|
|
INVITED REVIEW |
|
Year : 2014 | Volume
: 4
| Issue : 1 | Page : 9-18 |
|
3D modeling, custom implants and its future perspectives in craniofacial surgery
Jayanthi Parthasarathy
Department of Engineering, Director Engineering MedCAD Inc. Dallas TX 75226, USA
Date of Web Publication | 23-May-2014 |
Correspondence Address: Jayanthi Parthasarathy 1372 Todd Dr, Plano, TX 75023 USA
  | Check |
DOI: 10.4103/2231-0746.133065 PMID: 24987592
Custom implants for the reconstruction of craniofacial defects have gained importance due to better performance over their generic counterparts. This is due to the precise adaptation to the region of implantation, reduced surgical times and better cosmesis. Application of 3D modeling in craniofacial surgery is changing the way surgeons are planning surgeries and graphic designers are designing custom implants. Advances in manufacturing processes and ushering of additive manufacturing for direct production of implants has eliminated the constraints of shape, size and internal structure and mechanical properties making it possible for the fabrication of implants that conform to the physical and mechanical requirements of the region of implantation. This article will review recent trends in 3D modeling and custom implants in craniofacial reconstruction. Keywords: 3D modeling, implants, additive manufacturing, craniofacial surgery, porous titanium, PEEK implants, electron beam melting, patient specific implants, custom implants, CAD CAM surgery, CAD CAM implants
How to cite this article: Parthasarathy J. 3D modeling, custom implants and its future perspectives in craniofacial surgery. Ann Maxillofac Surg 2014;4:9-18 |
Introduction | |  |
Reconstruction of the craniofacial skeleton is extremely challenging even to the most experienced surgeon. Some of the critical factors that contribute to the complexity include anatomy, presence of vital structures adjacent to the affected part, uniqueness of each defect and chances of infection. In any craniofacial reconstruction whether secondary to trauma, ablative tumor resection, infection and congenital/developmental deformities, restoration of aesthetics and function is the primary goal and calls for precise pre-surgical planning and execution of the plan. Auto grafts are the gold standard for craniofacial skeletal reconstruction. However their use is limited by the availability of suitable donor site especially for large defects, additional expensive surgeries, tissue harvesting problems, donor site morbidity with an additional patient discomfort, chances of infection at both the recipient and donor sites, increased surgical time, resorption of the graft requiring secondary surgeries and the need for additionally skilled surgical team, which has led to the search of alloplastic material that would be suitable without the inherent problems. [1],[2],[3],[4],[5],[6] Craniofacial defects also have complex anatomical shapes that is hard to achieve intraoperatively by carving harvested bone from the donor site. Hence it would be very useful for the surgeon to be aided by standard practice and proven methods in engineering wherein, the design and performance of the reconstructed implants/prosthesis can be predicted with accuracy and precision.
Surgeons have adapted to enhanced visualization techniques for close to two decades and even today this is an advancing field. Advantages of virtual reality can be totally beneficial only when transferred to the clinical scenario, i.e., the operatory to achieve expected results. Development of computer assisted design (CAD) and computer assisted manufacturing (CAM) systems that adapt to the surgeons needs has resulted in a gamut of the armamentarium for computer assisted surgery. Such systems specifically focus on enhanced visualization tools - 3D modeling or better termed as virtual reality and gives the surgeon the ability for precise preoperative planning and perform virtual osteotomies resections and design patient specific implants preoperatively. These virtual models can be imported into an intraoperative navigation system for precise placement of bone segments, implants and hardware. Advances in manufacturing technology and material science has led to the possibility of turning such virtual model or design into reality as physical replica models, surgical guides or cutting jigs or splints for intraoperative use and patient specific implants.
The success and longevity of implants depend upon factors like material characteristics, design of the implant and the surgeon's skill. Advances in image processing and manufacturing technologies have made it possible for the surgeons to have hand held models for a tactile perception of the defect. The next level of automation has brought in fabrication of custom designed implants as the best option for reconstruction of craniofacial defects. Custom implants for the reconstruction of craniofacial defects have recently gained importance due to their better performance over their generic counterparts. This is attributed to, the precise adaptation to the region of implantation, that reduces surgical times, in turn leading to lesser chances for infection, faster recovery and better cosmesis in craniofacial surgery. [7],[8],[9]
Enhancements in recent years have been in the area of design, materials and manufacturing process for craniofacial implants. Use of the haptic device introduced a decade ago, and 3D visualization has given the graphic designer the capability to design these implants more aesthetically enhancing the cosmetic outcome of custom implants. Availability of multitude materials as, autologous bone flaps, titanium, polymethylmethacrylate (PMMA), bioceramics as hydroxyapatite (HA), polyethylene, biodegradable polymers that have been used for craniofacial reconstruction give the surgeon many options to choose from. Recent introduction of direct digital manufacturing technologies that enable the fabrication of porous implants with lattice and solid structures in one go from patient specific data has opened up a new horizon for the next generation of craniofacial implants.
CAD/CAM systems have enabled us the ability to design and manufacture custom implants at an acceptable cost in a reasonable time. Additive manufacturing technologies as stereolithography (SLA), polyjet, fused deposition modeling; 3D printing, selective laser melting (SLM), selective laser sintering (SLS) and electron beam melting (EBM) lend themselves to manufacturing of complex anatomic parts without any barriers of design constraints including lattice structures. SLS, SLM and EBM use biocompatible implantable materials as titanium, Ti6Al4V, chrome cobalt and polyetheretherketone (PEEK) and facilitate the direct production of implants with engineered properties that match properties of the tissues at the region of implantation. Surgeons can now have access to the facilities service providers.
The process flow | |  |
The complete process flow for CAD/CAM generated implants is shown in [Figure 1] and is described briefly below. | Figure 1: Process flow for design and manufacture of computer assisted design/computer assisted manufacturing generated implants
Click here to view |
The process generally known as reverse engineering in the engineering world starts with acquiring computed tomography (CT)/magnetic resonance imaging 2D image data as digital imaging and communications in medicine (DICOM) files. The DICOM data is then processed using software as MIMICS, Biobuild, 3D Doctor to name some to create a 3D model of the anatomy depicting the defect. The 3D model file is then imported into design software which could be either a haptic based environment as Freeform® Geomagic or CAD based one as 3 Matic™ from materialize to create the final implant design. The implant is then manufactured by machining a block of material (subtractive manufacturing) or by adding material layer by layer and fusion of the layers (additive manufacturing).
The process of 3D modeling and custom implants is continuously evolving with advancements in the design and manufacturing worlds. This article will review the recent literature on 3D Modeling and recent advances in custom implants in cranial, skull base, zygomatic orbital, midface, mandible reconstruction, orthognathic surgery and treatment of the syndromized patient more specifically in relation to application of CAD/CAM technologies craniofacial reconstruction with respect to various materials and also include the author's 15 years' experience in 3D modeling and design and manufacturing of custom implants and discuss future perspectives. A systematic search on National Library of Medicine (PubMed/Medlinehttp://www.ncbi.nlm.nih.gov/pubmed) for related articles with search criteria as 3D modeling, custom craniofacial implants, orbital implants, CAD/CAM craniofacial applications and computer assisted craniofacial surgery was performed. Articles related to 3D modeling, custom/patient specific implants in craniofacial surgery using various materials were chosen for review.
CAD/CAM in cranioplasty
Cranioplasty is the procedure of choice for treating cranial defects commonly caused by trauma, tumor removal or decompressive craniotomies. The main goal of cranioplasty is to protect the brain and alleviate psychological affliction caused by the defect and enhance social performance of the patients. Hence the ideal cranial implant material would fit the cranial defect and achieve complete closure, be, radiolucent - for postoperative imaging, resistant to infections, strong to biomechanical processes, easy to shape, not expensive and ready to use. The following paragraphs highlight the advantages of 3D modeling and custom implant manufacturing in cranioplasty that allows the surgeon to use the material of his choice.
Titanium
Titanium has been a material of choice for cranioplasty due to its biocompatibility, strength to weight ratio and osseo integrative property. Titanium in various forms as sheets, mesh have been in use for sometime more recently with the advent of EBM or direct metal laser sintering (DMLS) 3D printed cranial implants has come into vogue.
Titanium mesh reconstruction is a popular method among the surgeons due to the ability to use the preformed mesh as a template for resection. However, the strength of a thin dynamic mesh that can be molded intraoperatively at times requires to be enhanced with PMMA.
In recent years the model of the cranium with the defect is fabricated using 3D printing technologies and used as a replica or template of the actual region of interest depicting the precise defect. A secondary processing method as forming is used to produce the actual implant. [6],[10] This process delivers a well-fitting prosthesis and is very useful in treating large cranial defects with advantages of reduced, operating time, healing time and hospitalization period, eventually leading to reduced cost to the patient. However, the process involves fabrication of the rapid prototyping (RP) model at an additional cost and time. [Figure 2] shows a large titanium mesh cranioplasty implant and the same being fitted in surgery. | Figure 2: (a) Titanium mesh implant fitted to the cranium model, (b) Intraoperative fixation of implant
Click here to view |
The technology was used to assess the temporalis thickness and include in the design of the implant for achieving best cosmetic results and prevent the "hourglass facial deformity." [11]
A long-term (6-12 years) evaluation of CAD/CAM titanium cranioplasty of 26 patients with large cranial defects on a visual analog scale showed that none of the implants required removal, and all patients would have chosen cranioplasty again and had stated improvement in their life-style. However the authors observed sub optimal follow-up imaging in four patients with meningioma. The authors concluded titanium to be material of choice for secondary reconstruction of large cranial defects resulting from decompressive craniectomies following trauma or infarction. [12] PMMA would be the choice for primary reconstruction when monitoring with postoperative imaging is needed. The technology has also been used as a one-step procedure for resection and reconstruction of skull base meningioma wherein, the authors used the preformed titanium plate as a template for resecting the cranium. [13]
In the very recent past ushering ushering of metal additive in manufacturing EBM and DMLS has introduced the direct fabrication of the implant without the need for the template. This next gen implants will aim to confirm to the normalized shape of the part it replaces, with mechanical properties being close to that of the region of implantation preventing stress shielding in load bearing regions, porous for bone ingrowth, have repeatable properties. [14],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24]
As mentioned earlier, a 3D digital model of the cranium is generated from the CT data. The virtual model is then used to create the implant design either by mirroring from the contralateral side or by generating curves based on the anatomical region with CAD based/haptic devices. The implant model is then sent to the EBM machine from ARCAM AB® or DMLS from electro optical systems (EOS) GmbH EOS. The software then creates layers of 2D images that are sent to the machine for solidification of the part from a bed of Ti6AlV4 powder layer by layer that finally creates an implant ready for implantation. EBM and DMLS technologies alleviate the need for a skull model or a secondary process to create a custom implant. [Figure 3] shows a patient specific porous titanium implant made using EBM and the same fitting to the model and intraoperative fixation of the implant. | Figure 3: (a) Patient specific porous titanium implant made using electron beam melting, (b) Implant fitting to the cranium model, (c) Intraoperative fixation of implant
Click here to view |
PMMA, bioceramics and other polymers
CAD/CAM technology has been used successfully to make PMMA implants as well. 3D models of cranial implants were designed from CT scan DICOM data and 3D printing technology is used to produce mold templates of the proposed implant, which was then used intraoperatively to quickly make the implant in the operatory. [25] Similarly, CT scan data was used to create an implant digital model and RP to produce silicon molds which were then used for creating patient specific cranial implant. [26] The authors concluded that custom-made implants for cranioplasty showed a significant improvement in morphology especially for repairing large and complex-shaped cranial defects. The authors further concluded technique may be useful for the bone reconstruction of other sites as well. Custom implants from polypropylene and polyester were made using a computerized numerical control (CNC) milled 3D model of the skull generated from CT scan data. [27] Stereolithographic or 3D printed models of skull defects generated from CT scan can be used as templates to fabricate porous bioceramic Hydroxy Apatite implants. 60 patients received these implants and were followed-up for 2 years. [28] Similar implants were designed in CAD with and manufactured using the SLA photo polymerization process. The material used was a combination of resin and HA powder. The final implant seen in [Figure 4] had surface porosity for tissue ingrowth. [29] | Figure 4: Porous resin and hydroxyapatite implant manufactured by stereolithography
Click here to view |
PEEK cranial implants
PEEK custom cranial implants are being used more in the current times. [30],[31] PEEK is a highly strong engineering thermoplastic, which retains its chemical and mechanical properties even at high temperatures. The material has high biocompatibility and biostability maintaining its physical and chemical characteristics on long-term exposure to body fluids. The modulus of elasticity of PEEK is similar to that of cortical bone, preventing any stress shielding making it a better choice over metallic implants that have high modulus of elasticity. PEEK is also radiolucent facilitating postoperative imaging procedures. Implants can be designed to replace exact anatomy even in bulky regions as the material is very light. The material can be repeatedly sterilized by common methods as autoclave, gamma or ethylene oxide. PEEK lends itself to machining of complex organic shapes very well. PEEK implants can be fixated to the adjacent bone with standard screws and plates of surgeons' choice. All the above mentioned characteristics have made PEEK the sought after material for cranial implants by manufacturers and surgeons in the recent past. In general, PEEK implants are made from a block of extruded material using a CNC machining. [Figure 5]a-c shows images of machined PEEK implant and the same being fixed to the cranium in surgery and postoperative X-ray imaging. PEEK implants can be used in non-load bearing regions of the craniofacial skeleton. PEEK can also be sintered to produce implants similar to the machined PEEK. [32] CAD designed PEEK custom implants have been used to correct cranial, frontal, malar and mandibular defects. [33],[34] | Figure 5: (a) Machined polyetheretherketone implant, (b) Intraoperative fixation to the cranium, (c) Postoperative X-ray imaging
Click here to view |
CAD/CAM in mandible reconstruction
The ultimate goal of mandibular reconstruction is to restore speech, masticatory function and facial form. Current reconstruction procedures combine mandible reconstruction plate fixation and use of micro vascular flaps.
Virtual pre bending of mandible recon plates
Intraoperative bending of plates can be time consuming. Bending reconstruction plates depends on the complexity of resection and surgeon's skill. Bending the plates on the 3D models fabricated using additive manufacturing technologies prior to the surgery reduces operating times. Some authors [35] have found saving of an average of 0.4 hr while others [36] in a study of 30 patients reported a 1.4 hrs reduction of operating times. Ideal positioning of mandibular segments, time saving by no intraoperative repeated bending and adapting of plates, use of the original surface of the cortical bone as a template for adapting the recon plate, facilitating the preoperative surgical simulation and restoration of centric occlusion of the patient were some of the benefits of virtual surgical planning and construction. [37],[38] In a study, wherein five oral and maxilla facial surgeons adapted a standard 10-hole Compact UniLock 2.4-mm large plates (Synthes) on stereolithographic models and virtual bending was done by importing and bending polygonal model of the same plate into standard CAD/CAM software, the author found statistically significant better adaptation of the virtual model compared with the physical model which favors manufacturing of patient specific pre bent plates. [39] The above studies concur with the previous observation of preoperative bending of plates may result in lesser bending stresses and may reduce the chances of postoperative plate breakage reported. [40] Computer aided planning simulated the surgical resection and laser sintered model derived from the plan and CT data for pre bending the reconstruction plate has been successfully used by some authors [Figure 6]. [41] | Figure 6: Virtual surgical planning and manufacturing of the guides for mandible reconstruction
Click here to view |
Virtual surgical planning for mandible reconstruction and micro vascular bone tissue grafting
Micro vascular bone tissue grafting for mid facial and mandible reconstruction has improved over years and gives the surgeon a new outlook in reconstruction of large craniofacial defects. Placement of dental implants on the revascularized grafts has made the procedure very attractive to surgeons and patients as well. However the large variety of donor sites, shape and complexity of the facial skeleton, harvesting the exact shape, precise positioning of the grafts are some of the pertinent problems that make traditional planning methods challenging even for the experienced surgeon. Added to the complexity many procedures involve a combination of custom implants and micro vascular osteocutaneous flaps for best results. Computer assisted planning techniques and guides generated out of the process go a long way in assisting the surgeon in achieving facial symmetry, preventing dystopia and implant based dental rehabilitation comfortably with reduced operating time and lesser chances for repeat surgeries. For mid facial reconstruction custom implants would be the preferred method and for the mandible the traditional recon plates can be used.
Process flow for virtual surgical planning and manufacturing of the guides is shown in [Figure 7] a-e. The process starts with 3D reconstruction of both the donor (fibula, scapula etc as the case may be) and recipient site maxilla/mandible. Virtual 3D models are generated depicting the pathological region in the recipient region and the vasculature in the donor region. The part to be resected is then determined and the part to be harvested is designed accordingly. Resection and harvesting guides are then designed taking the surgical needs like access to the operative site and vasculature reconstruction. The guide is then produced with 3D printing methods using a biocompatible material approved for the purpose that can be used in surgery for resection of the recipient site and harvesting the flap from the donor site. The guide is a 3D printed part and is generated in accordance to the resection/harvesting postoperative plan of the craniofacial skeletal structures and the donor site. The postoperative plan mandible model is used to adapt the recon plate. The surgeon then uses the guide on the harvested fibula and precisely cuts the segments for reconstruction. The surgical planning is performed planned over the internet and teleconsultations gives access to technology and expertise of surgeons all over the globe even in remote locations. | Figure 7: (a-e) Process plan for virtual surgical planning for fibula reconstruction of mandible (f) Fibula guide fitting to fibula bone model and (g) post op reconstructed mandible bone mode
Click here to view |
Virtual surgical planning with 3D models using preoperative CT data enables the use of the outer surface contour of the un operated mandible as a reference for positioning the plate if there is no expansion of the buccal plates. Cutting guides can be very precisely designed and made with biocompatible materials for intraoperative use for tumor resection as well as harvesting of fibula segments. Fibula segments harvested using such jigs is found to be repositioned in the mandible very precisely with minimal adjustments if necessary and are very useful in extensive mandible reconstructions where the maxillary mandible relation is completely lost in all 3 directions. A mathematical algorithm to derive an optimal position for bone grafting from the iliac crest for reconstruction of large mandible resection defects had also been made for teleconsultations of experts between Vienna and Switzerland and established the possibility of using the technology on a global basis. [42]
The world's first additive manufactured full mandible was implanted in a patient by Dr. Jules Poukens and his team in Belgium is seen in [Figure 8]. [43]
Reducing operating time is one of the key prognostic factors in free flap surgery. In addition, reduced blood loss, chances of postoperative infection [44] and perioperative cost are some other benefits of virtual surgical planning and cutting guides. [45] A new protocol for mandible for design and manufacture of custom cutting guides for complete ablative tumor resection of the mandible including the condyles has been described. [46] The surgical device consisted of two components a cutting guide and a titanium reconstructive bone plate and was designed as a patient specific device from the patients CT scan data. The cutting guides assisted precisely to transfer the virtually planned osteotomies to the surgical scenario. The bone plate was designed using the patient's anatomical data including the condyles. The authors found a reduction of operating time.
Restoration of masticatory function is very dependent on the basal bone position and relationship of the maxilla and mandible. To achieve a good anatomic contour and optimal placement of the flap for prosthetic rehabilitation the need for precise computer assisted planning, pre and postoperative simulation 3D models cannot be over emphasized. The use of stereolithographic models for planning complex maxilla and mandibular reconstruction and generation of surgical guides has been emphasized.
Patient specific dental implants for atrophic bone
In atrophic mandible standard diameter root form implants are a challenge and bone reconstructive surgery may not be the treatment of choice due to patient acceptance or other contraindications. In a 2 year study of five patients with severe posterior atrophy of mandible custom designed blade implants made using CAD/CAM technologies manufactured using RP technology - SLS were successfully placed. Subsequently, prosthesis was also constructed successfully and no rejection, infection or failure of the treatment was seen. [47] This opens-up a whole new concept for dental implant design and prosthetic reconstruction.
Construction of arch forms or space holders for grafts
3D printed model can be used to adapt arch forms or titanium space holders for bone grafts to be held in position until integration with the host bone takes place. [48] 3D models are reconstructed from the CT scan data. The defective region is ascertained and a surgical resection is planned. An ideal arch form is then constructed considering the shape and position of implants to achieve a good occlusion. A 3D printed model is then fabricated that forms a template for adapting the titanium mesh which will be used as the space holder. [Figure 9] and [Figure 10] show a 3D reconstruction of a maxilla and mandible and the arch form reconstruction that was used as a space holder. | Figure 9: 3D reconstruction of a mandible tumor and arch form reconstruction for adaptation of titanium mesh as graft space holder
Click here to view |
 | Figure 10: 3D reconstruction of a maxillary bone and arch form reconstruction for adaptation of titanium mesh as graft space holder
Click here to view |
Midface reconstruction
Midface reconstruction after extensive ablative tumor resection often, extends to the regions from the orbit to the alveolar bone, involves the nasal bone medially and may be unilateral and bilateral. The defects themselves have been classified as Class I-IV according to extension of the pathology. [49] The authors further also state there is no single flap procedure that can provide a solution for larger Class III defects. Smaller defects involving only the alveolar ridge can be corrected using ridge form plates and bone grafting, but larger defects require a combination of procedures as osteocutaneous flaps and patient specific implants that makes it more difficult to visualize the outcome. In order to achieve the best cosmetic and functional outcome some critical considerations for treatment of larger defects of the midface include soft-tissue reconstruction, establishment of connection between the residual alveolar bone and the zygomatic buttress, orbito-zygomatic complex reconstruction and alveolar ridge reconstruction for dental implant placement. Computer assisted 3D modeling and virtual surgical planning can give the surgeon a better understanding of the anatomy, osteotomies of the donor and recipient sites and planning of patient specific implants help precise placement of the bone graft in an optimum position for dental rehabilitation. Reconstruction of the orbital wall by mirroring data from the normal side has been described by several authors. [50],[51],[52],[53] A methodology for computer assisted surgical planning and custom titanium plates and mesh for midfacial reconstruction. 3D printed models have been used as a template to presurgically adapt a titanium mesh or plate to precisely fit the defects of the orbital wall a procedure that helps to reduce surgical time. [54],[55] Stereolithographic models fabricated from patient's CT have been used to reshape a sheet of titanium for creating patient specific implants for orbital floor reconstruction. [56] CAD design for the implant was derived from the CT scan data and orbital implants were machined in bio ceramic glass material (Bioverit II). [57] A similar design process was used and an implant was made from external hexagon compound an artificial bone like material approved by Food and Drug Administration of China. [58] A combination of CT scan data, virtual surgical planning and custom titanium implants and micro vascular flap reconstruction was used for treatment of an extensive maxillary resection extending from the orbital floor to the alveolus. Dental implant placement was also determined in the virtual surgical planning. The defective region was imaged and data from the contralateral side was mirrored with reference to the mid sagittal plane for correction of the defect. The scapula was used as the donor site and an optimized location for the graft that would satisfy the design of the alveolar reconstruction was determined with virtual surgical planning. The authors mention osteomyocutaneous flap and the titanium implant design were separated by virtue of the outlines. The titanium implant supporting the midfacial region was then fabricated. The titanium implant and the flap were fixated to the basal bone using traditional plates and screws. The scapula flap was then positioned in the predetermined optimum location for placement of dental implants. The dental implants were then placed later as a secondary procedure. Manufacturing the implants and designing the scapula flap is a major part of the process and the complete success depends on placing the implant and the graft in the predetermined 3dimensional location. Precise placement can be achieved with intraoperative navigational systems. The titanium implant in this case replaced the zygomatic bone and arch and the orbital walls in a close to original shape [Figure 11]. [59] | Figure 11: Maxillary defect reconstruction and the use of a titanium mesh as a temporary space holder for the graft[59]
Click here to view |
Maxillo mandibular impressions were taken with trial dentures and articulated to arrive at a precise dental implant placement to achieve correct occlusion and guides for fibula resection and dental implant placement was constructed. The guides were used for fibula resection and placement of dental implants. Postoperative stable functional occlusion and good aesthetics were achieved. The authors concluded "the incorporation of CAD-CAM technologies to this field has enabled the refinement of both the surgical and prosthetic phases through a holistic 3D evaluation of the target defect, simulation of the surgical reconstruction and prosthetic rehabilitation and effective transfer of the preoperative plan to the operating room." The authors further, impact on clinical outcome and ultimately patients' quality-of-life should favor the implementation and further development of this technology despite the additional cost [Figure 12]. [60] | Figure 12: (a and b) Midface reconstruction plan with fibula graft, (c) Dental implants placement in the fibula flap
Click here to view |
Corrective surgery and implant combined procedures
In some cases, a combination of custom implants and other corrective surgical procedures as fixation of salvageable large chunks of fractured bone as in blown out midfacial fractures are performed to restore the facial structure. [Figure 13] shows correction of a blown out maxillary fracture by repositioning and fixation of some of the large bone pieces and a PEEK custom implant. A bigger implant was made and modified in surgery as per requirements. This allowed the surgeon to use autologous bone to the maximum possible extent and limit the use of alloplastic material to the minimal extent required. The ease of modification of the implant intraoperatively allows the surgeon to make the final decision in surgery. | Figure 13: (a) Reconstructed blown out maxillary fracture, (b) Repositioning and fixation of some of the large bone segments, (c) Intraoperative fixation of polyetheretherketone implant
Click here to view |
Similarly orthognathic surgery can be used to reposition the maxilla/mandible and structural differences between the right and left sides can be corrected using custom implants made of PEEK or silicone material.
Craniofacial reconstruction of the syndromic patient
The syndromic patient exhibits multiple distinctive facial characteristics as hypertelorism, frontal bossing, midfacial hypo/hyperplasia, malar and zygomatic region abnormalities and micrognathia to name a few. 3D modeling and custom implants would be very helpful to the surgeon in reconstruction of such multiple abnormalities that co-exist specifically due to the fact that multiple surgeries have to be performed over time and combination of bone grafts from regions of the body and patient specific implants would be required to restore near normal esthetics and functions in a growing individual. Surgical guides for resection and templates are very useful tools for the reconstructive surgeon. Establishment of morphometric data for the hard and soft-tissues of various regions of the face like the zygomatic arch, nose, malar, mandible angle, symphysis and contour and pre surgical simulation can go a long way in precise designing of the template and guides for resection.
Successful reconstruction of the hypo plastic zygomatic and orbital region in Treacher Collins syndrome More Details (TCS) using normative morphometric data derived from computer generated 3D models has been reported. [61] Four patients with TCS in the ages of 6, 10, 14 and 20 were chosen for tomodensitometric studies. 40 controls who underwent CT scan for reasons unrelated to facial skeleton were chosen. In total 8 TCS and 80 control orbital and zygomatic volumes were derived for comparison. Ideal zygoma for the patient was then chosen by computer simulation. Cutting guides generated from the simulation were used for resection of bone graft and fabricated by RP. Positioning guides made by a similar method was used for placement of the bone graft or the alloplastic implant. The authors concluded that the process established a stable reproducible methodology for zygomatic reconstruction in TCS. As a next step the authors evaluated soft tissue morphometrics and found the variation between normal and patients affected by TCS and found the results to be very useful in analyzing the deficient regions and quantifying the extent of reconstruction. [62]
Future perspectives
Two directional advancements are slated to happen as the next steps. Design of the implants themselves are dictated by the anatomy, improvements in better fixation methods will be seen. Advances in virtual reality and 3D image based reconstruction will lead to faster data processing reducing processing times even more. Accessibility of real time navigation systems to more surgeons will see it being utilized for precise placements of complex shaped implants using virtual reality and enhanced visualization.
The success of any craniofacial reconstruction depends on the restoration of facial aesthetic form and functions of speech, deglutition and mastication for which dental rehabilitation is a key component. Today's solutions do give a provision for placement of dental implants in an osteocutaneous flap. We also see there is a wide range of difference in the mechanical properties between the load bearing titanium tray and the bone graft and the dental implant itself. The future will see the ushering in of a new generation of porous metal-polymer hybrid direct manufactured implants with, mechanical properties close to the bone, replaced partially or completely by native tissue ingrowth withstanding the masticatory stresses. All the above mentioned functional requirements would be combined with replacing the lost anatomical structure.
Any specialty emerges as per needs of the end user. Engineers and Surgeons are leading towards the emergence of a new specialization as bio CAD/CAM that will make possible emergence of patient specific implants that will replicate not only form as it is today but also have mechanical, chemical and physiological properties similar to native tissues they replace and provide an environment for cell differentiation and growth.
Common biomaterials currently used have not changed much overtime even with the ushering in of bio ceramics that are osteoconductive and biopolymers that have mechanical properties closer to natural tissues. There is no one material that can provide a complete solution. The future is regenerative medicine that allows for growth of natural tissues similar to the region of implantation. Advances in material science and synthesis of bone and tissues will lead to a new generation of designer implants that can be named as "integratable implants made for you." Additive manufacturing which takes manufacturing to a whole new direction without the boundaries of shape and structure and create parts with repeatability will be the future of custom implants manufacture and will widen the spectrum of materials suitable for the purpose. To summarize the future will see more combination alloplastic and autologous materials being used in conjunction to create the next generation craniofacial implants.
Acknowledgments | |  |
The author gratefully acknowledges the support given by Nancy Hairston President Med CAD Dallas, USA in the preparation of this article. The author also acknowledges Prof. Raman and Prof. Starly, University of Oklahoma School of Industrial Engineering and Prof. Jebaraj and Dr. Gowri, College of Engineering Guindy, Chennai India for the knowledge and experience imparted in biomedical applications of 3D modeling and RP during her Doctoral and Master's program respectively.
References | |  |
1. | Shimko DA, Nauman EA. Development and characterization of a porous poly (methyl methacrylate) scaffold with controllable modulus and permeability. J Biomed Mater Res B Appl Biomater 2007;80:360-9.  |
2. | Schlickewei W, Schlickewei C. The use of bone substitutes in the treatment of bone defects-The clinical view and history. Macromol Symp 2007;253:10-23.  |
3. | Lane JM, Sandhu HS. Current approaches to experimental bone grafting. Orthop Clin North Am 1987;18:213-25.  [PUBMED] |
4. | St John TA, Vaccaro AR, Sah AP, Schaefer M, Berta SC, Albert T, et al. Physical and monetary costs associated with autogenous bone graft harvesting. Am J Orthop (Belle Mead NJ) 2003;32:18-23.  |
5. | Silber JS, Anderson DG, Daffner SD, Brislin BT, Leland JM, Hilibrand AS, et al. Donor site morbidity after anterior iliac crest bone harvest for single-level anterior cervical discectomy and fusion. Spine (Phila Pa 1976) 2003;28:134-9.  |
6. | Parthasarathy J, Parthiban JK. Rapid Prototyping in Custom Fabrication of Titanium Mesh Implants for Large Cranial Defects. RAPID, May 20-22. TP08PUB117 Lake Buena Vista, FL, USA: Society of Manufacturing Engineers; 2008.  |
7. | Connell H, Statham P, Collie D, Walker F, Moos K. Use of a template for custom cranioplasty. Phidias - EC Funded Network Project on Rapid Prototyping in Medicine 1999;2:7-8.  |
8. | D'Urso PS, Earwaker WJ, Barker TM, Redmond MJ, Thompson RG, Effeney DJ, et al. Custom cranioplasty using stereolithography and acrylic. Br J Plast Surg 2000;53:200-4.  |
9. | Lee MY, Chang CC, Lin CC, Lo LJ, Chen YR. Custom implant design for patients with cranial defects. IEEE Eng Med Biol Mag 2002;21:38-44.  |
10. | Chen JJ, Liu W, Li MZ, Wang CT. Digital manufacture of titanium prosthesis for cranioplasty. Int J Adv Manuf Technol 2006;27:1148-52.  |
11. | Scholz M, Wehmöller M, Lehmbrock J, Schmieder K, Engelhardt M, Harders A, et al. Reconstruction of the temporal contour for traumatic tissue loss using a CAD/CAM-prefabricated titanium implant-case report. J Craniomaxillofac Surg 2007;35:388-92.  |
12. | Cabraja M, Klein M, Lehmann TN. Long-term results following titanium cranioplasty of large skull defects. Neurosurg Focus 2009;26:E10.  |
13. | Schebesch KM, Höhne J, Gassner HG, Brawanski A. Preformed titanium cranioplasty after resection of skull base meningiomas-A technical note. J Craniomaxillofac Surg 2013;41:803-7.  |
14. | Parthasarathy J, Starly B, Raman S. Design of Patient-Specific Porous Titanium Implants for Craniofacial Applications. RAPID, May 20-22. TP08PUB116. Lake Buena Vista, FL, USA: Society of Manufacturing Engineers; 2008.  |
15. | Parthasarathy J, Starly B, Raman S. Computer aided bio-modeling and analysis of patient specific porous titanium mandibular implants. J Med Device 2009;3:3.  |
16. | Parthasarathy J, Starly B, Raman S. Patient specific craniofacial implants. In: Medical Manufacturing Year Book. 1 SME Drive Dearborn, MI: Society of Manufacturing Engineers; 2009. p. 39-43.  |
17. | Parthasarathy J, Starly B, Raman S. A design for the additive manufacture of functionally graded porous structures with tailored mechanical properties for biomedical applications. J Manuf Process 2011;13:2.  |
18. | Parthasarathy J, Starly B, Raman S, Christensen A. Mechanical evaluation of porous titanium (Ti6Al4V) structures with electron beam melting (EBM). J Mech Behav Biomed Mater 2010;3:249-59.  |
19. | Lopez-Heredia MA, Goyenvalle E, Aguado E, Pilet P, Leroux C, Dorget M, et al. Bone growth in rapid prototyped porous titanium implants. J Biomed Mater Res A 2008;85:664-73.  |
20. | Li X, Feng YF, Wang CT, Li GC, Lei W, Zhang ZY, et al. Evaluation of biological properties of electron beam melted Ti6Al4V implant with biomimetic coating in vitro and in vivo. PLoS One 2012;7:e52049.  |
21. | Abdelaal OA, Darwish SM. Review of rapid prototyping techniques for tissue engineering scaffolds fabrication. Adv Structured Mater 2013;29:33-54.  |
22. | Palmquist A, Snis A, Emanuelsson L, Browne M, Thomsen P. Long-term biocompatibility and osseointegration of electron beam melted, free-form-fabricated solid and porous titanium alloy: Experimental studies in sheep. J Biomater Appl 2013;27:1003-16.  |
23. | Sallica-Leva E, Jardini AL, Fogagnolo JB. Microstructure and mechanical behavior of porous Ti-6Al-4V parts obtained by selective laser melting. J Mech Behav Biomed Mater 2013;26:98-108.  |
24. | Xiong Y, Qian C, Sun J. Fabrication of porous titanium implants by three-dimensional printing and sintering at different temperatures. Dent Mater J 2012;31:815-20.  |
25. | Gerber N, Stieglitz L, Peterhans M, Nolte LP, Raabe A, Weber S. Using rapid prototyping molds to create patient specific polymethylmethacrylate implants in cranioplasty. Conf Proc IEEE Eng Med Biol Soc 2010;2010:3357-60.  |
26. | Rotaru H, Stan H, Florian IS, Schumacher R, Park YT, Kim SG, et al. Cranioplasty with custom-made implants: Analyzing the cases of 10 patients. J Oral Maxillofac Surg 2012;70:e169-76.  |
27. | Chrzan R, Urbanik A, Karbowski K, Moska³a M, Polak J, Pyrich M. Cranioplasty prosthesis manufacturing based on reverse engineering technology. Med Sci Monit 2012;18:MT1-6.  |
28. | Staffa G, Barbanera A, Faiola A, Fricia M, Limoni P, Mottaran R, et al. Custom made bioceramic implants in complex and large cranial reconstruction: A two-year follow-up. J Craniomaxillofac Surg 2012;40:e65-70.  |
29. | Brie J, Chartier T, Chaput C, Delage C, Pradeau B, Caire F, et al. A new custom made bioceramic implant for the repair of large and complex craniofacial bone defects. J Craniomaxillofac Surg 2013;41:403-7.  |
30. | Chacón-Moya E, Gallegos-Hernández JF, Piña-Cabrales S, Cohn-Zurita F, Goné-Fernández A. Cranial vault reconstruction using computer-designed polyetheretherketone (PEEK) implant: Case report. Cir Cir 2009;77:437-40.  |
31. | Foletti JM, Lari N, Dumas P, Compes P, Guyot L. PEEK customized implant for skull esthetic reconstruction. Rev Stomatol Chir Maxillofac 2012;113:468-71.  |
32. | Manning L. Additive manufacturing used to create first laser-sintered cranial implant geometry. Adv Mater Processes September 2012;33-35.  |
33. | Scolozzi P. Maxillofacial reconstruction using polyetheretherketone patient-specific implants by "mirroring" computational planning. Aesthetic Plast Surg 2012;36:660-5.  [PUBMED] |
34. | Camarini ET, Tomeh JK, Dias RR, da Silva EJ. Reconstruction of frontal bone using specific implant polyether-ether-ketone. J Craniofac Surg 2011;22:2205-7.  |
35. | Lethaus B, Poort L, Böckmann R, Smeets R, Tolba R, Kessler P. Additive manufacturing for microvascular reconstruction of the mandible in 20 patients. J Craniomaxillofac Surg 2012;40:43-6.  |
36. | Hanasono MM, Skoracki RJ. Improving the speed and accuracy of mandibular reconstruction using preoperative virtual planning and rapid prototype modeling. Plast Reconstr Surg 2010;125:80.  |
37. | Ciocca L, De Crescenzio F, Fantini M, Scotti R. CAD/CAM and rapid prototyped scaffold construction for bone regenerative medicine and surgical transfer of virtual planning: A pilot study. Comput Med Imaging Graph 2009;33:58-62.  |
38. | Leiggener C, Messo E, Thor A, Zeilhofer HF, Hirsch JM. A selective laser sintering guide for transferring a virtual plan to real time surgery in composite mandibular reconstruction with free fibula osseous flaps. Int J Oral Maxillofac Surg 2009;38:187-92.  |
39. | Dérand P, Hirsch JM. Virtual bending of mandibular reconstruction plates using a computer-aided design. J Oral Maxillofac Surg 2009;67:1640-3.  |
40. | Martola M, Lindqvist C, Hänninen H, Al-Sukhun J. Fracture of titanium plates used for mandibular reconstruction following ablative tumor surgery. J Biomed Mater Res B Appl Biomater 2007;80:345-52.  |
41. | Hallermann W, Olsen S, Bardyn T, Taghizadeh F, Banic A, Iizuka T. A new method for computer-aided operation planning for extensive mandibular reconstruction. Plast Reconstr Surg 2006;117:2431-7.  |
42. | Juergens P, Krol Z, Zeilhofer HF, Beinemann J, Schicho K, Ewers R, et al. Computer simulation and rapid prototyping for the reconstruction of the mandible. J Oral Maxillofac Surg 2009;67:2167-70.  |
43. | Available from: http://www.xilloc.com/patients/stories/total-mandibular-implant/ [Last accessed on 2013 Jul 7].  |
44. | Rosenberg AJ, Van Cann EM, van der Bilt A, Koole R, van Es RJ. A prospective study on prognostic factors for free-flap reconstructions of head and neck defects. Int J Oral Maxillofac Surg 2009;38:666-70.  |
45. | Macario A, Vitez TS, Dunn B, McDonald T. Where are the costs in perioperative care? Analysis of hospital costs and charges for inpatient surgical care. Anesthesiology 1995;83:1138-44.  |
46. | Ciocca L, Mazzoni S, Fantini M, Persiani F, Marchetti C, Scotti R. CAD/CAM guided secondary mandibular reconstruction of a discontinuity defect after ablative cancer surgery. J Craniomaxillofac Surg 2012;40:e511-5.  |
47. | Mangano F, Bazzoli M, Tettamanti L, Farronato D, Maineri M, Macchi A, et al. Custom-made, selective laser sintering (SLS) blade implants as a non-conventional solution for the prosthetic rehabilitation of extremely atrophied posterior mandible. Lasers Med Sci 2013;28:1241-7.  |
48. | Hou JS, Chen M, Pan CB, Wang M, Wang JG, Zhang B, et al. Application of CAD/CAM-assisted technique with surgical treatment in reconstruction of the mandible. J Craniomaxillofac Surg 2012;40:e432-7.  |
49. | Brown JS, Shaw RJ. Reconstruction of the maxilla and midface: Introducing a new classification. Lancet Oncol 2010;11:1001-8.  |
50. | Bell RB, Markiewicz MR. Computer-assisted planning, stereolithographic modeling, and intraoperative navigation for complex orbital reconstruction: A descriptive study in a preliminary cohort. J Oral Maxillofac Surg 2009;67:2559-70.  |
51. | Tang W, Guo L, Long J, Wang H, Lin Y, Liu L, et al. Individual design and rapid prototyping in reconstruction of orbital wall defects. J Oral Maxillofac Surg 2010;68:562-70.  |
52. | Zhang Y, He Y, Zhang ZY, An JG. Evaluation of the application of computer-aided shape-adapted fabricated titanium mesh for mirroring-reconstructing orbital walls in cases of late post-traumatic enophthalmos. J Oral Maxillofac Surg 2010;68:2070-5.  |
53. | Kokemueller H, Tavassol F, Ruecker M, Gellrich NC. Complex midfacial reconstruction: A combined technique of computer-assisted surgery and microvascular tissue transfer. J Oral Maxillofac Surg 2008;66:2398-406.  |
54. | Kozakiewicz M, Elgalal M, Loba P, Komuñski P, Arkuszewski P, Broniarczyk-Loba A, et al . Clinical application of 3D pre-bent titanium implants for orbital floor fractures. J Craniomaxillofac Surg 2009;37:229-34.  |
55. | Kozakiewicz M, Elgalal M, Piotr L, Broniarczyk-Loba A, Stefanczyk L. Treatment with individual orbital wall implants in humans-1-Year ophthalmologic evaluation. J Craniomaxillofac Surg 2011;39:30-6.  |
56. | Lieger O, Richards R, Liu M, Lloyd T. Computer-assisted design and manufacture of implants in the late reconstruction of extensive orbital fractures. Arch Facial Plast Surg 2010;12:186-91.  |
57. | Klein M, Glatzer C. Individual CAD/CAM fabricated glass-bioceramic implants in reconstructive surgery of the bony orbital floor. Plast Reconstr Surg 2006;117:565-70.  |
58. | Cao D, Yu Z, Chai G, Liu J, Mu X. Application of EH compound artificial bone material combined with computerized three-dimensional reconstruction in craniomaxillofacial surgery. J Craniofac Surg 2010;21:440-3.  |
59. | Mertens C, Löwenheim H, Hoffmann J. Image data based reconstruction of the midface using a patient-specific implant in combination with a vascularized osteomyocutaneous scapular flap. J Craniomaxillofac Surg 2013;41:219-25.  |
60. | Rohner D, Guijarro-Martínez R, Bucher P, Hammer B. Importance of patient-specific intraoperative guides in complex maxillofacial reconstruction. J Craniomaxillofac Surg 2013;41:382-90.  |
61. | Herlin C, Doucet JC, Bigorre M, Khelifa HC, Captier G. Computer-assisted midface reconstruction in Treacher Collins syndrome part 1: Skeletal reconstruction. J Craniomaxillofac Surg 2013;41:670-5.  |
62. | Herlin C, Doucet JC, Bigorre M, Captier G. Computer-assisted midface reconstruction in Treacher Collins syndrome part 2: Soft tissue reconstruction. J Craniomaxillofac Surg 2013;41:676-80.  |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13]
This article has been cited by | 1 |
An improved process for the fabrication and surface treatment of custom-made titanium cranioplasty implants informed by surface analysis |
|
| Milovan Joe Cardona,Catherine Turner,Calum Ross,Elaine Baird,Richard Anthony Black | | Journal of Biomaterials Applications. 2021; 35(6): 602 | | [Pubmed] | [DOI] | | 2 |
Impact of technology in temporomandibular joint reconstruction surgeries: A systematic review |
|
| Sumit Kumar,Vikram Khanna,Balendra P. Singh,Divya Mehrotra,Ranjit K. Patil | | Journal of Plastic, Reconstructive & Aesthetic Surgery. 2021; | | [Pubmed] | [DOI] | | 3 |
Synthetic skull bone defects for automatic patient-specific craniofacial implant design |
|
| Jianning Li,Christina Gsaxner,Antonio Pepe,Ana Morais,Victor Alves,Gord von Campe,Jürgen Wallner,Jan Egger | | Scientific Data. 2021; 8(1) | | [Pubmed] | [DOI] | | 4 |
Development of customized implant and customized surgical osteotomy guide in ablative tumor surgery for accurate mandibular reconstruction |
|
| Sandeep Dahake,Abhaykumar Kuthe,Mahesh Mawale,Pranav Sapkal,Ashutosh Bagde,Subodh Daronde,Manish Kamble,Bhupesh Sarode | | The International Journal of Medical Robotics and Computer Assisted Surgery. 2020; | | [Pubmed] | [DOI] | | 5 |
Patient-Specific Mandibular Reconstruction Plates Increase Accuracy and Long-Term Stability in Immediate Alloplastic Reconstruction of Segmental Mandibular Defects |
|
| A. N. Zeller,M. T. Neuhaus,L. V. M. Weissbach,M. Rana,A. Dhawan,F. M. Eckstein,N. C. Gellrich,R. M. Zimmerer | | Journal of Maxillofacial and Oral Surgery. 2020; | | [Pubmed] | [DOI] | | 6 |
3D printed composite materials for craniofacial implants: current concepts, challenges and future directions |
|
| Swati Jindal,Faisal Manzoor,Niall Haslam,Elena Mancuso | | The International Journal of Advanced Manufacturing Technology. 2020; | | [Pubmed] | [DOI] | | 7 |
A design approach to facilitate selective attachment of bacteria and mammalian cells to additively manufactured implants |
|
| Victor M. Villapún,Luke N. Carter,Nan Gao,Owen Addison,Mark A. Webber,Duncan E.T. Shepherd,James W. Andrews,Morgan Lowther,Steven Avery,Sarah J. Glanvill,Liam M. Grover,Sophie Cox | | Additive Manufacturing. 2020; 36: 101528 | | [Pubmed] | [DOI] | | 8 |
Comparative Cost-Effectiveness of Cranioplasty Implants |
|
| Adam Binhammer,Josie Jakubowski,Oleh Antonyshyn,Paul Binhammer | | Plastic Surgery. 2020; 28(1): 29 | | [Pubmed] | [DOI] | | 9 |
Direct ink writing of ceramics for bio medical applications – A Review |
|
| Utsav Golcha,A S Praveen,D L Belgin Paul | | IOP Conference Series: Materials Science and Engineering. 2020; 912: 032041 | | [Pubmed] | [DOI] | | 10 |
Integrative and multi-disciplinary framework for the 3D rehabilitation of large mandibular defects |
|
| Khaja Moiduddin,Syed Hammad Mian,Naveed Ahmed,Wadea Ameen,Hisham Al-Khalefah,Muneer khan Mohammed,Usama Umer | | The International Journal of Advanced Manufacturing Technology. 2020; | | [Pubmed] | [DOI] | | 11 |
The Predictive Hole Technique: A technical note. |
|
| Mohammed Qaisi,Mohamed Ali Boukheir,Biraj Shah,James Murphy | | Journal of Oral and Maxillofacial Surgery. 2020; | | [Pubmed] | [DOI] | | 12 |
Feasibility and Efficiency of Sutureless End Enterostomy by Means of a 3D-Printed Device in a Porcine Model |
|
| Eric Sejor,Tarek Debs,Niccolo Petrucciani,Pauline Brige,Sophie Chopinet,Mylčne Seux,Marjorie Piche,Aline Myx-Staccini,Imed Ben Amor,Sebastien Frey,Frederic Prate,Arnaud Zenerino,Jean Gugenheim | | Surgical Innovation. 2020; 27(2): 203 | | [Pubmed] | [DOI] | | 13 |
Patient-Specific Surgical Implant Using Cavity-Filled Approach for Precise and Functional Mandible Reconstruction |
|
| Khaja Moiduddin,Syed Hammad Mian,Wadea Ameen,Mohammed Alkindi,Sundar Ramalingam,Osama Alghamdi | | Applied Sciences. 2020; 10(17): 6030 | | [Pubmed] | [DOI] | | 14 |
Innovations and Future Directions in Head and Neck Microsurgical Reconstruction |
|
| Marissa Suchyta,Samir Mardini | | Clinics in Plastic Surgery. 2020; 47(4): 573 | | [Pubmed] | [DOI] | | 15 |
ADDITIVE MANUFACTURING (3D PRINTING) METHODS AND APPLICATIONS IN DENTISTRY |
|
| Elif DEMIRALP,Gülsüm DOGRU,Handan YILMAZ | | Clinical and Experimental Health Sciences. 2020; | | [Pubmed] | [DOI] | | 16 |
Surgical Advances in the Management of the Silent Sinus Syndrome; Our Experience and Review of Literature |
|
| Mirza Zain Baig,Joanna F. Weber,Faiz Bhora,Al Haitham Al Shetawi | | Journal of Oral and Maxillofacial Surgery. 2020; | | [Pubmed] | [DOI] | | 17 |
Three-Dimensional Planning of the Mandibular Margin in Hemifacial Microsomia Using a Printed Patient-Specific Implant |
|
| Sebastian Igelbrink,Leonardo Matos Santolim Zanettini,Lauren Bohner,Johannes Kleinheinz,Susanne Jung | | Journal of Craniofacial Surgery. 2020; 31(8): 2297 | | [Pubmed] | [DOI] | | 18 |
Simplifying Facial Feminization Surgery Using Virtual Modeling on the Female Skull |
|
| Han Hoang,Anthony A. Bertrand,Allison C. Hu,Justine C. Lee | | Plastic and Reconstructive Surgery - Global Open. 2020; 8(3): e2618 | | [Pubmed] | [DOI] | | 19 |
Metallic additive manufacturing for bone-interfacing implants |
|
| Avik Sarker,Martin Leary,Kate Fox | | Biointerphases. 2020; 15(5): 050801 | | [Pubmed] | [DOI] | | 20 |
Physical–Mechanical Characteristics and Microstructure of Ti6Al7Nb Lattice Structures Manufactured by Selective Laser Melting |
|
| Cosmin Cosma,Igor Drstvensek,Petru Berce,Simon Prunean,Stanislaw Legutko,Catalin Popa,Nicolae Balc | | Materials. 2020; 13(18): 4123 | | [Pubmed] | [DOI] | | 21 |
Exploring Macroporosity of Additively Manufactured Titanium Metamaterials for Bone Regeneration with Quality by Design: A Systematic Literature Review |
|
| Daniel Martinez-Marquez,Ylva Delmar,Shoujin Sun,Rodney A. Stewart | | Materials. 2020; 13(21): 4794 | | [Pubmed] | [DOI] | | 22 |
A Reflection on the Use of Additive Manufacturing in Nephrology for Education and Surgical Planning |
|
| Azhar Equbal,Shahid Akhtar,Md.Asif Equbal | | Apollo Medicine. 2020; 17(4): 264 | | [Pubmed] | [DOI] | | 23 |
Reconstruction in head and neck cancer surgery: The ways we came through and the path ahead |
|
| Subramania Iyer | | Journal of Head and Neck Physicians and Surgeons. 2020; 8(1): 1 | | [Pubmed] | [DOI] | | 24 |
The role of virtual and augmented reality in orthopedic trauma surgery: From diagnosis to rehabilitation |
|
| José Negrillo-Cárdenas,Juan-Roberto Jiménez-Pérez,Francisco R. Feito | | Computer Methods and Programs in Biomedicine. 2020; : 105407 | | [Pubmed] | [DOI] | | 25 |
A retrospective descriptive study of cranioplasty failure rates and contributing factors in novel 3D printed calcium phosphate implants compared to traditional materials |
|
| Michael Koller,Daniel Rafter,Gillian Shok,Sean Murphy,Sheena Kiaei,Uzma Samadani | | 3D Printing in Medicine. 2020; 6(1) | | [Pubmed] | [DOI] | | 26 |
Intraoperative Feedback and Quality Control in Orbital Reconstruction |
|
| Ruud Schreurs,Frank Wilde,Alexander Schramm,Nils-Claudius Gellrich | | Atlas of the Oral and Maxillofacial Surgery Clinics. 2020; | | [Pubmed] | [DOI] | | 27 |
Replicating Skull Base Anatomy With 3D Technologies |
|
| Ricky Chae,Jeffrey D. Sharon,Ioannis Kournoutas,Sinem S. Ovunc,Minghao Wang,Adib A. Abla,Ivan H. El-Sayed,Roberto Rodriguez Rubio | | Otology & Neurotology. 2020; 41(3): e392 | | [Pubmed] | [DOI] | | 28 |
Clinical and volumetric outcomes after vertical ridge augmentation using computer-aided-design/computer-aided manufacturing (CAD/CAM) customized titanium meshes: a pilot study |
|
| Alessandro Cucchi,Alessandro Bianchi,Paolo Calamai,Lisa Rinaldi,Francesco Mangano,Elisabetta Vignudelli,Giuseppe Corinaldesi | | BMC Oral Health. 2020; 20(1) | | [Pubmed] | [DOI] | | 29 |
Polyester-based ink platform with tunable bioactivity for 3D printing of tissue engineering scaffolds |
|
| Shen Ji,Koustubh Dube,Julian P. Chesterman,Stephanie L. Fung,Chya-Yan Liaw,Joachim Kohn,Murat Guvendiren | | Biomaterials Science. 2019; | | [Pubmed] | [DOI] | | 30 |
Comparative assessment of anatomical details of thoracic limb bones of a horse to that of models produced via scanning and 3D printing |
|
| Daniela de Alcântara Leite dos Reis,Beatriz Laura Rojas Gouveia,José Carlos Rosa Júnior,Antônio Chaves de Assis Neto | | 3D Printing in Medicine. 2019; 5(1) | | [Pubmed] | [DOI] | | 31 |
Biomechanical Assessment of Design Parameters on a Self-Developed 3D-Printed Titanium-Alloy Reconstruction/Prosthetic Implant for Mandibular Segmental Osteotomy Defect |
|
| Sheng-Ni Huang,Ming-You Shie,Yen-Wen Shen,Jui-Ting Hsu,Heng-Li Huang,Lih-Jyh Fuh | | Metals. 2019; 9(5): 597 | | [Pubmed] | [DOI] | | 32 |
Titanium surface modifications and their soft-tissue interface on nonkeratinized soft tissues—A systematic review (Review) |
|
| Brandaan G. R. Zigterman,Casper Van den Borre,Annabel Braem,Maurice Y. Mommaerts | | Biointerphases. 2019; 14(4): 040802 | | [Pubmed] | [DOI] | | 33 |
Development of 18 Quality Control Gates for Additive Manufacturing of Error Free Patient-Specific Implants |
|
| Daniel Martinez-Marquez,Milda Jokymaityte,Ali Mirnajafizadeh,Christopher P. Carty,David Lloyd,Rodney A. Stewart | | Materials. 2019; 12(19): 3110 | | [Pubmed] | [DOI] | | 34 |
Review of additive manufacturing methods for high-performance ceramic materials |
|
| Jia-Chang Wang,Hitesh Dommati,Sheng-Jen Hsieh | | The International Journal of Advanced Manufacturing Technology. 2019; | | [Pubmed] | [DOI] | | 35 |
3D surface imaging of abdominal wall muscular contraction |
|
| Silvia Todros,Niccolň de Cesare,Silvia Pianigiani,Gianmaria Concheri,Gianpaolo Savio,Arturo N. Natali,Piero G. Pavan | | Computer Methods and Programs in Biomedicine. 2019; 175: 103 | | [Pubmed] | [DOI] | | 36 |
Effect of Dexamethasone on Room Temperature Three-Dimensional Printing, Rheology, and Degradation of a Low Modulus Polyester for Soft Tissue Engineering |
|
| Tanmay Jain,David Saylor,Charlotte Piard,Qianhui Liu,Viraj Patel,Rahul Kaushal,Jae-Won Choi,John Fisher,Irada Isayeva,Abraham Joy | | ACS Biomaterials Science & Engineering. 2019; | | [Pubmed] | [DOI] | | 37 |
Selective laser sintered mould for orbital cavity reconstruction |
|
| Marco Mandolini,Agnese Brunzini,Michele Germani,Steve Manieri,Alida Mazzoli,Mario Pagnoni | | Rapid Prototyping Journal. 2019; 25(1): 95 | | [Pubmed] | [DOI] | | 38 |
3D printing of polyether-ether-ketone for biomedical applications |
|
| Sunpreet Singh,Chander Prakash,Seeram Ramakrishna | | European Polymer Journal. 2019; 114: 234 | | [Pubmed] | [DOI] | | 39 |
An In Vivo Evaluation of Biocompatibility and Implant Accuracy of the Electron Beam Melting and Commercial Reconstruction Plates |
|
| Khaja Moiduddin,Syed Hammad Mian,Mohammed Alkindi,Sundar Ramalingam,Hisham Alkhalefah,Osama Alghamdi | | Metals. 2019; 9(10): 1065 | | [Pubmed] | [DOI] | | 40 |
Sol–gel-derived mineral scaffolds within SiO2–P2O5–CaO–MgO–ZnO–CaF2 system |
|
| Sorin-Ion Jinga,Izabela Constantinoiu,Vasile-Adrian Surdu,Florin Iordache,Cristina Busuioc | | Journal of Sol-Gel Science and Technology. 2019; | | [Pubmed] | [DOI] | | 41 |
Reliability and accuracy of skin-supported surgical templates for computer-planned craniofacial implant placement, a comparison between surgical templates: With and without bony fixation |
|
| J.P.J. Dings,L. Verhamme,T.J.J. Maal,M.A.W. Merkx,G.J. Meijer | | Journal of Cranio-Maxillofacial Surgery. 2019; | | [Pubmed] | [DOI] | | 42 |
Evaluation of the Suitability of Cranial Measurements Obtained from Surface-Rendered CT Scans of Living People for Estimating Sex and Ancestry |
|
| Terrie L. Simmons-Ehrhardt,Christopher J. Ehrhardt,Keith L. Monson | | Journal of Forensic Radiology and Imaging. 2019; : 100338 | | [Pubmed] | [DOI] | | 43 |
Preparation and Characterization for Antibacterial Activities of 3D Printing Polyetheretherketone Disks Coated with Various Ratios of Ampicillin and Vancomycin Salts |
|
| Ngi-Chiong Lau,Min-Hua Tsai,Dave W. Chen,Chien-Hao Chen,Kong-Wei Cheng | | Applied Sciences. 2019; 10(1): 97 | | [Pubmed] | [DOI] | | 44 |
Patient Specific Three-Dimensional Implant for Reconstruction of Complex Mandibular Defect |
|
| Vignesh U,Divya Mehrotra,Debraj Howlader,Praveen Kumar Singh,Sneha Gupta | | Journal of Craniofacial Surgery. 2019; 30(4): e308 | | [Pubmed] | [DOI] | | 45 |
Clinical Application of a Specific Simulation Software for 3-Dimensional Orbital Volume Modeling for Orbital Wall Reconstruction |
|
| Min Ji Kim,Woo Shik Jeong,Yun Hwan Kim,Hannah Kim,Hyunchul Cho,Youngjun Kim,Jong-Woo Choi | | Annals of Plastic Surgery. 2019; 83(1): 48 | | [Pubmed] | [DOI] | | 46 |
Limb-sparing in dogs using patient-specific, three-dimensional-printed endoprosthesis for distal radial osteosarcoma: A pilot study |
|
| Bernard Séguin,Chris Pinard,Bertrand Lussier,Deanna Williams,Lynn Griffin,Brendan Podell,Sebastian Mejia,Anatolie Timercan,Yvan Petit,Vladimir Brailovski | | Veterinary and Comparative Oncology. 2019; | | [Pubmed] | [DOI] | | 47 |
Semiautomated fabrication of a custom orbital prosthesis with 3-dimensional printing technology |
|
| So-Hyun Kim,Woo-Beom Shin,Seung-Woon Baek,Jin-Sook Yoon | | The Journal of Prosthetic Dentistry. 2019; | | [Pubmed] | [DOI] | | 48 |
Fabrication and Analysis of a Ti6Al4V Implant for Cranial Restoration |
|
| Khaja Moiduddin,Syed Hammad Mian,Usama Umer,Hisham Alkhalefah | | Applied Sciences. 2019; 9(12): 2513 | | [Pubmed] | [DOI] | | 49 |
Impact Optimization of 3D-Printed Poly(methyl methacrylate) for Cranial Implants |
|
| Sandra Petersmann,Martin Spoerk,Philipp Huber,Margit Lang,Gerald Pinter,Florian Arbeiter | | Macromolecular Materials and Engineering. 2019; : 1900263 | | [Pubmed] | [DOI] | | 50 |
Optimization of extrusion based ceramic 3D printing process for complex bony designs |
|
| Uday Kiran Roopavath,Sara Malferrari,Annemieke Van Haver,Frederik Verstreken,Subha Narayan Rath,Deepak M. Kalaskar | | Materials & Design. 2019; 162: 263 | | [Pubmed] | [DOI] | | 51 |
Amorphous Silicon Oxynitrophosphide Coated Implants Boost Angiogenic Activity of Endothelial Cells |
|
| FELIPE MONTE,Kamal R. Awad,Neelam Ahuja,Harry Kim,Pranesh Aswath,Marco Brotto,Venu G Varanasi | | Tissue Engineering Part A. 2019; | | [Pubmed] | [DOI] | | 52 |
Computer-aided methods for single-stage fibrous dysplasia excision and reconstruction in the zygomatico-orbital complex |
|
| Igor Budak,Aleksandar Kiralj,Mario Sokac,Zeljko Santosi,Dominic Eggbeer,Sean Peel | | Rapid Prototyping Journal. 2019; | | [Pubmed] | [DOI] | | 53 |
Virtual Surgical Planning in Craniofacial Surgery |
|
| Lindsey N. Teal,Kristopher M. Day | | Journal of Craniofacial Surgery. 2019; 30(8): 2459 | | [Pubmed] | [DOI] | | 54 |
In Vitro Biomechanical Simulation Testing of Custom Fabricated Temporomandibular Joint Parts Made of Electron Beam Melted Titanium, Zirconia, and Poly-Methyl Methacrylate |
|
| Mohammed Alkindi,Sundar Ramalingam,Khaja Moiduddin,Osama Alghamdi,Hisham Alkhalefah,Mohammed Badwelan | | Applied Sciences. 2019; 9(24): 5455 | | [Pubmed] | [DOI] | | 55 |
The Use of a Three-Dimensional Printed Model for Surgical Excision of a Vascular Lesion in the Head and Neck |
|
| Marek A. Paul,Jakub Opyrchal,Jan Witowski,Ahmed M.S. Ibrahim,Michal Knakiewicz,Pawel Jaremków | | Journal of Craniofacial Surgery. 2019; 30(6): e566 | | [Pubmed] | [DOI] | | 56 |
Reconstruction of Complex Zygomatic Bone Defects Using Mirroring Coupled with EBM Fabrication of Titanium Implant |
|
| Khaja Moiduddin,Syed Hammad Mian,Usama Umer,Naveed Ahmed,Hisham Alkhalefah,Wadea Ameen | | Metals. 2019; 9(12): 1250 | | [Pubmed] | [DOI] | | 57 |
Tissue Engineering and 3-Dimensional Modeling for Facial Reconstruction |
|
| Kyle K. VanKoevering,David A. Zopf,Scott J. Hollister | | Facial Plastic Surgery Clinics of North America. 2019; 27(1): 151 | | [Pubmed] | [DOI] | | 58 |
Correction of a Posttraumatic Orbital Deformity Using Three-Dimensional Modeling, Virtual Surgical Planning with Computer-Assisted Design, and Three-Dimensional Printing of Custom Implants |
|
| Kristopher M. Day,Paul M. Phillips,Larry A. Sargent | | Craniomaxillofacial Trauma & Reconstruction. 2018; 11(1): 078 | | [Pubmed] | [DOI] | | 59 |
Addressing Unmet Clinical Needs with 3D Printing Technologies |
|
| Udayan Ghosh,Shen Ning,Yuzhu Wang,Yong Lin Kong | | Advanced Healthcare Materials. 2018; : 1800417 | | [Pubmed] | [DOI] | | 60 |
Development of a custom zygomatic implant using metal sintering |
|
| Vijay Kumar Meena,Vidya Rattan,Gaurav Luthra,Parveen Kalra | | Rapid Prototyping Journal. 2018; | | [Pubmed] | [DOI] | | 61 |
3D scanning applications in medical field: A literature-based review |
|
| Abid Haleem,Mohd. Javaid | | Clinical Epidemiology and Global Health. 2018; | | [Pubmed] | [DOI] | | 62 |
Materiales reabsorbibles en el tratamiento de fracturas maxilofaciales pediátricas |
|
| Alex Bernardo Pimentel-Mendoza,Lazaro Rico-Pérez,Luis Jesús Villarreal-Gómez | | Revista de Ciencias Tecnológicas. 2018; 1(1): 1 | | [Pubmed] | [DOI] | | 63 |
Accuracy in dental surgical guide fabrication using different 3-D printing techniques |
|
| Mamta Juneja,Niharika Thakur,Dinesh Kumar,Ankur Gupta,Babandeep Bajwa,Prashant Jindal | | Additive Manufacturing. 2018; 22: 243 | | [Pubmed] | [DOI] | | 64 |
Implementation of Computer-Assisted Design, Analysis, and Additive Manufactured Customized Mandibular Implants |
|
| Khaja Moiduddin | | Journal of Medical and Biological Engineering. 2018; | | [Pubmed] | [DOI] | | 65 |
Applications of Computer Technology in Complex Craniofacial Reconstruction |
|
| Kristopher M. Day,Kyle S. Gabrick,Larry A. Sargent | | Plastic and Reconstructive Surgery - Global Open. 2018; 6(3): e1655 | | [Pubmed] | [DOI] | | 66 |
A 3-Dimensional–Printed Short-Segment Template Prototype for Mandibular Fracture Repair |
|
| Parul Sinha,Gary Skolnick,Kamlesh B. Patel,Gregory H. Branham,John J. Chi | | JAMA Facial Plastic Surgery. 2018; 20(5): 373 | | [Pubmed] | [DOI] | | 67 |
Software Framework for the Creation and Application of Personalized Bone and Plate Implant Geometrical Models |
|
| Nikola Vitkovic,Srdan Mladenovic,Milan Trifunovic,Milan Zdravkovic,Miodrag Manic,Miroslav Trajanovic,Dragan Mišic,Jelena Mitic | | Journal of Healthcare Engineering. 2018; 2018: 1 | | [Pubmed] | [DOI] | | 68 |
Three Dimensional Osteometric Analysis of Mandibular Symmetry and Morphological Consistency in Cats |
|
| Peter Southerden,Richard M. Haydock,Duncan M. Barnes | | Frontiers in Veterinary Science. 2018; 5 | | [Pubmed] | [DOI] | | 69 |
DESIGN OF A MAXILLOFACIAL PROSTHESIS BASED ON TOPOLOGY OPTIMIZATION |
|
| NING DAI,JIAN-FENG ZHU,MIN ZHANG,LING-YIN MENG,XIAO-LING YU1,YI-HUA ZHANG,BING-YAO LIU,SEN-LIN ZHANG | | Journal of Mechanics in Medicine and Biology. 2018; : 1850024 | | [Pubmed] | [DOI] | | 70 |
Curved-Layered Additive Manufacturing of non-planar, parametric lattice structures |
|
| John C.S. McCaw,Enrique Cuan-Urquizo | | Materials & Design. 2018; 160: 949 | | [Pubmed] | [DOI] | | 71 |
Perturbations of radiation field caused by titanium dental implants in pencil proton beam therapy |
|
| C Oancea,A Luu,I Ambrožová,G Mytsin,V Vondrácek,M Davídková | | Physics in Medicine & Biology. 2018; 63(21): 215020 | | [Pubmed] | [DOI] | | 72 |
Patient-Specific Surgical Implants Made of 3D Printed PEEK: Material, Technology, and Scope of Surgical Application |
|
| Philipp Honigmann,Neha Sharma,Brando Okolo,Uwe Popp,Bilal Msallem,Florian M. Thieringer | | BioMed Research International. 2018; 2018: 1 | | [Pubmed] | [DOI] | | 73 |
Augmented patient-specific facial prosthesis production using medical imaging modelling and 3D printing technologies for improved patient outcomes |
|
| Mazher I. Mohammed,Brenton Cadd,Greg Peart,Ian Gibson | | Virtual and Physical Prototyping. 2018; : 1 | | [Pubmed] | [DOI] | | 74 |
Surface characteristics and biocompatibility of cranioplasty titanium implants following different surface treatments |
|
| Muhanad M. Hatamleh,Xiaohong Wu,Ahmad Alnazzawi,Jason Watson,David Watts | | Dental Materials. 2018; 34(4): 676 | | [Pubmed] | [DOI] | | 75 |
The Influence of Selective Laser Melting (SLM) Process Parameters on In-Vitro Cell Response |
|
| Bartlomiej Wysocki,Joanna Idaszek,Joanna Zdunek,Krzysztof Rozniatowski,Marcin Pisarek,Akiko Yamamoto,Wojciech Swieszkowski | | International Journal of Molecular Sciences. 2018; 19(6): 1619 | | [Pubmed] | [DOI] | | 76 |
Image based simulation of the low dose computed tomography images suggests 13?mAs 120?kV suitability for non-syndromic craniosynostosis diagnosis without iterative reconstruction algorithms |
|
| Arijanda Neverauskiene,Mazena Maciusovic,Marius Burkanas,Birute Griciene,Linas Petkevicius,Linas Zaleckas,Algirdas Tamosiunas,Jonas Venius | | European Journal of Radiology. 2018; 105: 168 | | [Pubmed] | [DOI] | | 77 |
Enabling personalized implant and controllable biosystem development through 3D printing |
|
| Neerajha Nagarajan,Agnes Dupret-Bories,Erdem Karabulut,Pinar Zorlutuna,Nihal Engin Vrana | | Biotechnology Advances. 2018; | | [Pubmed] | [DOI] | | 78 |
Microstructure and mechanical properties of porous titanium structures fabricated by electron beam melting for cranial implants |
|
| Khaja Moiduddin | | Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine. 2018; 232(2): 185 | | [Pubmed] | [DOI] | | 79 |
Electron beam melting in the fabrication of three-dimensional mesh titanium mandibular prosthesis scaffold |
|
| Rongzeng Yan,Danmei Luo,Haitao Huang,Runxin Li,Niu Yu,Changkui Liu,Min Hu,Qiguo Rong | | Scientific Reports. 2018; 8(1) | | [Pubmed] | [DOI] | | 80 |
Recent advances in the reconstruction of cranio-maxillofacial defects using computer-aided design/computer-aided manufacturing |
|
| Ji-hyeon Oh | | Maxillofacial Plastic and Reconstructive Surgery. 2018; 40(1) | | [Pubmed] | [DOI] | | 81 |
Three-dimensional printing of patient-specific surgical plates in head and neck reconstruction: A prospective pilot study |
|
| Wei-fa Yang,Wing Shan Choi,Yiu Yan Leung,Justin Paul Curtin,Ruxu Du,Chun-yu Zhang,Xian-shuai Chen,Yu-xiong Su | | Oral Oncology. 2018; 78: 31 | | [Pubmed] | [DOI] | | 82 |
Challenges for Product Development of Orthopedic Implants |
|
| Jitesh Madhavi,Jayesh Dange,Vivek Sunnapwar | | SSRN Electronic Journal. 2017; | | [Pubmed] | [DOI] | | 83 |
Interactive reconstructions of cranial 3D implants under MeVisLab as an alternative to commercial planning software |
|
| Jan Egger,Markus Gall,Alois Tax,Muammer Ücal,Ulrike Zefferer,Xing Li,Gord von Campe,Ute Schäfer,Dieter Schmalstieg,Xiaojun Chen,Peter M.A. van Ooijen | | PLOS ONE. 2017; 12(3): e0172694 | | [Pubmed] | [DOI] | | 84 |
Innovations and Future Directions in Head and Neck Microsurgical Reconstruction |
|
| Marissa Suchyta,Samir Mardini | | Clinics in Plastic Surgery. 2017; 44(2): 325 | | [Pubmed] | [DOI] | | 85 |
A technique for evaluating bone ingrowth into 3D printed, porous Ti6Al4V implants accurately using X-ray micro-computed tomography and histomorphometry |
|
| Anders Palmquist,Furqan A. Shah,Lena Emanuelsson,Omar Omar,Felicia Suska | | Micron. 2017; 94: 1 | | [Pubmed] | [DOI] | | 86 |
Biomechanical Stress and Strain Analysis of Mandibular Human Region from Computed Tomography to Custom Implant Development |
|
| Rafael Ferreira Gregolin,Cecília Amelia de Carvalho Zavaglia,Ruís Camargo Tokimatsu,Joăo A. Pereira | | Advances in Materials Science and Engineering. 2017; 2017: 1 | | [Pubmed] | [DOI] | | 87 |
Treatment Options for Exposed Calvarium Due to Trauma and Burns |
|
| Samuel Golpanian,Wrood Kassira,Mutaz B. Habal,Seth R. Thaller | | Journal of Craniofacial Surgery. 2017; 28(2): 318 | | [Pubmed] | [DOI] | | 88 |
3D printed drug delivery devices: perspectives and technical challenges |
|
| Mirja Palo,Jenny Holländer,Jaakko Suominen,Jouko Yliruusi,Niklas Sandler | | Expert Review of Medical Devices. 2017; : 1 | | [Pubmed] | [DOI] | | 89 |
Screw extrusion-based additive manufacturing of PEEK |
|
| Jian-Wei Tseng,Chao-Yuan Liu,Yi-Kuang Yen,Johannes Belkner,Tobias Bremicker,Bernard Haochih Liu,Ta-Ju Sun,An-Bang Wang | | Materials & Design. 2017; | | [Pubmed] | [DOI] | | 90 |
Three-dimensional printing for craniomaxillofacial regeneration |
|
| Laura Gaviria,Joseph J. Pearson,Sergio A. Montelongo,Teja Guda,Joo L. Ong | | Journal of the Korean Association of Oral and Maxillofacial Surgeons. 2017; 43(5): 288 | | [Pubmed] | [DOI] | | 91 |
Additive manufacturing in maxillofacial reconstruction |
|
| Luciana Laura Dinca,Alexandra Banu,Aurelian Visan,N. Balc | | MATEC Web of Conferences. 2017; 137: 02001 | | [Pubmed] | [DOI] | | 92 |
Clinical outcomes of patient-specific porous titanium endoprostheses in dogs with tumors of the mandible, radius, or tibia: 12 cases (2013–2016) |
|
| Jonathan P. Bray,Andrew Kersley,Warwick Downing,Katherine R. Crosse,Andrew J. Worth,Arthur K. House,Guy Yates,Alastair R. Coomer,Ian W. M. Brown | | Journal of the American Veterinary Medical Association. 2017; 251(5): 566 | | [Pubmed] | [DOI] | | 93 |
Different post-processing conditions for 3D bioprinted a-tricalcium phosphate scaffolds |
|
| Liciane Sabadin Bertol,Rodrigo Schabbach,Luis Alberto Loureiro dos Santos | | Journal of Materials Science: Materials in Medicine. 2017; 28(10) | | [Pubmed] | [DOI] | | 94 |
Calvarial Defects: Cell-Based Reconstructive Strategies in the Murine Model |
|
| Matthew P. Murphy,Natalina Quarto,Michael T. Longaker,Derrick C. Wan | | Tissue Engineering Part C: Methods. 2017; | | [Pubmed] | [DOI] | | 95 |
Two different techniques of manufacturing TMJ replacements – a technical report |
|
| Marcin Kozakiewicz,Tomasz Wach,Piotr Szymor,Rafal Zielinski | | Journal of Cranio-Maxillofacial Surgery. 2017; | | [Pubmed] | [DOI] | | 96 |
3D printing and modelling of customized implants and surgical guides for non-human primates |
|
| Xing Chen,Jessy K. Possel,Catherine Wacongne,Anne F. van Ham,P. Christiaan Klink,Pieter R. Roelfsema | | Journal of Neuroscience Methods. 2017; 286: 38 | | [Pubmed] | [DOI] | | 97 |
Virtual surgical planning and 3D printing in repeat calvarial vault reconstruction for craniosynostosis: technical note |
|
| Melissa LoPresti,Bradley Daniels,Edward P. Buchanan,Laura Monson,Sandi Lam | | Journal of Neurosurgery: Pediatrics. 2017; : 1 | | [Pubmed] | [DOI] | | 98 |
Mechanical characterization of structurally porous biomaterials built via additive manufacturing: experiments, predictive models, and design maps for load-bearing bone replacement implants |
|
| D. Melancon,Z.S. Bagheri,R.B. Johnston,L. Liu,M. Tanzer,D. Pasini | | Acta Biomaterialia. 2017; | | [Pubmed] | [DOI] | | 99 |
Controversies in Traditional Oral and Maxillofacial Reconstruction |
|
| John S. Vorrasi,Antonia Kolokythas | | Oral and Maxillofacial Surgery Clinics of North America. 2017; 29(4): 401 | | [Pubmed] | [DOI] | | 100 |
Three-dimensional Cross-Platform Planning for Complex Spinal Procedures |
|
| Michael Kosterhon,Angelika Gutenberg,Sven R. Kantelhardt,Jens Conrad,Amr Nimer Amr,Joachim Gawehn,Alf Giese | | Clinical Spine Surgery. 2017; 30(7): E1000 | | [Pubmed] | [DOI] | | 101 |
Measuring and Establishing the Accuracy and Reproducibility of 3D Printed Medical Models |
|
| Elizabeth George,Peter Liacouras,Frank J. Rybicki,Dimitrios Mitsouras | | RadioGraphics. 2017; : 160165 | | [Pubmed] | [DOI] | | 102 |
Computer-aided position planning of miniplates to treat facial bone defects |
|
| Jan Egger,Jürgen Wallner,Markus Gall,Xiaojun Chen,Katja Schwenzer-Zimmerer,Knut Reinbacher,Dieter Schmalstieg,Jose Manuel Garcia Aznar | | PLOS ONE. 2017; 12(8): e0182839 | | [Pubmed] | [DOI] | | 103 |
Experimental investigation and constitutive modeling of the deformation behavior of Poly-Ether-Ether-Ketone at elevated temperatures |
|
| Bing Zheng,Haitao Wang,Zhigao Huang,Yi Zhang,Huamin Zhou,Dequn Li | | Polymer Testing. 2017; | | [Pubmed] | [DOI] | | 104 |
Standardized Protocol for Virtual Surgical Plan and 3-Dimensional Surgical Template–Assisted Single-Stage Mandible Contour Surgery |
|
| Xi Fu,Jia Qiao,Sabine Girod,Feng Niu,Jian feng Liu,Gordon K. Lee,Lai Gui | | Annals of Plastic Surgery. 2017; 79(3): 236 | | [Pubmed] | [DOI] | | 105 |
A digital design methodology for surgical planning and fabrication of customized mandible implants |
|
| Emad Abouel Nasr,Abdurahman Mushabab Al-Ahmari,Khaja Moiduddin,Mohammed Al Kindi,Ali K. Kamrani | | Rapid Prototyping Journal. 2017; 23(1): 101 | | [Pubmed] | [DOI] | | 106 |
Computer Assisted Design and Analysis of Customized Porous Plate for Mandibular Reconstruction |
|
| K. Moiduddin,S. Anwar,N. Ahmed,M. Ashfaq,A. Al-Ahmari | | IRBM. 2017; | | [Pubmed] | [DOI] | | 107 |
Multi and mixed 3D-printing of graphene-hydroxyapatite hybrid materials for complex tissue engineering |
|
| Adam E. Jakus,Ramille. N. Shah | | Journal of Biomedical Materials Research Part A. 2017; 105(1): 274 | | [Pubmed] | [DOI] | | 108 |
Influence of CT parameters on STL model accuracy |
|
| Maureen van Eijnatten,Ferco Henricus Berger,Pim de Graaf,Juha Koivisto,Tymour Forouzanfar,Jan Wolff | | Rapid Prototyping Journal. 2017; 23(4): 678 | | [Pubmed] | [DOI] | | 109 |
The use of 3D-printed titanium mesh tray in treating complex comminuted mandibular fractures |
|
| Junli Ma,Limin Ma,Zhifa Wang,Xiongjie Zhu,Weijian Wang | | Medicine. 2017; 96(27): e7250 | | [Pubmed] | [DOI] | | 110 |
Fabrication of mandible fracture plate by indirect additive manufacturing |
|
| M Aizat,S F Khan | | Journal of Physics: Conference Series. 2017; 908: 012063 | | [Pubmed] | [DOI] | | 111 |
Rapid prototyping assisted fabrication of customized surgical guides in mandibular distraction osteogenesis: a case report |
|
| Sandeep W. Dahake,Abhaykumar M. Kuthe,Jitendra Chawla,Mahesh B. Mawale | | Rapid Prototyping Journal. 2017; 23(3): 602 | | [Pubmed] | [DOI] | | 112 |
Structural and mechanical characterization of custom design cranial implant created using Additive manufacturing |
|
| Khaja Moiduddin,Saied Darwish,Abdulrahman Al-Ahmari,Sherif ElWatidy,Ashfaq Mohammad,Wadea Ameen | | Electronic Journal of Biotechnology. 2017; | | [Pubmed] | [DOI] | | 113 |
Surface Finish has a Critical Influence on Biofilm Formation and Mammalian Cell Attachment to Additively Manufactured Prosthetics |
|
| Sophie C. Cox,Parastoo Jamshidi,Neil M. Eisenstein,Mark A. Webber,Hanna Burton,Richard J. A. Moakes,Owen Addison,Moataz Attallah,Duncan E.T. Shepherd,Liam M. Grover | | ACS Biomaterials Science & Engineering. 2017; | | [Pubmed] | [DOI] | | 114 |
Three-Dimensional Printing and Its Applications in Otorhinolaryngology–Head and Neck Surgery |
|
| Trevor D. Crafts,Susan E. Ellsperman,Todd J. Wannemuehler,Travis D. Bellicchi,Taha Z. Shipchandler,Avinash V. Mantravadi | | Otolaryngology–Head and Neck Surgery. 2017; 156(6): 999 | | [Pubmed] | [DOI] | | 115 |
Three-Dimensional Printing: Custom-Made Implants for Craniomaxillofacial Reconstructive Surgery |
|
| Mariana Matias,Horácio Zenha,Horácio Costa | | Craniomaxillofacial Trauma & Reconstruction. 2017; 10(2): 089 | | [Pubmed] | [DOI] | | 116 |
The use of virtual surgical planning and navigation in the treatment of orbital trauma |
|
| Alan Scott Herford,Meagan Miller,Floriana Lauritano,Gabriele Cervino,Fabrizio Signorino,Carlo Maiorana | | Chinese Journal of Traumatology. 2017; | | [Pubmed] | [DOI] | | 117 |
Novel Osteogenic Ti-6Al-4V Device For Restoration Of Dental Function In Patients With Large Bone Deficiencies: Design, Development And Implementation |
|
| D. J. Cohen,A. Cheng,A. Kahn,M. Aviram,A. J. Whitehead,S. L. Hyzy,R. M. Clohessy,B. D. Boyan,Z. Schwartz | | Scientific Reports. 2016; 6: 20493 | | [Pubmed] | [DOI] | | 118 |
3D printing from diagnostic images: a radiologist’s primer with an emphasis on musculoskeletal imaging—putting the 3D printing of pathology into the hands of every physician |
|
| Tamir Friedman,Mark Michalski,T. Rob Goodman,J. Elliott Brown | | Skeletal Radiology. 2016; 45(3): 307 | | [Pubmed] | [DOI] | | 119 |
Improve the accuracy, surface smoothing and material adaption in STL file for RP medical models |
|
| Manmadhachary A.,Ravi Kumar Y.,Krishnanand L. | | Journal of Manufacturing Processes. 2016; 21: 46 | | [Pubmed] | [DOI] | | 120 |
Advancing the field of 3D biomaterial printing |
|
| Adam E Jakus,Alexandra L Rutz,Ramille N Shah | | Biomedical Materials. 2016; 11(1): 014102 | | [Pubmed] | [DOI] | | 121 |
Three-Dimensional Printing and Medical Imaging: A Review of the Methods and Applications |
|
| Alessandro Marro,Taha Bandukwala,Walter Mak | | Current Problems in Diagnostic Radiology. 2016; 45(1): 2 | | [Pubmed] | [DOI] | | 122 |
Current Trends in 3D Printing, Bioprosthetics, and Tissue Engineering in Plastic and Reconstructive Surgery |
|
| Cesar Colasante,Zachary Sanford,Evan Garfein,Oren Tepper | | Current Surgery Reports. 2016; 4(3) | | [Pubmed] | [DOI] | | 123 |
Topological design and additive manufacturing of porous metals for bone scaffolds and orthopaedic implants: A review |
|
| Xiaojian Wang,Shanqing Xu,Shiwei Zhou,Wei Xu,Martin Leary,Peter Choong,M. Qian,Milan Brandt,Yi Min Xie | | Biomaterials. 2016; 83: 127 | | [Pubmed] | [DOI] | | 124 |
3D Printed, Customized Cranial Implant for Surgical Planning |
|
| Venkata Phanindra Bogu,Yennam Ravi Kumar,Khanra Asit Kumar | | Journal of The Institution of Engineers (India): Series C. 2016; | | [Pubmed] | [DOI] | | 125 |
3D-Printing Technologies for Craniofacial Rehabilitation, Reconstruction, and Regeneration |
|
| Ethan L. Nyberg,Ashley L. Farris,Ben P. Hung,Miguel Dias,Juan R. Garcia,Amir H. Dorafshar,Warren L. Grayson | | Annals of Biomedical Engineering. 2016; | | [Pubmed] | [DOI] | | 126 |
A Pilot Study Assessing the Impact of 3-D Printed Models of Aortic Aneurysms on Management Decisions in EVAR Planning |
|
| Matthew D. Tam,Tom R. Latham,Mark Lewis,Kunal Khanna,Ali Zaman,Mike Parker,Iris Q. Grunwald | | Vascular and Endovascular Surgery. 2016; 50(1): 4 | | [Pubmed] | [DOI] | | 127 |
Customized porous implants by additive manufacturing for zygomatic reconstruction |
|
| Khaja Moiduddin,Abdulrahman Al-Ahmari,Mohammed Al Kindi,Emad S. Abouel Nasr,Ashfaq Mohammad,Sundar Ramalingam | | Biocybernetics and Biomedical Engineering. 2016; | | [Pubmed] | [DOI] | | 128 |
Simultaneous Computer-Aided Design/Computer-Aided Manufacture Bimaxillary Orthognathic Surgery and Mandibular Reconstruction Using Selective-Laser Sintered Titanium Implant |
|
| Muhanad M. Hatamleh,Gurprit Bhamrah,Francine Ryba,Gavin Mack,Chrisopher Huppa | | Journal of Craniofacial Surgery. 2016; 27(7): 1810 | | [Pubmed] | [DOI] | | 129 |
Technology and vascularized composite allotransplantation (VCA)—lessons learned from the first bilateral pediatric hand transplant |
|
| Arash Momeni,Benjamin Chang,L. Scott Levin | | Journal of Materials Science: Materials in Medicine. 2016; 27(11) | | [Pubmed] | [DOI] | | 130 |
A comparison study on the design of mirror and anatomy reconstruction technique in maxillofacial region |
|
| Khaja Moiduddin,Abdulrahman Al-Ahmari,Emad S. Abouel Nasr,Syed Hammad Mian,Mohammed Al Kindi | | Technology and Health Care. 2016; 24(3): 377 | | [Pubmed] | [DOI] | | 131 |
Advances in Bioprinting Technologies for Craniofacial Reconstruction |
|
| Dafydd O. Visscher,Elisabet Farré-Guasch,Marco N. Helder,Susan Gibbs,Tymour Forouzanfar,Paul P. van Zuijlen,Jan Wolff | | Trends in Biotechnology. 2016; | | [Pubmed] | [DOI] | | 132 |
Designing Biomaterials for 3D Printing |
|
| Murat Guvendiren,Joseph Molde,Rosane M.D. Soares,Joachim Kohn | | ACS Biomaterials Science & Engineering. 2016; | | [Pubmed] | [DOI] | | 133 |
Steps for biomodel acquisition through addtive manufacturing for health |
|
| Ana Waleska Pessoa BARROS,Érika PORTO,Jefferson Felipe Silva de LIMA,Nadja Maria da Silva Oliveira BRITO,Renata de Souza Coelho SOARES | | RGO - Revista Gaúcha de Odontologia. 2016; 64(4): 442 | | [Pubmed] | [DOI] | | 134 |
Use of 3D Printed Bone Plate in Novel Technique to Surgically Correct Hallux Valgus Deformities |
|
| Kathryn E. Smith,Kenneth M. Dupont,David L. Safranski,Jeremy W. Blair,Dawn R. Buratti,Vladimir Zeetser,Ryan Callahan,Jason S. Lin,Ken Gall | | Techniques in Orthopaedics. 2016; 31(3): 181 | | [Pubmed] | [DOI] | | 135 |
Computerassistierte Gesichtsschädelrekonstruktion |
|
| F. Wilde,A. Schramm | | HNO. 2016; | | [Pubmed] | [DOI] | | 136 |
Custom implant design for large cranial defects |
|
| Filipe M. M. Marreiros,Y. Heuzé,M. Verius,C. Unterhofer,W. Freysinger,W. Recheis | | International Journal of Computer Assisted Radiology and Surgery. 2016; | | [Pubmed] | [DOI] | | 137 |
Evaluation of Physical Properties of Titanium Specimen Fabricated by 3D Printing Technique |
|
| Yun-Jeong Oh,Soohwang Seok,Sang-Hyeok Lee,Kwang-Mahn Kim,Jae-Sung Kwon,Bum-Soon Lim | | Korean Journal of Dental Materials. 2016; 43(1): 29 | | [Pubmed] | [DOI] | | 138 |
Comparations of the 3D Printing Methods for the Production of the Reporting Medical Models |
|
| Peter Sedlacko,Radovan Hudák,Teodor Tóth,Tatiana Kelemenová,Jozef Živcák | | Acta Mechanica Slovaca. 2015; 19(4): 44 | | [Pubmed] | [DOI] | | 139 |
The Use of Computer-aided Design and 3-Dimensional Models in the Treatment of Forearm Malunions in Children |
|
| Dora A.R. Storelli,Andrea S. Bauer,Lisa L. Lattanza,H. Relton McCarroll | | Techniques in Hand & Upper Extremity Surgery. 2015; 19(1): 23 | | [Pubmed] | [DOI] | | 140 |
Computer-Based Surgical Planning and Custom-Made Titanium Implants for Cranial Fibrous Dysplasia |
|
| Ozkan Tehli,Ahmet Murat Dursun,Caglar Temiz,Ilker Solmaz,Cahit Kural,Murat Kutlay,Yunus Kacar,Mehmet Can Ezgu,Erbil Oguz,Mehmet K. Daneyemez,Yusuf Izci | | Neurosurgery. 2015; 11: 213 | | [Pubmed] | [DOI] | | 141 |
Regenerative Approach to Bilateral Rostral Mandibular Reconstruction in a Case Series of Dogs |
|
| Boaz Arzi,Derek D. Cissell,Rachel E. Pollard,Frank J. M. Verstraete | | Frontiers in Veterinary Science. 2015; 2 | | [Pubmed] | [DOI] | | 142 |
Application of Customized Navigated Template for Percutaneous Radiofrequency Thermocoagulation Treatment of Primary Trigeminal Neuralgia |
|
| Peng Wang,Tiebao Gu,Zefeng Zhang,Huiqun Wu,Dafeng Ji | | Chinese Medicine. 2015; 06(03): 175 | | [Pubmed] | [DOI] | | 143 |
Update of patient-specific maxillofacial implant |
|
| James A. Owusu,Kofi Boahene | | Current Opinion in Otolaryngology & Head and Neck Surgery. 2015; 23(4): 261 | | [Pubmed] | [DOI] | | 144 |
Individualized Physical 3-dimensional Kidney Tumor Models Constructed From 3-dimensional Printers Result in Improved Trainee Anatomic Understanding |
|
| Margaret Knoedler,Allison H. Feibus,Andrew Lange,Michael M. Maddox,Elisa Ledet,Raju Thomas,Jonathan L. Silberstein | | Urology. 2015; 85(6): 1257 | | [Pubmed] | [DOI] | | 145 |
Haptics-assisted Virtual Planning of Bone, Soft Tissue, and Vessels in Fibula Osteocutaneous Free Flaps |
|
| Pontus Olsson,Fredrik Nysjö,Andrés Rodríguez-Lorenzo,Andreas Thor,Jan-Michaél Hirsch,Ingrid B. Carlbom | | Plastic and Reconstructive Surgery - Global Open. 2015; 3(8): e479 | | [Pubmed] | [DOI] | | 146 |
3D printing in dentistry |
|
| A. Dawood,B. Marti Marti,V. Sauret-Jackson,A. Darwood | | BDJ. 2015; 219(11): 521 | | [Pubmed] | [DOI] | |
|
 |
 |
|