An In Vivo Evaluation of Biocompatibility and Implant Accuracy of the Electron Beam Melting and Commercial Reconstruction Plates

Craniofacial Reconstruction with Personalized Lightweight Scaffold Fabricated Using Electron-Beam Additive Manufacturing

Implants are the most popular option for restoring the facial anatomy in the event of a mishap. The commercially available craniofacial implants are of standard shapes, which need to be tailored and shaped to accurately fit the patient’s anatomy. The manual shaping of the implant to match the bone contours is conducted during surgical operation, and is a cumbersome and inaccurate process. Recent breakthroughs in computer-aided design, analysis, and additive manufacturing (AM) have allowed the precise and rapid manufacture of bespoke scaffolds for difficult anatomical restoration. The goal of this research is to investigate the use of scaffolds for craniofacial reconstruction and their fabrication using electron-beam additive manufacturing (EBAM). Personalized cheekbone scaffolds are additively fabricated using Ti6Al4V and subjected to compression testing. Finally, the scaffold design with the highest compressive strength is subjected to biomechanical analysis. The biomechanical analysis results indicate that the maximum Von Mises stress (40 MPa) and equivalent strain (0.4 µm) are significantly low in magnitude, thus providing a desirable implant that is both flexible and stable. The custom-designed cheekbone scaffold manufactured with AM technology not only aids in bone-implant ingrowth but also helps in reducing implant weight and ensuring implant stability and long-term effectiveness.

Development of AM Technologies for Metals in the Sector of Medical Implants

Additive manufacturing (AM) processes have undergone significant progress in recent years, having been implemented in sectors as diverse as automotive, aerospace, electrical component manufacturing, etc. In the medical sector, different devices are printed, such as implants, surgical guides, scaffolds, tissue engineering, etc. Although nowadays some implants are made of plastics or ceramics, metals have been traditionally employed in their manufacture. However, metallic implants obtained by traditional methods such as machining have the drawbacks that they are manufactured in standard sizes, and that it is difficult to obtain porous structures that favor fixation of the prostheses by means of osseointegration. The present paper presents an overview of the use of AM technologies to manufacture metallic implants. First, the different technologies used for metals are presented, focusing on the main advantages and drawbacks of each one of them. Considered technologies are binder jetting (BJ), selective laser melting (SLM), electron beam melting (EBM), direct energy deposition (DED), and material extrusion by fused filament fabrication (FFF) with metal filled polymers. Then, different metals used in the medical sector are listed, and their properties are summarized, with the focus on Ti and CoCr alloys. They are divided into two groups, namely ferrous and non-ferrous alloys. Finally, the state-of-art about the manufacture of metallic implants with AM technologies is summarized. The present paper will help to explain the latest progress in the application of AM processes to the manufacture of implants.

Reconstruction of Complex Zygomatic Bone Defects Using Mirroring Coupled with EBM Fabrication of Titanium Implant

Reconstruction of zygomatic complex defects is a surgical challenge, owing to the accurate restoration of structural symmetry as well as facial projection. Generally, there are many available techniques for zygomatic reconstruction, but they hardly achieve aesthetic and functional properties. To our knowledge, there is no such study on zygomatic titanium bone reconstruction, which involves the complete steps from patient computed tomography scan to the fabrication of titanium zygomatic implant and evaluation of implant accuracy. The objective of this study is to propose an integrated system methodology for the reconstruction of complex zygomatic bony defects using titanium comprising several steps, right from the patient scan to implant fabrication while maintaining proper aesthetic and facial symmetry. The integrated system methodology involves computer-assisted implant design based on the patient computed tomography data, the implant fitting accuracy using three-dimensional comparison techniques, finite element analysis to investigate the biomechanical behavior under loading conditions, and finally titanium fabrication of the zygomatic implant using state-of-the-art electron beam melting technology. The resulting titanium implant has a superior aesthetic appearance and preferable biocompatibility. The customized mirrored implant accurately fit on the defective area and restored the tumor region with inconsequential inconsistency. Moreover, the outcome from the two-dimensional analysis provided a good accuracy within 2 mm as established through physical prototyping. Thus, the designed implant produced faultless fitting, favorable symmetry, and satisfying aesthetics. The simulation results also demonstrated the load resistant ability of the implant with max stress within 1.76 MPa. Certainly, the mirrored and electron beam melted titanium implant can be considered as the practical alternative for a bone substitute of complex zygomatic reconstruction.