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

Abstract

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.

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

“…Metals 2020, 9, x FOR PEER REVIEW 2 of 31 0.7 mm. Moiduddin et al obtained a titanium zygomatic implant with the EBM technique, using Ti-6Al-4V ELI (extra low interstitial) powder [144]. The same author [145] compared different kinds of Ti-6Al-4V ELI mandibular implants for goats: EBM plate with mesh, EBM titanium plate without mesh and a commercial reconstruction plate.…”

Titanium Alloys and Titanium-Based Matrix Composites

“…The material was evaluated as a potential prosthetic biomaterial used for cortical bone replacement and compared with commercial, pure Ti used for bone replacement implants. Moiduddin et al [16] proposed an integrated system methodology for the reconstruction of complex zygomatic bone defects, using Ti-6Al-4V ELI alloy, comprising several steps, right from the patient scan to implant fabrication, while maintaining proper aesthetic and facial symmetry. Finally, it was concluded that a mirror-designed titanium implant (fabricated by the electron beam melting method) satisfies the aesthetic, functional, and mechanical properties for efficient zygomatic bone reconstruction.…”

Achieving the Minimum Roughness of Laser Milled Micro-Impressions on Ti 6Al 4V, Inconel 718, and Duralumin

“…Titanium alloy (Ti 6Al 4V), nickel alloy (Inconel 718), and aluminum alloy (AA 2024) are widely used materials in various engineering applications such as biomedical implants, aerospace, ship building, automotive, and many more as reported by Lupi et al [ 1 ], Nalli et al [ 2 ], and Wang et al [ 3 ]. The production of these materials in the form of near-net-shape products is extensively carried out through several means, especially selective laser melting (SLM) as adopted by Fan and Feng [ 4 ], and electron beam melting (EBM) used by Moiduddin et al [ 5 ]. The surface roughness of these produced alloys through the said processes is experienced to be very high.…”