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Chae MP, Chung RD, Smith JA, Hunter-Smith DJ, Rozen WM. The accuracy of clinical 3D printing in reconstructive surgery: literature review and in vivo validation study. Gland Surg 2021; 10:2293-2303. [PMID: 34422600 PMCID: PMC8340329 DOI: 10.21037/gs-21-264] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/23/2021] [Indexed: 01/17/2023]
Abstract
A growing number of studies demonstrate the benefits of 3D printing in improving surgical efficiency and subsequently clinical outcomes. However, the number of studies evaluating the accuracy of 3D printing techniques remains scarce. All publications appraising the accuracy of 3D printing between 1950 and 2018 were reviewed using well-established databases, including PubMed, Medline, Web of Science and Embase. An in vivo validation study of our 3D printing technique was undertaken using unprocessed chicken radius bones (Gallus gallus domesticus). Calculating its maximum length, we compared the measurements from computed tomography (CT) scans (CT group), image segmentation (SEG group) and 3D-printed (3DP) models (3DP group). Twenty-eight comparison studies in 19 papers have been identified. Published mean error of CT-based 3D printing techniques were 0.46 mm (1.06%) in stereolithography, 1.05 mm (1.78%) in binder jet technology, 0.72 mm (0.82%) in PolyJet technique, 0.20 mm (0.95%) in fused filament fabrication (FFF) and 0.72 mm (1.25%) in selective laser sintering (SLS). In the current in vivo validation study, mean errors were 0.34 mm (0.86%) in CT group, 1.02 mm (2.51%) in SEG group and 1.16 mm (2.84%) in 3DP group. Our Peninsula 3D printing technique using a FFF 3D printer thus produced accuracy similar to the published studies (1.16 mm, 2.84%). There was a statistically significant difference (P<10-4) between the CT group and the latter SEG and 3DP groups indicating that most of the error is introduced during image segmentation stage.
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Affiliation(s)
- Michael P. Chae
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, Victoria, Australia
- Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia
- Department of Surgery, School of Clinical Sciences at Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | - Ru Dee Chung
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, Victoria, Australia
- Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia
- Department of Surgery, School of Clinical Sciences at Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | - Julian A. Smith
- Department of Surgery, School of Clinical Sciences at Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | - David J. Hunter-Smith
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, Victoria, Australia
- Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia
- Department of Surgery, School of Clinical Sciences at Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | - Warren Matthew Rozen
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, Victoria, Australia
- Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia
- Department of Surgery, School of Clinical Sciences at Monash University, Monash Medical Centre, Clayton, Victoria, Australia
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Accuracy Assessment of Molded, Patient-Specific Polymethylmethacrylate Craniofacial Implants Compared to Their 3D Printed Originals. J Clin Med 2020; 9:jcm9030832. [PMID: 32204321 PMCID: PMC7141183 DOI: 10.3390/jcm9030832] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/30/2020] [Accepted: 03/14/2020] [Indexed: 12/17/2022] Open
Abstract
The use of patient-specific implants (PSIs) in craniofacial surgery is often limited due to a lack of expertise and/or production costs. Therefore, a simple and cost-efficient template-based fabrication workflow has been developed to overcome these disadvantages. The aim of this study is to assess the accuracy of PSIs made from their original templates. For a representative cranial defect (CRD) and a temporo-orbital defect (TOD), ten PSIs were made from polymethylmethacrylate (PMMA) using computer-aided design (CAD) and three-dimensional (3D) printing technology. These customized implants were measured and compared with their original 3D printed templates. The implants for the CRD revealed a root mean square (RMS) value ranging from 1.128 to 0.469 mm with a median RMS (Q1 to Q3) of 0.574 (0.528 to 0.701) mm. Those for the TOD revealed an RMS value ranging from 1.079 to 0.630 mm with a median RMS (Q1 to Q3) of 0.843 (0.635 to 0.943) mm. This study demonstrates that a highly precise duplication of PSIs can be achieved using this template-molding workflow. Thus, virtually planned implants can be accurately transferred into haptic PSIs. This workflow appears to offer a sophisticated solution for craniofacial reconstruction and continues to prove itself in daily clinical practice.
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Msallem B, Sharma N, Cao S, Halbeisen FS, Zeilhofer HF, Thieringer FM. Evaluation of the Dimensional Accuracy of 3D-Printed Anatomical Mandibular Models Using FFF, SLA, SLS, MJ, and BJ Printing Technology. J Clin Med 2020; 9:jcm9030817. [PMID: 32192099 PMCID: PMC7141211 DOI: 10.3390/jcm9030817] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/14/2020] [Accepted: 03/16/2020] [Indexed: 11/19/2022] Open
Abstract
With the rapid progression of additive manufacturing and the emergence of new 3D printing technologies, accuracy assessment is mostly being performed on isosymmetric-shaped test bodies. However, the accuracy of anatomic models can vary. The dimensional accuracy of root mean square values in terms of trueness and precision of 50 mandibular replicas, printed with five common printing technologies, were evaluated. The highest trueness was found for the selective laser sintering printer (0.11 ± 0.016 mm), followed by a binder jetting printer (0.14 ± 0.02 mm), and a fused filament fabrication printer (0.16 ± 0.009 mm). However, highest precision was identified for the fused filament fabrication printer (0.05 ± 0.005 mm) whereas other printers had marginally lower values. Despite the statistically significance (p < 0.001), these differences can be considered clinically insignificant. These findings demonstrate that all 3D printing technologies create models with satisfactory dimensional accuracy for surgical use. Since satisfactory results in terms of accuracy can be reached with most technologies, the choice should be more strongly based on the printing materials, the intended use, and the overall budget. The simplest printing technology (fused filament fabrication) always scored high and thus is a reliable choice for most purposes.
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Affiliation(s)
- Bilal Msallem
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (N.S.); (S.C.); (H.-F.Z.); (F.M.T.)
- Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland
- Correspondence:
| | - Neha Sharma
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (N.S.); (S.C.); (H.-F.Z.); (F.M.T.)
- Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland
| | - Shuaishuai Cao
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (N.S.); (S.C.); (H.-F.Z.); (F.M.T.)
- Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland
| | - Florian S. Halbeisen
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland;
| | - Hans-Florian Zeilhofer
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (N.S.); (S.C.); (H.-F.Z.); (F.M.T.)
| | - Florian M. Thieringer
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (N.S.); (S.C.); (H.-F.Z.); (F.M.T.)
- Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland
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Uldin T. Virtual anthropology - a brief review of the literature and history of computed tomography. Forensic Sci Res 2017; 2:165-173. [PMID: 30483637 PMCID: PMC6197098 DOI: 10.1080/20961790.2017.1369621] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 08/16/2017] [Indexed: 11/21/2022] Open
Abstract
Computed tomography (CT) has influenced numerous fields since its inception in the 1970s. The field of palaeoanthropology significantly benefited from this efficient and non-invasive medium in terms of the conservation, reconstruction and analysis of fossil human remains. Over the past decade, there has been a steady increase in the number of forensic anthropological studies incorporating virtual osteological analyses. Because of the increasing importance of these modern cross-sectional imaging techniques and the requirement for standardized parameters in forensic science, we deemed it important to outline the history and development of CT applications in these related academic areas. The present paper outlines the history of “virtual anthropology” and osteological multi-detector CT in the context of palaeoanthropology and forensic anthropology.
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Affiliation(s)
- Tanya Uldin
- Department of Medicine and Community Health, University Center of Legal Medicine Lausanne-Geneva, University Hospital of Lausanne, Lausanne, Switzerland
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George E, Liacouras P, Rybicki FJ, Mitsouras D. Measuring and Establishing the Accuracy and Reproducibility of 3D Printed Medical Models. Radiographics 2017; 37:1424-1450. [PMID: 28800287 PMCID: PMC5621728 DOI: 10.1148/rg.2017160165] [Citation(s) in RCA: 141] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 09/25/2016] [Accepted: 12/21/2016] [Indexed: 12/20/2022]
Abstract
Despite the rapid growth of three-dimensional (3D) printing applications in medicine, the accuracy and reproducibility of 3D printed medical models have not been thoroughly investigated. Although current technologies enable 3D models to be created with accuracy within the limits of clinical imaging spatial resolutions, this is not always achieved in practice. Inaccuracies are due to errors that occur during the imaging, segmentation, postprocessing, and 3D printing steps. Radiologists' understanding of the factors that influence 3D printed model accuracy and the metrics used to measure this accuracy is key in directing appropriate practices and establishing reference standards and validation procedures. The authors review the various factors in each step of the 3D model printing process that contribute to model inaccuracy, including the intrinsic limitations of each printing technology. In addition, common sources of model inaccuracy are illustrated. Metrics involving comparisons of model dimensions and morphology that have been developed to quantify differences between 3D models also are described and illustrated. These metrics can be used to define the accuracy of a model, as compared with the reference standard, and to measure the variability of models created by different observers or using different workflows. The accuracies reported for specific indications of 3D printing are summarized, and potential guidelines for quality assurance and workflow assessment are discussed. Online supplemental material is available for this article. ©RSNA, 2017.
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Affiliation(s)
- Elizabeth George
- From the Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115 (E.G., D.M.); 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L.); and Department of Radiology, University of Ottawa Faculty of Medicine and The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (F.J.R.)
| | - Peter Liacouras
- From the Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115 (E.G., D.M.); 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L.); and Department of Radiology, University of Ottawa Faculty of Medicine and The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (F.J.R.)
| | - Frank J. Rybicki
- From the Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115 (E.G., D.M.); 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L.); and Department of Radiology, University of Ottawa Faculty of Medicine and The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (F.J.R.)
| | - Dimitrios Mitsouras
- From the Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115 (E.G., D.M.); 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (P.L.); and Department of Radiology, University of Ottawa Faculty of Medicine and The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (F.J.R.)
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Bortolotto C, Eshja E, Peroni C, Orlandi MA, Bizzotto N, Poggi P. 3D Printing of CT Dataset: Validation of an Open Source and Consumer-Available Workflow. J Digit Imaging 2017; 29:14-21. [PMID: 26175139 DOI: 10.1007/s10278-015-9810-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The broad availability of cheap three-dimensional (3D) printing equipment has raised the need for a thorough analysis on its effects on clinical accuracy. Our aim is to determine whether the accuracy of 3D printing process is affected by the use of a low-budget workflow based on open source software and consumer's commercially available 3D printers. A group of test objects was scanned with a 64-slice computed tomography (CT) in order to build their 3D copies. CT datasets were elaborated using a software chain based on three free and open source software. Objects were printed out with a commercially available 3D printer. Both the 3D copies and the test objects were measured using a digital professional caliper. Overall, the objects' mean absolute difference between test objects and 3D copies is 0.23 mm and the mean relative difference amounts to 0.55 %. Our results demonstrate that the accuracy of 3D printing process remains high despite the use of a low-budget workflow.
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Affiliation(s)
- Chandra Bortolotto
- Radiology Department, Ospedale Maggiore di Lodi, Piazzale Donatori di Sangue, Lodi, Italy.
| | - Esmeralda Eshja
- Radiology Department, Ospedale Maggiore di Lodi, Piazzale Donatori di Sangue, Lodi, Italy
| | - Caterina Peroni
- Radiology Department, Ospedale Maggiore di Lodi, Piazzale Donatori di Sangue, Lodi, Italy
| | - Matteo A Orlandi
- Radiology Department, Ospedale Maggiore di Lodi, Piazzale Donatori di Sangue, Lodi, Italy
| | - Nicola Bizzotto
- Azienda Ospedaliera Universitaria Polo Chirurgico Confortini, Verona, Italy
| | - Paolo Poggi
- Radiology Department, Ospedale Maggiore di Lodi, Piazzale Donatori di Sangue, Lodi, Italy
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The production of digital and printed resources from multiple modalities using visualization and three-dimensional printing techniques. Int J Comput Assist Radiol Surg 2016; 12:13-23. [PMID: 27480284 DOI: 10.1007/s11548-016-1461-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/19/2016] [Indexed: 01/17/2023]
Abstract
PURPOSE Virtual digital resources and printed models have become indispensable tools for medical training and surgical planning. Nevertheless, printed models of soft tissue organs are still challenging to reproduce. This study adopts open source packages and a low-cost desktop 3D printer to convert multiple modalities of medical images to digital resources (volume rendering images and digital models) and lifelike printed models, which are useful to enhance our understanding of the geometric structure and complex spatial nature of anatomical organs. MATERIALS AND METHODS Neuroimaging technologies such as CT, CTA, MRI, and TOF-MRA collect serial medical images. The procedures for producing digital resources can be divided into volume rendering and medical image reconstruction. To verify the accuracy of reconstruction, this study presents qualitative and quantitative assessments. Subsequently, digital models are archived as stereolithography format files and imported to the bundled software of the 3D printer. The printed models are produced using polylactide filament materials. RESULTS We have successfully converted multiple modalities of medical images to digital resources and printed models for both hard organs (cranial base and tooth) and soft tissue organs (brain, blood vessels of the brain, the heart chambers and vessel lumen, and pituitary tumor). Multiple digital resources and printed models were provided to illustrate the anatomical relationship between organs and complicated surrounding structures. Three-dimensional printing (3DP) is a powerful tool to produce lifelike and tangible models. CONCLUSIONS We present an available and cost-effective method for producing both digital resources and printed models. The choice of modality in medical images and the processing approach is important when reproducing soft tissue organs models. The accuracy of the printed model is determined by the quality of organ models and 3DP. With the ongoing improvement of printing techniques and the variety of materials available, 3DP will become an indispensable tool in medical training and surgical planning.
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Evaluating Preoperative Models: A Methodologic Contribution. World Neurosurg 2016; 89:681-5. [DOI: 10.1016/j.wneu.2015.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/07/2015] [Accepted: 12/07/2015] [Indexed: 11/19/2022]
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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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Naftulin JS, Kimchi EY, Cash SS. Streamlined, Inexpensive 3D Printing of the Brain and Skull. PLoS One 2015; 10:e0136198. [PMID: 26295459 PMCID: PMC4546422 DOI: 10.1371/journal.pone.0136198] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/31/2015] [Indexed: 12/12/2022] Open
Abstract
Neuroimaging technologies such as Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) collect three-dimensional data (3D) that is typically viewed on two-dimensional (2D) screens. Actual 3D models, however, allow interaction with real objects such as implantable electrode grids, potentially improving patient specific neurosurgical planning and personalized clinical education. Desktop 3D printers can now produce relatively inexpensive, good quality prints. We describe our process for reliably generating life-sized 3D brain prints from MRIs and 3D skull prints from CTs. We have integrated a standardized, primarily open-source process for 3D printing brains and skulls. We describe how to convert clinical neuroimaging Digital Imaging and Communications in Medicine (DICOM) images to stereolithography (STL) files, a common 3D object file format that can be sent to 3D printing services. We additionally share how to convert these STL files to machine instruction gcode files, for reliable in-house printing on desktop, open-source 3D printers. We have successfully printed over 19 patient brain hemispheres from 7 patients on two different open-source desktop 3D printers. Each brain hemisphere costs approximately $3–4 in consumable plastic filament as described, and the total process takes 14–17 hours, almost all of which is unsupervised (preprocessing = 4–6 hr; printing = 9–11 hr, post-processing = <30 min). Printing a matching portion of a skull costs $1–5 in consumable plastic filament and takes less than 14 hr, in total. We have developed a streamlined, cost-effective process for 3D printing brain and skull models. We surveyed healthcare providers and patients who confirmed that rapid-prototype patient specific 3D models may help interdisciplinary surgical planning and patient education. The methods we describe can be applied for other clinical, research, and educational purposes.
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Affiliation(s)
- Jason S. Naftulin
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Eyal Y. Kimchi
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Sydney S. Cash
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
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Anderson PJ, Yong R, Surman TL, Rajion ZA, Ranjitkar S. Application of three-dimensional computed tomography in craniofacial clinical practice and research. Aust Dent J 2014; 59 Suppl 1:174-85. [DOI: 10.1111/adj.12154] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- PJ Anderson
- Australian Craniofacial Unit; Women's and Children's Hospital; North Adelaide South Australia Australia
- School of Dentistry; The University of Adelaide; South Australia Australia
- School of Dental Sciences, Health Campus; Universiti Sains Malaysia; Kota Bharu Kelantan Malaysia
| | - R Yong
- School of Dentistry; The University of Adelaide; South Australia Australia
| | - TL Surman
- Australian Craniofacial Unit; Women's and Children's Hospital; North Adelaide South Australia Australia
- School of Dentistry; The University of Adelaide; South Australia Australia
| | - ZA Rajion
- School of Dental Sciences, Health Campus; Universiti Sains Malaysia; Kota Bharu Kelantan Malaysia
| | - S Ranjitkar
- School of Dentistry; The University of Adelaide; South Australia Australia
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Fasel JHD, Beinemann J, Schaller K, Peitgen HO. Computer Science Tools for Manual Editing of Computed Tomographic Images: Impact on the Quality of 3D Printed Models. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ss.2014.510068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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A critical inventory of preoperative skull replicas. Br Dent J 2013. [DOI: 10.1038/sj.bdj.2013.1168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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