Direct metal laser sintering (DMLS) of a customized titanium mesh for prosthetically guided bone regeneration of atrophic maxillary arches

Abstract

This study describes a protocol for the direct manufacturing of a customized titanium mesh using CAD-CAM procedures and rapid prototyping to augment maxillary bone and minimize surgery when severe atrophy or post-oncological deformities are present. Titanium mesh and particulate autogenous plus bovine demineralised bone were planned for patient rehabilitation. Bone augmentation planning was performed using the pre-op CT data set in relation to the prosthetic demands, minimizing the bone volume to augment at the minimum necessary for implants. The containment mesh design was used to prototype the 0.6 mm thickness customized titanium mesh, by direct metal laser sintering. The levels of regenerated bone were calculated using the post-op CT data set, through comparison with the pre-op CT data set. The mean vertical height difference of the crestal bone was 2.57 mm, while the mean buccal-palatal dimension of thickness difference was 3.41 mm. All planned implants were positioned after an 8 month healing period using two-step implant surgery, and finally restored with a partial fixed prosthesis. We present a viable and reproducible method to determine the correct bone augmentation prior to implant placement and CAD-CAM to produce a customized direct laser-sintered titanium mesh that can be used for bone regeneration.

Laser and Electron Beam Additive Manufacturing Methods of Fabricating Titanium Bone Implants

“…Some variants use powder provided beforehand in special beds. Those methods, called "powder in bed", include Selective Laser Sintering (SLS) [20], also known as DMLS (Direct Metal Laser Sintering) [21], and Selective Laser Melting (SLM) [22]. Other DMLF methods deliver the powder by injection nozzles just above the sample.…”

Surface Finishes for Ti-6Al-4V Alloy Produced by Direct Metal Laser Sintering

“…Currently, additive manufacturing allows production of custom prosthetic implants, fitting them directly to patient needs. It can be used in many medical specialties including neurosurgery, maxillofacial surgery, craniofacial and plastic surgery, oncology, dentistry and orthopedics [3][4][5][6][7][8] . The main metallic materials used in orthopedic implants are stainless steel alloys, cobalt-chromium alloys and titanium alloys 1,9,10 .…”

Introductory Chapter: Multi-Aspect Bibliographic Analysis of the Synergy of Technical, Biological and Medical Sciences Concerning Materials and Technologies Used for Medical and Dental Implantable Devices

“…Such technologies can be applied for various engineering materials, not only metals and alloys which are prepared, respectively, as powder or liquid, rolled material or thin fibres. Additive technologies have been widely used for fabricating diverse, customised elements applied in medicine, in particular, scaffolds with required porosity and strength with living cells implanted into an organism [225][226][227], models of implants and dental bridges [228][229][230], implants of individualised implants of the upper jaw bone, hip joint and skull fragments [231][232][233][234][235][236][237][238]. Considering the additive technologies applied most widely, the following have found their application for scaffold manufacturing, in implantology and prosthetics, i.e., electron beam melting (EBM) [222,[239][240][241][242][243], and also 3D printing for production of indirect models, although selective laser sintering/selective laser melting (SLS/SLM) and its technological variants offers broadest opportunities [220,222,[244][245][246][247][248][249][250][251][252][253], which was noted in discussing each group of materials.…”