)
- Anni Suomalainen
- Department of Radiology, University of Helsinki and HUS Radiology (Medical Imaging Center)
| | - Patricia Stoor
- Department of Maxillofacial Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Karri Mesimäki
- Department of Maxillofacial Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Risto K Kontio
- Department of Maxillofacial Surgery, Helsinki University Hospital, Helsinki, Finland
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Gibbs DMR, Vaezi M, Yang S, Oreffo ROC. Hope versus hype: what can additive manufacturing realistically offer trauma and orthopedic surgery? Regen Med 2015; 9:535-49. [PMID: 25159068 DOI: 10.2217/rme.14.20] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Additive manufacturing (AM) is a broad term encompassing 3D printing and several other varieties of material processing, which involve computer-directed layer-by-layer synthesis of materials. As the popularity of AM increases, so to do expectations of the medical therapies this process may offer. Clinical requirements and limitations of current treatment strategies in bone grafting, spinal arthrodesis, osteochondral injury and treatment of periprosthetic joint infection are discussed. The various approaches to AM are described, and the current state of clinical translation of AM across these orthopedic clinical scenarios is assessed. Finally, we attempt to distinguish between what AM may offer orthopedic surgery from the hype of what has been promised by AM.
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Affiliation(s)
- David M R Gibbs
- Bone & Joint Research Group, Centre for Human Development, Stem Cells & Regeneration, Institute of Developmental Sciences (MP887), Southampton General Hospital, University of Southampton, Southampton, Hampshire S016 6YD, UK
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Huo J, Dérand P, Rännar LE, Hirsch JM, Gamstedt EK. Failure location prediction by finite element analysis for an additive manufactured mandible implant. Med Eng Phys 2015; 37:862-9. [DOI: 10.1016/j.medengphy.2015.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 05/13/2015] [Accepted: 06/09/2015] [Indexed: 11/24/2022]
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