Individualized 3D-Printed Bone-Anchored Maxillary Protraction Device for Growth Modification in Skeletal Class III Malocclusion

Abstract

Bone-anchored maxillary protraction (BAMP) is effective for skeletal Class III malocclusion. However, infection, screw and plate loosening, and device failures occur with conventional plates. This pilot prospective study analyzed the feasibility of individualized BAMP using preoperative simulation and 3D titanium printing in patients referred by the orthodontic department for four BAMP miniplates. Preoperative cone beam computed tomography data were analyzed using CAD/CAM software to fabricate the individualized 3D-printed BAMP device. The customized plates were printed using selective laser sintering and inserted onto the bone through an adjunct transfer jig. The accuracy of preoperative simulation and actual placement of the BAMP device were tested by superimposing simulated positioned digital images and postoperative computed tomography data. The growth modification effect depended on superimposition of lateral cephalograms and comparative changes in SNA, SNB, ANB, and Wits. Two male patients were finally included in the study. BAMP decreased the ANB difference (−4.56 to −1.09) and Wits appraisal (−7.52 to −3.26) after 2 years. Normal measurement indices for sagittal and vertical growth indicated successful growth modification. The mean accuracy between preoperative simulation and actual surgery was 0.1081 ± 0.5074 mm. This treatment modality involving preoperative simulation and 3D titanium printing for fabricating and placing customized BAMP devices precisely at planned locations is effective for treating skeletal Class III malocclusion.

Impact of digital orthodontics on maxillary protraction with implants in children with skeletal class III: A systematic review and meta-analysis

“… 100 % None reported 15. Kim et al (2021) Pilot Controlled clinical trials The feasibility of individualized bone-anchored maxillary protraction using preoperative simulation and 3D titanium printing was being analyzed. Bone-anchored maxillary protraction CBCT and intraoral scanning 24 months Preoperative simulation and 3D titanium printing allowed for the precise fabrication and placement of customized BAMP devices.…”

Clinically Relevant Properties of 3D Printable Materials for Intraoral Use in Orthodontics: A Critical Review of the Literature

“…The mini-plates were designed according to maxillary bone anatomy and the position of the roots and then 3D printed by selective laser melting (SLM) of titanium powder [ 14 ]. Similarly, Kim et al [ 8 ] used a customized bone-anchored maxillary protraction device, 3D printed in a titanium alloy with SLS, to hook intermaxillary elastics in the treatment of two patients with Class III malocclusion. Graf et al [ 15 ] showed that a digital workflow involving intraoral digital scan, digital design, direct 3D metal printing via SLM (Concept Laser, Lichtenfels, Germany), and laser welding could be efficient for constructing Hyrax-type rapid palatal expanders (RPEs), also supported by mini-implants [ 16 ].…”

“…It has also been claimed that 3D printing provides greater opportunities for the customization of intraoral and extraoral devices [ 1 , 5 , 6 , 7 , 8 ].…”

Effectiveness of individualized 3D titanium-printed Orthognathic osteotomy guides and custom plates

“…CAD/CAM technology has enabled preoperative virtual simulation according to the treatment plan [ 5 ], while 3D printing technology plays a role in the application of virtual preoperative simulation to the surgical field. In addition, 3D-metal printing using selective laser sintering allows the fabrication of individualized bone fixation plates and bone reconstruction materials [ 6 , 7 ]. Although several studies have described computer-assisted virtual planning for orthognathic surgeries [ 8 - 11 ], the accurate application of the prefabricated device to the determined location during surgery remains a challenge, as does the lack of any evaluation of the effectiveness and accuracy of the 3D-printed plates and osteotomy guides to ensure they are correct for surgical implementation.…”