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Oley MH, Oley MC, Sukarno V, Faruk M. Advances in Three-Dimensional Printing for Craniomaxillofacial Trauma Reconstruction: A Systematic Review. J Craniofac Surg 2024; 35:1926-1933. [PMID: 38958985 DOI: 10.1097/scs.0000000000010451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/01/2024] [Indexed: 07/04/2024] Open
Abstract
Craniomaxillofacial (CMF) fractures present significant challenges for plastic surgeons due to their intricate nature. Conventional methods such as autologous bone grafts have limitations, necessitating advancements in reconstructive surgery techniques. This study reviewed the use of three-dimensional printing for CMF trauma reconstruction using human studies. A systematic search of PubMed, EMBASE, and Google Scholar was conducted in February 2024 for case reports, case series, and clinical trials related to CMF trauma reconstruction using three-dimensional printing technology. The authors' systematic review included 20 studies and a total of 170 participants with CMF bone defects. In general, the authors observed low bias risk in analyzed case reports and series, serious bias risk in nonrandomized controlled trials, and moderate bias risk in randomized controlled trials. The printed objects included CMF structure model prototypes, patient-specific implants, and other custom surgical devices. Studies reveal successful outcomes, including restored facial symmetry and function, restored orbital occlusion, resolved enophthalmos and diplopia, achieved cosmetically symmetrical lower face reconstruction, and precise fitting of surgical devices, enhancing patient and surgeon comfort. However, complications such as local infection, implant exposure, and persistent diplopia were reported. Three-dimensional printed devices reduced surgery time but increased preparation time and production costs. In-house production options could mitigate these time and cost expenditures. Three-dimensional printing holds potential in CMF trauma reconstruction, addressing both functional and esthetic restoration. Nevertheless, challenges persist in implementing this advanced technology in resource-limited environments.
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Affiliation(s)
- Mendy Hatibie Oley
- Division of Plastic Reconstructive and Esthetic Surgery, Department of Surgery, Faculty of Medicine, Sam Ratulangi University
- Division of Plastic Reconstructive and Esthetic Surgery, Department of Surgery, Kandou Hospital
- Hyperbaric Centre Siloam Hospital
| | - Maximillian Christian Oley
- Hyperbaric Centre Siloam Hospital
- Division of Neurosurgery, Faculty of Medicine, Department of Surgery, Sam Ratulangi University
- Division of Neurosurgery, Department of Surgery, Kandou Hospital, Manado
| | | | - Muhammad Faruk
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
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Wakjira Y, Kurukkal NS, Lemu HG. Assessment of the accuracy of 3D printed medical models through reverse engineering. Heliyon 2024; 10:e31829. [PMID: 38845933 PMCID: PMC11153247 DOI: 10.1016/j.heliyon.2024.e31829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 05/12/2024] [Accepted: 05/22/2024] [Indexed: 06/09/2024] Open
Abstract
The dimensional accuracy of additively manufactured (3D printed) medical models can be affected by various parameters. Although different methods are used to evaluate the accuracy of additively manufactured models, this study focused on the investigation of the dimensional accuracy of the medical model based the combination of reverse engineering (RE) and additive manufacturing (AM) technologies. Human femur bone was constructed from CT images and manufactured, using Fortus 450mc Industrial material extrusion 3D Printer. The additive manufactured femur bone was subsequently 3D scanned using three distinct non-contact 3D scanners. MeshLab was used for mesh analysis, while VX Elements was used for post-processing of the point cloud. A combination of the VX Inspect environment and MeshLab was used to evaluate the scanning performance. The deviation of the 3D scanned 3D models from the reference mesh was determined using relative metrics and absolute measurements. The scanners reported deviations ranging from -0.375 mm to 0.388 mm, resulting in a total range of approximately 0.763 mm with average root mean square (RMS) deviation of 0.22 mm. The results indicate that the additively manufactured model, as measured by 3D scanning, has a mean deviation with an average range of approximately 0.46 mm and an average mean value of around 0.16 mm.
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Affiliation(s)
- Yosef Wakjira
- University of Stavanger, Faculty of Science and Technology, Department of Mechanical and Structural Engineering and Materials Science, Kjell Arholms Gate 41, 4021, Stavanger, Norway
| | - Navaneethan S. Kurukkal
- University of Stavanger, Faculty of Science and Technology, Department of Mechanical and Structural Engineering and Materials Science, Kjell Arholms Gate 41, 4021, Stavanger, Norway
| | - Hirpa G. Lemu
- University of Stavanger, Faculty of Science and Technology, Department of Mechanical and Structural Engineering and Materials Science, Kjell Arholms Gate 41, 4021, Stavanger, Norway
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Prajapati HP, Singh DK. A Single Standard Polyvinyl Chloride 3D Skull Model to Create the Polymethyl Methacrylate Cranioplasty Flap: A Novel and Low-Cost Technique. J Neurol Surg A Cent Eur Neurosurg 2024. [PMID: 38621709 DOI: 10.1055/s-0044-1785648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND Although, cranioplasty is a commonly performed neurosurgical procedure worldwide, the cost of available cranioplasty implants is a major issue in a low-income country like India. The aims of this study were to introduce a novel and low-cost technique using a single standard three-dimensional (3D) skull model to guide the polymethyl methacrylate (PMMA) cranioplasty flap production and to evaluate the functional and cosmetic outcomes. METHODS We retrospectively evaluated 47 cases of PMMA cranioplasty in the period from February 2019 to June 2022. A single standard 3D skull model was used to make the PMMA cranioplasty flaps. The overall cost of this PMMA implant was compared with that of other available cranioplasty implants. The functional and cosmetic outcomes were evaluated postoperatively. RESULTS The mean age of our patients was 37.17 ± 13.83 years and the age range was 17 to 63 years. The primary cause of surgery was trauma in the majority of cases (n = 31, 65.96%). The mean operative time was 78.55 ± 19.82 minutes. The cosmetic results were very satisfying in 46 of 47 (97.87%) patients and moderately satisfying in 1 (2.12%) patient. Overall, there were three (6.38%) complications. CONCLUSION Our technique provides excellent functional and cosmetic outcomes. The overall surgical cost of these PMMA implants was lower than that of the other available cranioplasty implants. This technique is currently the most cost-effective option for cranioplasty.
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Affiliation(s)
- Hanuman Prasad Prajapati
- Department of Neurosurgery, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India
| | - Deepak Kumar Singh
- Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Reconstructive Surgery. J Oral Maxillofac Surg 2023; 81:E263-E299. [PMID: 37833026 DOI: 10.1016/j.joms.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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Arias-Amezquita E, Alkureishi L, Purnell C, Zhao L, Lee O, Mathis SA, Patel PK, Cohen M. Virtual Reality Planning in Reconstructive Surgery for Orbital Prosthetic Rehabilitation Using ImmersiveTouch Platform: Preliminary Report. J Craniofac Surg 2023:00001665-990000000-01138. [PMID: 37889858 DOI: 10.1097/scs.0000000000009794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/01/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND/PURPOSE Virtual reality (VR) is emerging as an effective and intuitive surgical planning and 3D visualization tool. Digital surgical planning is the gold standard for planning the placement of implants in maxillofacial prosthetics, but the field lacks a platform exclusively designed to perform the task. Virtual reality planning (VRP) specific for maxillofacial prosthetics offers the clinician improved control of the presurgical planning and the potential to limit the need to adapt other advanced segmentation software. Furthermore, the virtual plan can be directly translated to the patient through custom 3D printed (3DP) surgical guides and visual aids. To the best of our knowledge, this article outlines the development of the world's first virtual reality planning platform and workflow for pre-operatory planning within a VR environment for clinical use specific to facial prosthetics and anaplastology. METHOD The workflow was applied to managing 2 patients presenting with unilateral total exenteration and severe contracture enucleation, respectively (n=2). A cone-beam CT was acquired for each patient, and their data set was directly imported into the ImmersiveView Surgical Plan VR environment (ImmersiveTouch Inc, Chicago, IL). The clinicians virtually selected appropriately sized craniofacial implants and placed the implants in the desired orientation. Various measurement tools are available to aid in clinical decision-making. The ideal location of craniofacial implants was set according to an orbital and auricular prosthetic reconstruction. The resultant VR plan was exported for 3DP. The patients were evaluated preoperatively and postoperatively using the proposed VRP treatment. The workflow's data accuracy was validated postoperatively by comparing posterative CT data and the proposed VRP. Analysis was performed using Mimics software (Materialise, Leuven, Belgium). RESULT It takes, on average, 10 minutes to place 4 implants in the virtual reality space. The 3DP files resulting from VRP take ~2 hours to print and are constructed with a biocompatible resin appropriate for clinical use as surgical guides. Our user-friendly VRP workflow allows for an accurate simulation of surgical and nonsurgical procedures with an average displacement in XYZ of 0.6 mm and an SD of 0.3 mm. In addition, VRP is an excellent tool to simulate the craniofacial placement procedure and improves unsupervised self-learning teaching. CONCLUSION VRP is an exciting tool for training clinicians and students in complex surgical procedures. This study shows the promising applicability and efficiency of VR in clinical planning and management of facial rehabilitation. Patients allowed to interact with VR have been engaged, which would aid their treatment acceptance and patient education. A valuable advantage of surgical simulation is the reduced costs associated with renting instruments, buying implant dummies, and surgical hardware. The authors will explore VR to plan and treat surgical and nonsurgical reconstructive procedures and improve soft tissue manipulation. This study outlines the development of an original platform and workflow for segmentation, preoperative planning, and digital design within a VR environment and the clinical use in reconstructive surgery and anaplastology.
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Affiliation(s)
- Eduardo Arias-Amezquita
- Department of Surgery, The Craniofacial Center, Division of Plastic, Cosmetic, and Reconstructive Surgery, The University of Illinois, Chicago, IL
| | - Lee Alkureishi
- Department of Surgery, The Craniofacial Center, Division of Plastic, Cosmetic, and Reconstructive Surgery, The University of Illinois, Chicago, IL
| | - Chad Purnell
- Department of Surgery, The Craniofacial Center, Division of Plastic, Cosmetic, and Reconstructive Surgery, The University of Illinois, Chicago, IL
| | - Linping Zhao
- Department of Surgery, The Craniofacial Center, Division of Plastic, Cosmetic, and Reconstructive Surgery, The University of Illinois, Chicago, IL
| | - Olivia Lee
- The University of Illinois College of Medicine, Chicago, IL
| | | | - Pravin K Patel
- Department of Surgery, The Craniofacial Center, Division of Plastic, Cosmetic, and Reconstructive Surgery, The University of Illinois, Chicago, IL
| | - Mimis Cohen
- Department of Surgery, The Craniofacial Center, Division of Plastic, Cosmetic, and Reconstructive Surgery, The University of Illinois, Chicago, IL
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Bečulić H, Spahić D, Begagić E, Pugonja R, Skomorac R, Jusić A, Selimović E, Mašović A, Pojskić M. Breaking Barriers in Cranioplasty: 3D Printing in Low and Middle-Income Settings-Insights from Zenica, Bosnia and Herzegovina. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1732. [PMID: 37893450 PMCID: PMC10608598 DOI: 10.3390/medicina59101732] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/16/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Cranial defects pose significant challenges in low and middle-income countries (LIMCs), necessitating innovative and cost-effective craniofacial reconstruction strategies. The purpose of this study was to present the Bosnia and Herzegovina model, showcasing the potential of a multidisciplinary team and 3D-based technologies, particularly PMMA implants, to address cranial defects in a resource-limited setting. Materials and Methods: An observational, non-experimental prospective investigation involved three cases of cranioplasty at the Department of Neurosurgery, Cantonal Hospital Zenica, Bosnia and Herzegovina, between 2019 and 2023. The technical process included 3D imaging and modeling with MIMICS software (version 10.01), 3D printing of the prototype, mold construction and intraoperative modification for precise implant fitting. Results: The Bosnia and Herzegovina model demonstrated successful outcomes in cranioplasty, with PMMA implants proving cost-effective and efficient in addressing cranial defects. Intraoperative modification contributed to reduced costs and potential complications, while the multidisciplinary approach and 3D-based technologies facilitated accurate reconstruction. Conclusions: The Bosnia and Herzegovina model showcases a cost-effective and efficient approach for craniofacial reconstruction in LIMICs. Collaborative efforts, 3D-based technologies, and PMMA implants contribute to successful outcomes. Further research is needed to validate sustained benefits and enhance craniofacial reconstruction strategies in resource-constrained settings.
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Affiliation(s)
- Hakija Bečulić
- Department of Neurosurgery, Cantonal Hospital Zenica, 72000 Zenica, Bosnia and Herzegovina
- Department of Anatomy, School of Medicine, University of Zenica, 72000 Zenica, Bosnia and Herzegovina; (R.S.); (A.M.)
| | - Denis Spahić
- Department of Constructions and CAD Technologies, School of Mechanical Engineering, University of Zenica, 72000 Zenica, Bosnia and Herzegovina;
- iDEAlab, School of Mechanical Engineering, University of Zenica, 72000 Zenica, Bosnia and Herzegovina
| | - Emir Begagić
- Deparment of General Medicine, School of Medicine, University of Zenica, 72000 Zenica, Bosnia and Herzegovina;
| | - Ragib Pugonja
- Deparment of General Medicine, School of Medicine, University of Zenica, 72000 Zenica, Bosnia and Herzegovina;
| | - Rasim Skomorac
- Department of Anatomy, School of Medicine, University of Zenica, 72000 Zenica, Bosnia and Herzegovina; (R.S.); (A.M.)
- Department of Surgery, School of Medicine, University of Zenica, 72000 Zenica, Bosnia and Herzegovina;
| | - Aldin Jusić
- Department of Anatomy, School of Medicine, University of Zenica, 72000 Zenica, Bosnia and Herzegovina; (R.S.); (A.M.)
| | - Edin Selimović
- Department of Surgery, School of Medicine, University of Zenica, 72000 Zenica, Bosnia and Herzegovina;
| | - Anes Mašović
- Department of Anatomy, School of Medicine, University of Zenica, 72000 Zenica, Bosnia and Herzegovina; (R.S.); (A.M.)
| | - Mirza Pojskić
- Department of Neurosurgery, University Hospital Marburg, Baldinger Str., 35033 Marburg, Germany
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Mohd N, Razali M, Fauzi MB, Abu Kasim NH. In Vitro and In Vivo Biological Assessments of 3D-Bioprinted Scaffolds for Dental Applications. Int J Mol Sci 2023; 24:12881. [PMID: 37629064 PMCID: PMC10454183 DOI: 10.3390/ijms241612881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Three-dimensional (3D) bioprinting is a unique combination of technological advances in 3D printing and tissue engineering. It has emerged as a promising approach to address the dilemma in current dental treatments faced by clinicians in order to repair or replace injured and diseased tissues. The exploration of 3D bioprinting technology provides high reproducibility and precise control of the bioink containing the desired cells and biomaterial over the architectural and dimensional features of the scaffolds in fabricating functional tissue constructs that are specific to the patient treatment need. In recent years, the dental applications of different 3D bioprinting techniques, types of novel bioinks, and the types of cells used have been extensively explored. Most of the findings noted significant challenges compared to the non-biological 3D printing approach in constructing the bioscaffolds that mimic native tissues. Hence, this review focuses solely on the implementation of 3D bioprinting techniques and strategies based on cell-laden bioinks. It discusses the in vitro applications of 3D-bioprinted scaffolds on cell viabilities, cell functionalities, differentiation ability, and expression of the markers as well as the in vivo evaluations of the implanted bioscaffolds on the animal models for bone, periodontal, dentin, and pulp tissue regeneration. Finally, it outlines some perspectives for future developments in dental applications.
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Affiliation(s)
- Nurulhuda Mohd
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia;
| | - Masfueh Razali
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia;
| | - Mh Busra Fauzi
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia;
| | - Noor Hayaty Abu Kasim
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia
- Dean Office, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
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Gu L, Huang R, Ni N, Gu P, Fan X. Advances and Prospects in Materials for Craniofacial Bone Reconstruction. ACS Biomater Sci Eng 2023; 9:4462-4496. [PMID: 37470754 DOI: 10.1021/acsbiomaterials.3c00399] [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] [Indexed: 07/21/2023]
Abstract
The craniofacial region is composed of 23 bones, which provide crucial function in keeping the normal position of brain and eyeballs, aesthetics of the craniofacial complex, facial movements, and visual function. Given the complex geometry and architecture, craniofacial bone defects not only affect the normal craniofacial structure but also may result in severe craniofacial dysfunction. Therefore, the exploration of rapid, precise, and effective reconstruction of craniofacial bone defects is urgent. Recently, developments in advanced bone tissue engineering bring new hope for the ideal reconstruction of the craniofacial bone defects. This report, presenting a first-time comprehensive review of recent advances of biomaterials in craniofacial bone tissue engineering, overviews the modification of traditional biomaterials and development of advanced biomaterials applying to craniofacial reconstruction. Challenges and perspectives of biomaterial development in craniofacial fields are discussed in the end.
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Affiliation(s)
- Li Gu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Rui Huang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Ni Ni
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Ping Gu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Xianqun Fan
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
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Joshi S, Salema HJ, Pawar S, Nair VS, Koranne V, Sane VD. Patient-Specific Implants in Maxillofacial Reconstruction - A Case Report. Ann Maxillofac Surg 2023; 13:258-261. [PMID: 38405555 PMCID: PMC10883205 DOI: 10.4103/ams.ams_126_23] [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: 07/13/2023] [Revised: 10/28/2023] [Accepted: 11/29/2023] [Indexed: 02/27/2024] Open
Abstract
Rationale The successful utilisation of three dimensional (3D) techniques in engineering a titanium patient specific implant (PSI) for a patient who underwent hemimaxillectomy following post COVID mucormycosis infection. Patient Concerns Issues related to problems associated with resection following mucormycosis, such as occlusal function, aesthetics and facial asymmetry. Diagnosis The patient affected by mucormycosis was left with Aramany class 1 and Cordeiro type II sub total maxillectomy defect. Treatment The patient was operated for mucormycosis followed by reconstruction with patient specific implant. Outcome Positive clinical outcomes, including improved facial symmetry, function and psychological well being with immediate replacement of the teeth, the benefits of which far outweigh the traditional approach. Take away Lessons The advances in the use of PSI by integration of 3D printing and computer aided design computer aided manufacturing (CAD-CAM) technology for extensive and challenging defects in the maxillofacial region have been highlighted in this case report.
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Affiliation(s)
- Samir Joshi
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth (Deemed To Be) Dental College and Hospital, Pune, Maharashtra, India
| | - Hamza Javed Salema
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth (Deemed To Be) Dental College and Hospital, Pune, Maharashtra, India
| | - Sudhir Pawar
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth (Deemed To Be) Dental College and Hospital, Pune, Maharashtra, India
| | - Vivek Sunil Nair
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth (Deemed To Be) Dental College and Hospital, Pune, Maharashtra, India
| | - Vaishali Koranne
- Department of Oral Medicine and Radiology, Bharati Vidyapeeth (Deemed To Be) Dental College and Hospital, Pune, Maharashtra, India
| | - Vikrant Dilip Sane
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth (Deemed To Be) Dental College and Hospital, Pune, Maharashtra, India
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Vidakis N, Petousis M, Mountakis N, Moutsopoulou A, Karapidakis E. Energy Consumption vs. Tensile Strength of Poly[methyl methacrylate] in Material Extrusion 3D Printing: The Impact of Six Control Settings. Polymers (Basel) 2023; 15:845. [PMID: 36850131 PMCID: PMC9966017 DOI: 10.3390/polym15040845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
The energy efficiency of material extrusion additive manufacturing has a significant impact on the economics and environmental footprint of the process. Control parameters that ensure 3D-printed functional products of premium quality and mechanical strength are an established market-driven requirement. To accomplish multiple objectives is challenging, especially for multi-purpose industrial polymers, such as the Poly[methyl methacrylate]. The current paper explores the contribution of six generic control factors (infill density, raster deposition angle, nozzle temperature, print speed, layer thickness, and bed temperature) to the energy performance of Poly[methyl methacrylate] over its mechanical performance. A five-level L25 Taguchi orthogonal array was composed, with five replicas, involving 135 experiments. The 3D printing time and the electrical consumption were documented with the stopwatch approach. The tensile strength, modulus, and toughness were experimentally obtained. The raster deposition angle and the printing speed were the first and second most influential control parameters on tensile strength. Layer thickness and printing speed were the corresponding ones for the energy consumption. Quadratic regression model equations for each response metric over the six control parameters were compiled and validated. Thus, the best compromise between energy efficiency and mechanical strength is achievable, and a tool creates significant value for engineering applications.
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Affiliation(s)
- Nectarios Vidakis
- Department of Mechanical Engineering, Hellenic Mediterranean University, 71410 Heraklion, Greece
| | - Markos Petousis
- Department of Mechanical Engineering, Hellenic Mediterranean University, 71410 Heraklion, Greece
| | - Nikolaos Mountakis
- Department of Mechanical Engineering, Hellenic Mediterranean University, 71410 Heraklion, Greece
| | - Amalia Moutsopoulou
- Department of Mechanical Engineering, Hellenic Mediterranean University, 71410 Heraklion, Greece
| | - Emmanuel Karapidakis
- Electrical and Computer Engineering Department, Hellenic Mediterranean University, 71410 Heraklion, Greece
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Bodansky DMS, Sandow MJ, Volk I, Luria S, Verstreken F, Horwitz MD. Insights and trends review: the role of three-dimensional technology in upper extremity surgery. J Hand Surg Eur Vol 2023; 48:383-395. [PMID: 36748271 DOI: 10.1177/17531934221150498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The use of three-dimensional (3-D) technology in upper extremity surgery has the potential to revolutionize the way that hand and upper limb procedures are planned and performed. 3-D technology can assist in the diagnosis and treatment of conditions, allowing virtual preoperative planning and surgical templating. 3-D printing can allow the production of patient-specific jigs, instruments and implants, allowing surgeons to plan and perform complex procedures with greater precision and accuracy. Previously, cost has been a barrier to the use of 3-D technology, which is now falling rapidly. This review article will discuss the current status of 3-D technology and printing, including its applications, ethics and challenges in hand and upper limb surgery. We have provided case examples to outline how clinicians can incorporate 3-D technology in their clinical practice for congenital deformities, management of acute fracture and malunion and arthroplasty.
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Affiliation(s)
- David M S Bodansky
- Department of Plastic Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK
| | | | - Ido Volk
- Hadassah Medical Organisation, Jerusalem, Israel
| | - Shai Luria
- Hadassah Medical Organisation, Jerusalem, Israel
| | | | - Maxim D Horwitz
- Department of Plastic Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK
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12
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Ostaș D, Almășan O, Ileșan RR, Andrei V, Thieringer FM, Hedeșiu M, Rotar H. Point-of-Care Virtual Surgical Planning and 3D Printing in Oral and Cranio-Maxillofacial Surgery: A Narrative Review. J Clin Med 2022; 11:jcm11226625. [PMID: 36431101 PMCID: PMC9692897 DOI: 10.3390/jcm11226625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/04/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022] Open
Abstract
This paper provides an overview on the use of virtual surgical planning (VSP) and point-of-care 3D printing (POC 3DP) in oral and cranio-maxillofacial (CMF) surgery based on a literature review. The authors searched PubMed, Web of Science, and Embase to find papers published between January 2015 and February 2022 in English, which describe human applications of POC 3DP in CMF surgery, resulting in 63 articles being included. The main review findings were as follows: most used clinical applications were anatomical models and cutting guides; production took place in-house or as "in-house-outsourced" workflows; the surgeon alone was involved in POC 3DP in 36 papers; the use of free versus paid planning software was balanced (50.72% vs. 49.27%); average planning time was 4.44 h; overall operating time decreased and outcomes were favorable, though evidence-based studies were limited; and finally, the heterogenous cost reports made a comprehensive financial analysis difficult. Overall, the development of in-house 3D printed devices supports CMF surgery, and encouraging results indicate that the technology has matured considerably.
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Affiliation(s)
- Daniel Ostaș
- Department of Oral and Cranio-Maxillofacial Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, 33 Moților Street, 400001 Cluj-Napoca, Romania
| | - Oana Almășan
- Department of Prosthetic Dentistry and Dental Materials, “Iuliu Hațieganu” University of Medicine and Pharmacy, 32 Clinicilor Street, 400006 Cluj-Napoca, Romania
| | - Robert R. Ileșan
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 21 Spitalstrasse, 4031 Basel, Switzerland
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, 16 Gewerbestrasse, 4123 Allschwil, Switzerland
- Correspondence:
| | - Vlad Andrei
- Department of Oral Rehabilitation, Faculty of Dentistry, “Iuliu Hațieganu” University of Medicine and Pharmacy, 15 Victor Babes Street, 400012 Cluj-Napoca, Romania
| | - Florian M. Thieringer
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 21 Spitalstrasse, 4031 Basel, Switzerland
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, 16 Gewerbestrasse, 4123 Allschwil, Switzerland
| | - Mihaela Hedeșiu
- Department of Maxillofacial Surgery and Implantology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 37 Cardinal Iuliu Hossu, 400029 Cluj-Napoca, Romania
| | - Horațiu Rotar
- Department of Oral and Cranio-Maxillofacial Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, 33 Moților Street, 400001 Cluj-Napoca, Romania
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Moncayo-Matute FP, Peña-Tapia PG, Vázquez-Silva E, Torres-Jara PB, Abad-Farfán G, Moya-Loaiza DP, Andrade-Galarza AF. Description and application of a comprehensive methodology for custom implant design and surgical planning. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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14
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Ji T, Yao P, Zeng Y, Qian Z, Wang K, Gao L. Subgaleal Effusion and Brain Midline Shift After Cranioplasty: A Retrospective Study Between Polyetheretherketone Cranioplasty and Titanium Cranioplasty After Decompressive Craniectomy. Front Surg 2022; 9:923987. [PMID: 35937601 PMCID: PMC9351718 DOI: 10.3389/fsurg.2022.923987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/10/2022] [Indexed: 11/21/2022] Open
Abstract
Cranioplasty with polyetheretherketone (PEEK) has recently shown better cerebral protection performance, improved brain function, and aesthetic contour compared with titanium mesh. However, whether patients undergoing PEEK cranioplasty tend to develop subgaleal effusions remains elusive. This retrospective study included patients who underwent cranioplasty with PEEK implants or titanium mesh after decompressive craniectomy between July 2017 and July 2020. Patient information, including general information, location, size of the defect, subgaleal depth, and brain midline shift was collected and statistically analyzed. There were 130 cases of cranioplasty, including 35 with PEEK implants and 95 with a titanium mesh. Patients who underwent cranioplasty with a PEEK implant had a higher subgaleal effusion rate than those who underwent cranioplasty with titanium mesh (85.71% vs. 53.68%, P < 0.001), while a midline shift >5 mm was more frequently observed in the PEEK group than in the titanium group (20% vs. 6.3%, P = 0.021). The PEEK material was the only factor associated with subgaleal effusion after cranioplasty (OR 5.589, P = 0.002). Logistic regression analysis further showed that age was a protective factor against midline shift in the PEEK cranioplasty group (OR 0.837, P = 0.029). Patients who underwent cranioplasty with PEEK implants were more likely to develop severe subgaleal effusion and significant brain midline shifts than those with titanium mesh implants.
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Affiliation(s)
- Tao Ji
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Peiwen Yao
- School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Yu Zeng
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Zhouqi Qian
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Ke Wang
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
- Correspondence: Liang Gao Ke Wang
| | - Liang Gao
- School of Clinical Medicine, Nanjing Medical University, Nanjing, China
- Correspondence: Liang Gao Ke Wang
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15
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Splavski B, Lakicevic G, Kovacevic M, Godec D. Customized alloplastic cranioplasty of large bone defects by 3D-printed prefabricated mold template after posttraumatic decompressive craniectomy: A technical note. Surg Neurol Int 2022; 13:169. [PMID: 35509538 PMCID: PMC9062916 DOI: 10.25259/sni_1239_2021] [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: 12/14/2021] [Accepted: 03/16/2022] [Indexed: 11/09/2022] Open
Abstract
Background Manufacturing of customized three-dimensional (3D)-printed cranioplastic implant after decompressive craniectomy has been introduced to overcome the difficulties of intraoperative implant molding. The authors present and discuss the technique, which consists of the prefabrication of silicone implant mold using additive manufacturing, also known as 3D printing, and polymethyl methacrylate (PMMA) implant casting. Methods To reconstruct a large bone defect sustained after decompressive craniectomy due to traumatic brain injury (TBI), a 3D-printed prefabricated mold template was used to create a customized PMMA implant for cranial vault repair in five consecutive patients. Results A superb restoration of the symmetrical contours and curvature of the cranium was achieved in all patients. The outcome was clinically and cosmetically favorable in all of them. Conclusion Customized alloplastic cranioplasty using 3D-printed prefabricated mold for casting PMMA implant is easy to perform technique for the restoration of cranial vault after a decompressive craniectomy following moderate-to-severe TBI. It is a valuable and modern technique to advance manufacturing of personalized prefabricated cranioplastic implants used for the reconstruction of large skull defects having complex geometry. It is a safe and cost-effective procedure having an excellent cosmetic outcome, which may considerably decrease expenses and time needed for cranial reconstructive surgery.
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Affiliation(s)
- Bruno Splavski
- Department of Neurosurgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Goran Lakicevic
- Department of Neurosurgery, Mostar University Hospital, Mostar, Bosnia and Herzegovina, Osijek, Croatia
| | - Marko Kovacevic
- Department of Neurosurgery, Osijek University Hospital Center, Osijek, Croatia
| | - Damir Godec
- Department of Technology, Chair of Polymer Processing, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia
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Msallem B, Maintz M, Halbeisen FS, Meyer S, Sigron GR, Sharma N, Cao S, Thieringer FM. Biomechanical Evaluation of Patient-Specific Polymethylmethacrylate Cranial Implants for Virtual Surgical Planning: An In-Vitro Study. MATERIALS 2022; 15:ma15051970. [PMID: 35269201 PMCID: PMC8911603 DOI: 10.3390/ma15051970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/19/2022] [Accepted: 03/01/2022] [Indexed: 02/06/2023]
Abstract
Cranioplasty with freehand-molded polymethylmethacrylate implants is based on decades of experience and is still frequently used in clinical practice. However, data confirming the fracture toughness and standard biomechanical tests are rare. This study aimed to determine the amount of force that could be applied to virtually planned, template-molded, patient-specific implants (n = 10) with an implant thickness of 3 mm, used in the treatment of a temporoparietal skull defect (91.87 cm2), until the implant cracks and finally breaks. Furthermore, the influence of the weight and porosity of the implant on its force resistance was investigated. The primary outcome showed that a high force was required to break the implant (mean and standard deviation 1484.6 ± 167.7 N), and this was very strongly correlated with implant weight (Pearson’s correlation coefficient 0.97; p < 0.001). Secondary outcomes were force application at the implant’s first, second, and third crack. Only a moderate correlation could be found between fracture force and the volume of porosities (Pearson’s correlation coefficient 0.59; p = 0.073). The present study demonstrates that an implant thickness of 3 mm for a temporoparietal skull defect can withstand sufficient force to protect the brain. Greater implant weight and, thus, higher material content increases thickness, resulting in more resistance. Porosities that occur during the described workflow do not seem to reduce resistance. Therefore, precise knowledge of the fracture force of polymethylmethacrylate cranial implants provides insight into brain injury prevention and serves as a reference for the virtual design process.
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Affiliation(s)
- Bilal Msallem
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (B.M.); (N.S.); (S.C.); (F.M.T.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
| | - Michaela Maintz
- Medical Additive Manufacturing Research Group (Swiss MAM), 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;
| | - Simon Meyer
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (B.M.); (N.S.); (S.C.); (F.M.T.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
- Correspondence:
| | - Guido R. Sigron
- Clinic of Oral and Cranio-Maxillofacial Surgery, Cantonal Hospital Aarau, CH-5001 Aarau, Switzerland;
| | - Neha Sharma
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (B.M.); (N.S.); (S.C.); (F.M.T.)
- Medical Additive Manufacturing Research Group (Swiss MAM), 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; (B.M.); (N.S.); (S.C.); (F.M.T.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
| | - Florian M. Thieringer
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (B.M.); (N.S.); (S.C.); (F.M.T.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
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Baldia M, Joseph M, Sharma S, Kumar D, Retnam A, Koshy S, Karuppusami R. Customized cost-effective polymethylmethacrylate cranioplasty: a cosmetic comparison with other low-cost methods of cranioplasty. Acta Neurochir (Wien) 2022; 164:655-667. [PMID: 35107617 DOI: 10.1007/s00701-022-05121-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 01/10/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Intraoperative hand-moulded cranioplasty and polymethylmethacrylate (PMMA) prostheses made from bone impressions are economical but the cosmetic results are less than satisfactory. Commercially available customized prostheses perform better but are prohibitively expensive. We evaluate the performance of a locally developed, low-cost customized PMMA cranioplasty prosthesis. OBJECTIVE To compare the cosmetic outcome of 3 types of PMMA cranioplasty as well as with objective measurements on postoperative CT scans METHODS: This study includes 70 patients who underwent cranioplasty between March 2016 and June 2020. In this period, patients had their cranioplasty prostheses made by intra-operative hand moulding (HM), by using the removed bone as a template and making a bone impression (BI) or by 3D printing the prosthesis based on a CT scan. Cosmetic outcomes were assessed by the patient and the operating surgeon on an 8-point scale. The degree of measured anthropometric asymmetry was measured on a postoperative CT scan and correlated with the cosmetic outcome. RESULTS Our locally produced 3D-printed cranioplasty prostheses showed a statistically better performance in cosmetic scores when compared to the HM and BI (p value < 0.001). CT anthropometric measurements significantly correlated with cosmetic outcome (p value 0.01) CONCLUSION: Our 3D cranioplasty prostheses had better cosmetic outcomes than HM and BI prostheses, and our technique is able to produce them at 10% of the cost of the currently available commercial customized prostheses.
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Affiliation(s)
- Manish Baldia
- Department of Neurosurgery, Jaslok Hospital and Research Centre, Mumbai, 400026, Maharashtra, India.
| | - Mathew Joseph
- Department of Neurological Sciences, Christian Medical College, Vellore, 632004, Tamil Nadu, India
| | - Suryaprakash Sharma
- Department of Dental Sciences, Christian Medical College, Vellore, 632004, Tamil Nadu, India
| | - Deva Kumar
- Department of Nuclear Medicine, Christian Medical College, Vellore, 632004, Tamil Nadu, India
| | - Ashwin Retnam
- Department of Neurological Sciences, Christian Medical College, Vellore, 632004, Tamil Nadu, India
| | - Santosh Koshy
- Department of Dental Sciences, Christian Medical College, Vellore, 632004, Tamil Nadu, India
| | - Reka Karuppusami
- Department of Biostatistics, Christian Medical College, Vellore, 632004, Tamil Nadu, India
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A Structured Approach for the Design and Manufacturing of Titanium Cranial Prostheses via Sheet Metal Forming. METALS 2022. [DOI: 10.3390/met12020293] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Currently, the growing need for highly customized implants has become one of the key aspects to increase the life expectancy and reduce time and costs for prolonged hospitalizations due to premature failures of implanted prostheses. According to the literature, several technological solutions are considered suitable to achieve the necessary geometrical complexity, from the conventional subtractive approaches to the more innovative additive solutions. In the case of cranial prostheses, which must guarantee a very good fitting of the region surrounding the implant in order to minimize micromotions and reduce infections, the need of a product characterized by high geometrical complexity combined with both strength and limited weight, has pushed the research towards the adoption of manufacturing processes able to improve the product’s quality but being fast and flexible enough. The attention has been thus focused in this paper on sheet metal forming processes and, namely on the Single Point Incremental Forming (SPIF) and the Superplastic Forming (SPF). In particular, the complete procedure to design and produce titanium cranial prostheses for in vivo tests is described: starting from Digital Imaging and COmmunications in Medicine (DICOM) images of the ovine animal, the design was conducted and the production process simulated to evaluate the process parameters and the production set up. The forming characteristics of the prostheses were finally evaluated in terms of thickness distributions and part’s geometry. The effectiveness of the proposed methodology has been finally assessed through the implantation of the manufactured prostheses in sheep.
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Okishev DN, Cherebylo SA, Konovalov AN, Chelushkin DM, Shekhtman OD, Konovalov NA, Okisheva EA, Kravchuk AD, Eliava SS. [Features of modeling a polymer implant for closing a defect after decompressive craniotomy]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2022; 86:17-27. [PMID: 35170273 DOI: 10.17116/neiro20228601117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Individual polymer implants are widespread for bone reconstruction after decompressive craniectomy. Despite the availability of customized titanium products, various specialists and hospitals prefer polymer implants. OBJECTIVE To compare the methods of modeling and manufacturing the polymethylmethacrylate implants and identify the features affecting the quality of reconstruction. MATERIAL AND METHODS We analyzed 14 patients with extensive skull defects after installation of polymethyl methacrylate implants. Software used for modeling of individual implants by different specialists was compared. RESULTS Satisfactory reconstruction result was obtained in all cases. There were no infectious complications. The authors outlined certain important aspects for modeling of individual polymer products: local use of anatomical thickness of the implant, leaving safe spaces, prevention of temporal retraction, template-based resection before reconstruction. CONCLUSION To date, skull defect closure with polymeric materials remains relevant, and even has certain advantages over customized titanium products.
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Affiliation(s)
- D N Okishev
- Burdenko Neurosurgical Center, Moscow, Russia
| | - S A Cherebylo
- Institute for Problems of Laser and Information Technologies, Shatura, Russia
| | | | | | | | | | - E A Okisheva
- Sechenov First Moscow State Medical University, Moscow, Russia
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20
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Scerrati A, Travaglini F, Gelmi CAE, Lombardo A, De Bonis P, Cavallo MA, Zamboni P. Patient specific Polymethyl methacrylate customised cranioplasty using 3D printed silicone moulds: Technical note. Int J Med Robot 2021; 18:e2353. [PMID: 34786816 PMCID: PMC9285906 DOI: 10.1002/rcs.2353] [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: 08/05/2021] [Revised: 10/12/2021] [Accepted: 11/11/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Cranioplasty after decompressive craniectomy can be performed with several techniques and materials. With the common use of 3D printing, custom cranioplasty can be produced at affordable cost. Aim of this technical note is to describe our technique for producing patient specific Polymethyl methacrylate (PMMA) cranioplasty using 3D printed silicone moulds. MATERIALS AND METHODS We enrolled seven patients from January 2020 to June 2021 who required surgery for cranioplasty. The 3D printing was used to produce silicone moulds for defining the exact shape of the PMMA cranioplasty, according to the CT scan of the patient. RESULTS We performed seven procedures. The mean time of the surgery was 80 min. All cranioplasties perfectly matched the patient specific anatomy. No complications occurred. CONCLUSIONS Using 3D printed patient specific silicone moulds and PMMA resulted to be effective, with affordable costs and ensuring a good cosmetic result.
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Affiliation(s)
- Alba Scerrati
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Department of Neurosurgery, Sant'Anna University Hospital of Ferrara, Ferrara, Italy.,3D Bioprinting Laboratory, University of Ferrara, Ferrara, Italy
| | - Francesco Travaglini
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Department of Neurosurgery, Sant'Anna University Hospital of Ferrara, Ferrara, Italy
| | - Clarissa Ann Elisabeth Gelmi
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Department of Neurosurgery, Sant'Anna University Hospital of Ferrara, Ferrara, Italy
| | - Andrea Lombardo
- 3D Bioprinting Laboratory, University of Ferrara, Ferrara, Italy
| | - Pasquale De Bonis
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Department of Neurosurgery, Sant'Anna University Hospital of Ferrara, Ferrara, Italy
| | - Michele Alessandro Cavallo
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Department of Neurosurgery, Sant'Anna University Hospital of Ferrara, Ferrara, Italy
| | - Paolo Zamboni
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,3D Bioprinting Laboratory, University of Ferrara, Ferrara, Italy.,Hub Center for Venous and Lymphatic Diseases Regione Emilia-Romagna, Sant'Anna University Hospital of Ferrara, Ferrara, Italy
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21
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Quality control methods in musculoskeletal tissue engineering: from imaging to biosensors. Bone Res 2021; 9:46. [PMID: 34707086 PMCID: PMC8551153 DOI: 10.1038/s41413-021-00167-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/23/2021] [Accepted: 06/27/2021] [Indexed: 02/06/2023] Open
Abstract
Tissue engineering is rapidly progressing toward clinical application. In the musculoskeletal field, there has been an increasing necessity for bone and cartilage replacement. Despite the promising translational potential of tissue engineering approaches, careful attention should be given to the quality of developed constructs to increase the real applicability to patients. After a general introduction to musculoskeletal tissue engineering, this narrative review aims to offer an overview of methods, starting from classical techniques, such as gene expression analysis and histology, to less common methods, such as Raman spectroscopy, microcomputed tomography, and biosensors, that can be employed to assess the quality of constructs in terms of viability, morphology, or matrix deposition. A particular emphasis is given to standards and good practices (GXP), which can be applicable in different sectors. Moreover, a classification of the methods into destructive, noninvasive, or conservative based on the possible further development of a preimplant quality monitoring system is proposed. Biosensors in musculoskeletal tissue engineering have not yet been used but have been proposed as a novel technology that can be exploited with numerous advantages, including minimal invasiveness, making them suitable for the development of preimplant quality control systems.
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22
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Nica DF, Gabor AG, Duma VF, Tudericiu VG, Tudor A, Sinescu C. Sinus Lift and Implant Insertion on 3D-Printed Polymeric Maxillary Models: Ex Vivo Training for In Vivo Surgical Procedures. J Clin Med 2021; 10:jcm10204718. [PMID: 34682841 PMCID: PMC8538196 DOI: 10.3390/jcm10204718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 12/14/2022] Open
Abstract
Background and Objectives: The aim of this study is to demonstrate the increased efficiency achieved by dental practitioners when carrying out an ex vivo training process on 3D-printed maxillaries before performing in vivo surgery. Materials and Methods: This developed ex vivo procedure comprises the following phases: (i) scanning the area of interest for surgery; (ii) obtaining a 3D virtual model of this area using Cone Beam Computed Tomography (CBCT); (iii) obtaining a 3D-printed model (based on the virtual one), on which (iv) the dental practitioner simulates/rehearses ex vivo (most of) the surgery protocol; (v) assess with a new CBCT the 3D model after simulation. The technical steps of sinus augmentation and implant insertion could be performed on the corresponding 3D-printed hemi-maxillaries prior to the real in vivo surgery. Two study groups were considered, with forty patients divided as follows: Group 1 comprises twenty patients on which the developed simulation and rehearsal procedure was applied; Group 2 is a control one which comprises twenty patients on which similar surgery was performed without this procedure (considered in order to compare operative times without and with rehearsals). Results: Following the ex vivo training/rehearsal, an optimal surgery protocol was developed for each considered case. The results of the surgery on patients were compared with the results obtained after rehearsals on 3D-printed models. The performed quantitative assessment proved that, using the proposed training procedure, the results of the in vivo surgery are not significantly different (p = 0.089) with regard to the ex vivo simulation for both the mezio-distal position of the implant and the distance from the ridge margin to sinus window. On the contrary, the operative time of Group 1 was reduced significantly (p = 0.001), with an average of 20% with regard to in vivo procedures performed without rehearsals (on the control Group 2). Conclusions: The study demonstrated that the use of 3D-printed models can be beneficial to dental surgeon practitioners, as well as to students who must be trained before performing clinical treatments.
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Affiliation(s)
- Diana Florina Nica
- School of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy of Timisoara, 2A Eftimie Murgu Place, 300070 Timisoara, Romania;
| | - Alin Gabriel Gabor
- Research Center in Dental Medicine Using Conventional and Alternative Technologies, School of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy of Timisoara, 9 Revolutiei 1989 Ave., 300070 Timisoara, Romania; (A.G.G.); (A.T.); (C.S.)
| | - Virgil-Florin Duma
- 3OM Optomechatronics Group, Faculty of Engineering, “Aurel Vlaicu” University of Arad, 2 Elena Dragoi, 310177 Arad, Romania
- Doctoral School, Polytechnic University of Timisoara, 1 Mihai Viteazu Ave., 300222 Timisoara, Romania
- Correspondence: ; Tel.: +40-751-511451
| | | | - Anca Tudor
- Research Center in Dental Medicine Using Conventional and Alternative Technologies, School of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy of Timisoara, 9 Revolutiei 1989 Ave., 300070 Timisoara, Romania; (A.G.G.); (A.T.); (C.S.)
| | - Cosmin Sinescu
- Research Center in Dental Medicine Using Conventional and Alternative Technologies, School of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy of Timisoara, 9 Revolutiei 1989 Ave., 300070 Timisoara, Romania; (A.G.G.); (A.T.); (C.S.)
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Sharma N, Aghlmandi S, Dalcanale F, Seiler D, Zeilhofer HF, Honigmann P, Thieringer FM. Quantitative Assessment of Point-of-Care 3D-Printed Patient-Specific Polyetheretherketone (PEEK) Cranial Implants. Int J Mol Sci 2021; 22:8521. [PMID: 34445228 PMCID: PMC8395180 DOI: 10.3390/ijms22168521] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 07/26/2021] [Accepted: 08/05/2021] [Indexed: 12/18/2022] Open
Abstract
Recent advancements in medical imaging, virtual surgical planning (VSP), and three-dimensional (3D) printing have potentially changed how today's craniomaxillofacial surgeons use patient information for customized treatments. Over the years, polyetheretherketone (PEEK) has emerged as the biomaterial of choice to reconstruct craniofacial defects. With advancements in additive manufacturing (AM) systems, prospects for the point-of-care (POC) 3D printing of PEEK patient-specific implants (PSIs) have emerged. Consequently, investigating the clinical reliability of POC-manufactured PEEK implants has become a necessary endeavor. Therefore, this paper aims to provide a quantitative assessment of POC-manufactured, 3D-printed PEEK PSIs for cranial reconstruction through characterization of the geometrical, morphological, and biomechanical aspects of the in-hospital 3D-printed PEEK cranial implants. The study results revealed that the printed customized cranial implants had high dimensional accuracy and repeatability, displaying clinically acceptable morphologic similarity concerning fit and contours continuity. From a biomechanical standpoint, it was noticed that the tested implants had variable peak load values with discrete fracture patterns and failed at a mean (SD) peak load of 798.38 ± 211.45 N. In conclusion, the results of this preclinical study are in line with cranial implant expectations; however, specific attributes have scope for further improvements.
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Affiliation(s)
- Neha Sharma
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (N.S.); (H.-F.Z.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
| | - Soheila Aghlmandi
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, CH-4031 Basel, Switzerland;
| | - Federico Dalcanale
- Institute for Medical Engineering and Medical Informatics, University of Applied Sciences and Arts North-Western Switzerland, CH-4132 Muttenz, Switzerland; (F.D.); (D.S.)
| | - Daniel Seiler
- Institute for Medical Engineering and Medical Informatics, University of Applied Sciences and Arts North-Western Switzerland, CH-4132 Muttenz, Switzerland; (F.D.); (D.S.)
| | - Hans-Florian Zeilhofer
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (N.S.); (H.-F.Z.)
| | - Philipp Honigmann
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
- Hand Surgery, Cantonal Hospital Baselland, CH-4410 Liestal, Switzerland
- Amsterdam UMC, Department of Biomedical Engineering and Physics, University of Amsterdam, Amsterdam Movement Sciences, NL-1105 Amsterdam, The Netherlands
| | - Florian M. Thieringer
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (N.S.); (H.-F.Z.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
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Tel A, Tuniz F, Sembronio S, Costa F, Bresadola V, Robiony M. Cubik system: maximizing possibilities of in-house computer-guided surgery for complex craniofacial reconstruction. Int J Oral Maxillofac Surg 2021; 50:1554-1562. [PMID: 34312041 DOI: 10.1016/j.ijom.2021.07.008] [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: 12/24/2020] [Revised: 05/06/2021] [Accepted: 07/13/2021] [Indexed: 11/19/2022]
Abstract
Craniofacial reconstruction represents a major challenge due to the complex anatomical morphology. Although implant production has often been outsourced to external companies, in-house planning and manufacturing has developed in many centres. This note introduces a conceptualized modular mould system to perform any desired craniofacial reconstruction, named 'Cubik', inspired by the famous Rubik's cube. A sophisticated virtual process is described that simulates realistic cranio-orbital resections, and the workflow to create multi-component moulds in order to achieve intraoperatively moulded implants is presented. The description focuses on the appropriate definition of interfaces between the subdivision surfaces of the planned implant, which is the key element to successful design and function of the moulds during surgery and is the peculiarity of the Cubik system. The use of Cubik does not prolong the overall duration of surgery, and it appears to be a very versatile tool, allowing personalized implants with different morphology to be created, which are suitable to cover every potential defect of the skull and the orbital region. This study extends the potential of in-house production, allowing highly accurate implantable craniofacial implants to be fabricated, and in the future this might represent a solution to achieve in-house replacement of other segments of the facial skeleton.
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Affiliation(s)
- A Tel
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - F Tuniz
- Neurosurgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - S Sembronio
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - F Costa
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - V Bresadola
- Simulation Centre, General Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - M Robiony
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy.
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Wittner C, Borowski M, Pirl L, Kastner J, Schrempf A, Schäfer U, Trieb K, Senck S. Thickness accuracy of virtually designed patient-specific implants for large neurocranial defects. J Anat 2021; 239:755-770. [PMID: 34086982 PMCID: PMC8450480 DOI: 10.1111/joa.13465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/27/2021] [Accepted: 05/12/2021] [Indexed: 12/15/2022] Open
Abstract
The combination of computer‐aided design (CAD) techniques based on computed tomography (CT) data to generate patient‐specific implants is in use for decades. However, persisting disadvantages are complicated design procedures and rigid reconstruction protocols, for example, for tailored implants mimicking the patient‐specific thickness distribution of missing cranial bone. In this study we used two different approaches, CAD‐ versus thin‐plate spline (TPS)‐based implants, to reconstruct extensive unilateral and bilateral cranial defects in three clinical cases. We used CT data of three complete human crania that were virtually damaged according to the missing regions in the clinical cases. In total, we carried out 132 virtual reconstructions and quantified accuracy from the original to the generated implant and deviations in the resulting implant thickness as root‐mean‐square error (RMSE). Reconstructions using TPS showed an RMSE of 0.08–0.18 mm in relation to geometric accuracy. CAD‐based implants showed an RMSE of 0.50–1.25 mm. RMSE in relation to implant thickness was between 0.63 and 0.70 mm (TPS) while values for CAD‐based implants were significantly higher (0.63–1.67 mm). While both approaches provide implants showing a high accuracy, the TPS‐based approach additionally provides implants that accurately reproduce the patient‐specific thickness distribution of the affected cranial region.
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Affiliation(s)
- Claudia Wittner
- Research Group Computed Tomography, University of Applied Sciences Upper Austria, Wels, Austria
| | - Markus Borowski
- Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig GmbH, Braunschweig, Germany
| | - Lukas Pirl
- Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig GmbH, Braunschweig, Germany
| | - Johann Kastner
- Research Group Computed Tomography, University of Applied Sciences Upper Austria, Wels, Austria
| | - Andreas Schrempf
- Research Group for Surgical Simulators Linz, University of Applied Sciences Upper Austria, Linz, Austria
| | - Ute Schäfer
- Forschungseinheit Experimentelle Neurotraumatologie, Medizinische Universität Graz, Graz, Austria
| | - Klemens Trieb
- Research Group Computed Tomography, University of Applied Sciences Upper Austria, Wels, Austria.,Department of Orthopedic and Trauma Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Sascha Senck
- Research Group Computed Tomography, University of Applied Sciences Upper Austria, Wels, Austria
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Sharma N, Ostas D, Rotar H, Brantner P, Thieringer FM. Design and Additive Manufacturing of a Biomimetic Customized Cranial Implant Based on Voronoi Diagram. Front Physiol 2021; 12:647923. [PMID: 33897455 PMCID: PMC8063040 DOI: 10.3389/fphys.2021.647923] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/15/2021] [Indexed: 12/21/2022] Open
Abstract
Reconstruction of cranial defects is an arduous task for craniomaxillofacial surgeons. Additive manufacturing (AM) or three-dimensional (3D) printing of titanium patient-specific implants (PSIs) made its way into cranioplasty, improving the clinical outcomes in complex surgical procedures. There has been a significant interest within the medical community in redesigning implants based on natural analogies. This paper proposes a workflow to create a biomimetic patient-specific cranial prosthesis with an interconnected strut macrostructure mimicking bone trabeculae. The method implements an interactive generative design approach based on the Voronoi diagram or tessellations. Furthermore, the quasi-self-supporting fabrication feasibility of the biomimetic, lightweight titanium cranial prosthesis design is assessed using Selective Laser Melting (SLM) technology.
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Affiliation(s)
- Neha Sharma
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, Medical Additive Manufacturing Research Group (SwissMAM), University of Basel, Allschwil, Switzerland
| | - Daniel Ostas
- Department of Oral and Cranio-Maxillofacial Surgery, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Horatiu Rotar
- Department of Oral and Cranio-Maxillofacial Surgery, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Philipp Brantner
- Department of Biomedical Engineering, Medical Additive Manufacturing Research Group (SwissMAM), University of Basel, Allschwil, Switzerland.,Department of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Florian Markus Thieringer
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, Medical Additive Manufacturing Research Group (SwissMAM), University of Basel, Allschwil, Switzerland
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Overview of In-Hospital 3D Printing and Practical Applications in Hand Surgery. BIOMED RESEARCH INTERNATIONAL 2021; 2021:4650245. [PMID: 33855068 PMCID: PMC8019389 DOI: 10.1155/2021/4650245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 01/03/2021] [Accepted: 03/22/2021] [Indexed: 12/12/2022]
Abstract
Three-dimensional (3D) printing is spreading in hand surgery. There is an increasing number of practical applications like the training of junior hand surgeons, patient education, preoperative planning, and 3D printing of customized casts, customized surgical guides, implants, and prostheses. Some high-quality studies highlight the value for surgeons, but there is still a lack of high-level evidence for improved clinical endpoints and hence actual impact on the patient's outcome. This article provides an overview over the latest applications of 3D printing in hand surgery and practical experience of implementing them into daily clinical routine.
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Basu B, Bhaskar N, Barui S, Sharma V, Das S, Govindarajan N, Hegde P, Perikal PJ, Antharasanahalli Shivakumar M, Khanapure K, Tekkatte Jagannatha A. Evaluation of implant properties, safety profile and clinical efficacy of patient-specific acrylic prosthesis in cranioplasty using 3D binderjet printed cranium model: A pilot study. J Clin Neurosci 2021; 85:132-142. [PMID: 33581784 DOI: 10.1016/j.jocn.2020.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/14/2020] [Indexed: 01/21/2023]
Abstract
There exists a significant demand to develop patient-specific prosthesis in reconstruction of cranial vaults after decompressive craniectomy. we report here, the outcomes of an unicentric pilot study on acrylic cranial prosthesis fabricated using a 3D printed cranium model with its clinically relevant mechanical properties. METHODS The semi-crystalline polymethyl methacrylate (PMMA) implants, shaped to the cranial defects of 3D printed cranium model, were implanted in 10 patients (mean age, 40.8 ± 14.8 years). A binderjet 3D printer was used to create patient-specific mould and PMMA was casted to fabricate prosthesis which was analyzed for microstructure and properties. Patients were followed up for allergy, infection and cosmesis for a period of 6 months. RESULTS As-cast PMMA flap exhibited hardness of 15.8 ± 0.24Hv, tensile strength of 30.7 ± 3.9 MPa and elastic modulus of 1.5 ± 0.1 GPa. 3D microstructure of the semi-crystalline acrylic implant revealed 2.5-15 µm spherical isolated pores. The mean area of the calvarial defect in craniectomy patients was 94.7 ± 17.4 cm2. We achieved a cranial index of symmetry (CIS -%) of 94.5 ± 3.9, while the average post-operative Glasgow outcome scale (GOS) score recorded was 4.2 ± 0.9. CONCLUSIONS 3D printing based patient-specific design and fabrication of acrylic cranioplasty implant is safe and achieves acceptable cosmetic and clinical outcomes in patients with decompressive craniectomy. Our study ensured clinically acceptable structural and mechanical properties of implanted PMMA, suggesting that a low cost 3D printer based PMMA flap is an affordable option for cranioplasty in resource constrained settings.
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Affiliation(s)
- Bikramjit Basu
- Materials Research Center, Indian Institute of Science, Bangalore 560012, India; Center for BioSystems Science and Engineering, Indian Institute of Science, Bangalore 560012, India
| | - Nitu Bhaskar
- Materials Research Center, Indian Institute of Science, Bangalore 560012, India
| | - Srimanta Barui
- Materials Research Center, Indian Institute of Science, Bangalore 560012, India
| | - Vidushi Sharma
- Materials Research Center, Indian Institute of Science, Bangalore 560012, India
| | - Soumitra Das
- Materials Research Center, Indian Institute of Science, Bangalore 560012, India
| | - Nikhil Govindarajan
- Department of Metallurgical and Materials Engineering, National Institute of Technology, Surathkal, Mangaluru 575025, Karnataka, India
| | - Pranoy Hegde
- Department of Neurosurgery, Ramaiah Medical College, Bengaluru, Karnataka 560054, India
| | - Parichay J Perikal
- Department of Neurosurgery, Ramaiah Medical College, Bengaluru, Karnataka 560054, India
| | | | - Kiran Khanapure
- Department of Neurosurgery, Ramaiah Medical College, Bengaluru, Karnataka 560054, India
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Dabadi S, Dhungel RR, Sharma U, Shrestha D, Gurung P, Shrestha R, Pant B. Customized Cost-Effective Polymethyl-Methacrylate Cranioplasty Implant Using Three-Dimensional Printer. Asian J Neurosurg 2021; 16:150-154. [PMID: 34211884 PMCID: PMC8202387 DOI: 10.4103/ajns.ajns_441_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/11/2021] [Accepted: 01/26/2021] [Indexed: 01/01/2023] Open
Abstract
There is no doubt that many synthetic materials used in cranioplasty have given good result regarding patient's calvarial shape. However, the use of these materials is costly to the patient and requires complex intraoperative process. There has been a long history regarding the use of acrylic bone cement called as polymethyl-methacrylate (PMMA) as an implant due to its desirable properties. Here, we present three cases of simple, cost effective manually sculpted calvarial defect using three-dimensional (3D) printer. Sharing the achievement and challenges, we want to focus that the 3D customized implant of PMMA can be used as bone substitute.
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Affiliation(s)
- Sambardhan Dabadi
- Department of Biomedical Engineering, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Raju Raj Dhungel
- Department of Biomedical Engineering, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Upama Sharma
- Department of Neurosurgery, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Dinuj Shrestha
- Department of Neurosurgery, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Pritam Gurung
- Department of Neurosurgery, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Resha Shrestha
- Department of Neurosurgery, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
| | - Basant Pant
- Department of Neurosurgery, Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
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Tel A, Tuniz F, Fabbro S, Sembronio S, Costa F, Robiony M. Computer-Guided In-House Cranioplasty: Establishing a Novel Standard for Cranial Reconstruction and Proposal of an Updated Protocol. J Oral Maxillofac Surg 2020; 78:2297.e1-2297.e16. [DOI: 10.1016/j.joms.2020.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 12/11/2022]
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Sharma N, Aghlmandi S, Cao S, Kunz C, Honigmann P, Thieringer FM. Quality Characteristics and Clinical Relevance of In-House 3D-Printed Customized Polyetheretherketone (PEEK) Implants for Craniofacial Reconstruction. J Clin Med 2020; 9:jcm9092818. [PMID: 32878160 PMCID: PMC7563642 DOI: 10.3390/jcm9092818] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/13/2020] [Accepted: 08/30/2020] [Indexed: 12/11/2022] Open
Abstract
Additive manufacturing (AM) of patient-specific implants (PSIs) is gradually moving towards in-house or point-of-care (POC) manufacturing. Polyetheretherketone (PEEK) has been used in cranioplasty cases as a reliable alternative to other alloplastic materials. As only a few fused filament fabrication (FFF) printers are suitable for in-house manufacturing, the quality characteristics of the implants fabricated by FFF technology are still under investigated. This paper aimed to investigate PEEK PSIs fabricated in-house for craniofacial reconstruction, discussing the key challenges during the FFF printing process. Two exemplary cases of class III (Group 1) and class IV (Group 2) craniofacial defects were selected for the fabrication of PEEK PSIs. Taguchi’s L9 orthogonal array was selected for the following nonthermal printing process parameters, i.e., layer thickness, infill rate, number of shells, and infill pattern, and an assessment of the dimensional accuracy of the fabricated implants was made. The root mean square (RMS) values revealed higher deviations in Group 1 PSIs (0.790 mm) compared to Group 2 PSIs (0.241 mm). Horizontal lines, or the characteristic FFF stair-stepping effect, were more perceptible across the surface of Group 1 PSIs. Although Group 2 PSIs revealed no discoloration, Group 1 PSIs displayed different zones of crystallinity. These results suggest that the dimensional accuracy of PSIs were within the clinically acceptable range; however, attention must be paid towards a requirement of optimum thermal management during the printing process to fabricate implants of uniform crystallinity.
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Affiliation(s)
- Neha Sharma
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (N.S.); (S.C.); (C.K.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
| | - Soheila Aghlmandi
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, CH-4031 Basel, Switzerland;
| | - Shuaishuai Cao
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (N.S.); (S.C.); (C.K.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
| | - Christoph Kunz
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (N.S.); (S.C.); (C.K.)
| | - Philipp Honigmann
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
- Hand Surgery, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Florian M. Thieringer
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (N.S.); (S.C.); (C.K.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
- Correspondence:
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