Immediate Teeth in Fibulas: Planning and Digital Workflow With Point-of-Care 3D Printing

Abstract

Point-of-care 3-dimensional (3D) printing has become more common in recent years because many hospitals have created 3D printing laboratories. Traditional techniques to fabricate an immediate dental prosthesis for fibula and implant reconstructions have involved outsourcing to dental laboratories. This results in delays, making it suitable only for benign disease. In the present report, we have demonstrated a technique for in-house creation of a 3D printed dental prosthesis for placement of implants at free fibula maxillofacial reconstruction. Our digital method has reduced costs and shortened the interval to surgery compared with traditional laboratory techniques. Materials and Methods: Twelve patients underwent free fibula reconstruction of the mandible or maxilla with immediate implants and immediate teeth. A dental implant-retained restoration was created before surgery for immediate placement at fibula reconstruction. For the first 5 patients, the prosthesis was fabricated by a dental laboratory after virtual surgical planning. For the next 7 patients, the prosthesis was designed by the surgeon and 3D printed via the in-house laboratory. Four of these in-house cases were performed for malignant disease with skin paddles. Results: All 12 patients received an immediate implant-retained fixed prosthesis at fibula reconstruction. The time required to generate the in-house 3D printed prostheses was significantly shorter than that required to create the dental laboratory-fabricated prostheses. The costs were also less with the 3D printed prostheses compared with the dental laboratory-fabricated prostheses. Conclusions: The digital workflow we have presented eliminates the delay in creating a dental laboratory-fabricated provisional dental prosthesis for fibula and implant reconstruction. This allows for immediate dental restoration for patients with malignant disease previously considered unsuitable owing to the inherent delay required using an offsite dental laboratory. A decrease in cost to create in-house 3D printed prostheses was noted compared with the prostheses fabricated by a dental laboratory. Case selection is critical to predict the soft tissue needs for composite defects.

Immediate Teeth in Fibulas: Expanded Clinical Applications and Surgical Technique

“…Our digital workflow has been previously described. 4 In this series, no patients experienced a delay in surgery waiting on their dental prosthesis, and no patients were delayed in beginning adjuvant radiation therapy due to implant/prosthetic issues.…”

“…Interest in comprehensive jaw reconstruction has led to the development of new techniques to provide immediate implants and teeth at the same time as vascularized bone reconstruction. 1,2,3,4 While immediate implants in vascularized fibulas have been placed for many years, these implants are usually not immediately restored. 5,6 Delayed early provisionalization has been described but requires a period of days or weeks without teeth.…”

Point-of-care three-dimensional printing for craniomaxillofacial trauma

“…Considering the price of 3D printers is continuing to drop, for example, the MSRP of a FormLabs Form3 printer is approximately $3000, and the learning curve of the CAD/CAM programs is becoming flatter, many surgeons and institutions are turning to point-of-care (POC) manufacturing [25] . POC manufacturing refers to the "just-in-time" creation of anatomic models or other items at the place of care, such as the hospital or clinic [25] .…”

“…Considering the price of 3D printers is continuing to drop, for example, the MSRP of a FormLabs Form3 printer is approximately $3000, and the learning curve of the CAD/CAM programs is becoming flatter, many surgeons and institutions are turning to point-of-care (POC) manufacturing [25] . POC manufacturing refers to the "just-in-time" creation of anatomic models or other items at the place of care, such as the hospital or clinic [25] . POC or in-house 3D printing and manufacturing provide cost-effective CAD/CAM technologies in the delivery of services that otherwise would not be feasible due to, at least in part, the high cost of third-party VSP sessions and manufactured products and the lead time required for these services/products [25] .…”

“…POC manufacturing refers to the "just-in-time" creation of anatomic models or other items at the place of care, such as the hospital or clinic [25] . POC or in-house 3D printing and manufacturing provide cost-effective CAD/CAM technologies in the delivery of services that otherwise would not be feasible due to, at least in part, the high cost of third-party VSP sessions and manufactured products and the lead time required for these services/products [25] . Several great examples of surgeon-led in-house manufacturing techniques are starting to emerge within the literature [21][22][23][24]26] .…”