Three-Dimensional Printing: Custom-Made Implants for Craniomaxillofacial Reconstructive Surgery

Abstract

Craniomaxillofacial reconstructive surgery is a challenging field. First it aims to restore primary functions and second to preserve craniofacial anatomical features like symmetry and harmony. Three-dimensional (3D) printed biomodels have been widely adopted in medical fields by providing tactile feedback and a superior appreciation of visuospatial relationship between anatomical structures. Craniomaxillofacial reconstructive surgery was one of the first areas to implement 3D printing technology in their practice. Biomodeling has been used in craniofacial reconstruction of traumatic injuries, congenital disorders, tumor removal, iatrogenic injuries (e.g., decompressive craniectomies), orthognathic surgery, and implantology. 3D printing has proven to improve and enable an optimization of preoperative planning, develop intraoperative guidance tools, reduce operative time, and significantly improve the biofunctional and the aesthetic outcome. This technology has also shown great potential in enriching the teaching of medical students and surgical residents. The aim of this review is to present the current status of 3D printing technology and its practical and innovative applications, specifically in craniomaxillofacial reconstructive surgery, illustrated with two clinical cases where the 3D printing technology was successfully used.

The use of 3D printing in cardiac surgery

“…Pre-surgical planning has also improved with technology, with preoperative 3D reconstruction of radiographic CT images, virtual simulation of surgery (7), and preparation for surgery using stereolithographic or 3D printed models (8), custom made surgical instruments (9) and patient-specific surgical implants (10). There are a number of surgical specialties where surgical planning, 3D printing and computer aided design are particularly relevant, namely specialties that involves reconstruction (11), such as craniofacial reconstruction surgery, orthopedic surgery, where the patient suffers from a defect usually due to congenital malformation, trauma or malignancy.…”

Identifying a commercially-available 3D printing process that minimizes model distortion after annealing and autoclaving and the effect of steam sterilization on mechanical strength

“…Keywords: 3D printing, 3D printing materials, Additive manufacturing, Annealing, Autoclave, Medical devices, Optimization, Sterilization, Surgical instruments, Polylactic acid Background 3D printing is currently used in the medical field for a wide variety of purposes, including printing patient-personalized anatomical models to guide surgeons preoperatively, creating in-house anatomical models for medical student and resident training, and printing surgical instruments, prostheses, and implants [1][2][3][4][5][6][7]. 3D printed models have already been adopted to plan surgeries in fields including, but not limited to, cardiothoracic, craniomaxillofacial, hepatic, neonatal, neurological, ophthalmologic, orthopaedic, and plastic surgery [8][9][10][11][12][13][14][15][16][17][18][19]. Therefore, the accuracy of 3D printed models becomes exceedingly important.…”

3D printing technology in orthodontics – review of current applications

“…A recently developed and reported application of 3D printing with biomaterials has taken place in the field of regenerative periodontal surgery to manufacture resorbable scaffolds, such as hydrogels [20]. Maxillofacial surgery has also profited from integrating 3D printing; it has been used to reconstruct bony structures of maxilla and mandible damaged by trauma or neoplasm by fabricating metal plates and customized implants [11,21]. Orthognathic procedures have also been a target for 3D printing application, since orthognathic surgery wafers may be fabricated by additive technologies [11,13,22].…”

“…Orthognathic procedures have also been a target for 3D printing application, since orthognathic surgery wafers may be fabricated by additive technologies [11,13,22]. Likewise, in case of general surgery, 3D printing of anatomical models serves as an important aid for maxillofacial surgeons in thorough surgery planning, which has been reported to result in reduced surgery time and improved functional and esthetic treatment outcomes [13,21]. On the other hand, in prosthodontics, 3D printing has been applied to fabricate individual impression trays, metal frameworks for removable dentures, fixed metal copings, mockups, and resin patterns for further conventional metal castings [22].…”