3D modeling, custom implants and its future perspectives in craniofacial surgery

Jayanthi Parthasarathy, Jayanthi Parthasarathy

Abstract

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; CAD CAM implants; CAD CAM surgery; PEEK implants; additive manufacturing; craniofacial surgery; custom implants; electron beam melting; implants; patient specific implants; porous titanium.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Process flow for design and manufacture of computer assisted design/computer assisted manufacturing generated implants
Figure 2
Figure 2
(a) Titanium mesh implant fitted to the cranium model, (b) Intraoperative fixation of implant
Figure 3
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
Figure 4
Figure 4
Porous resin and hydroxyapatite implant manufactured by stereolithography
Figure 5
Figure 5
(a) Machined polyetheretherketone implant, (b) Intraoperative fixation to the cranium, (c) Postoperative X-ray imaging
Figure 6
Figure 6
Virtual surgical planning and manufacturing of the guides for mandible reconstruction
Figure 7
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
Figure 8
Figure 8
3D printed titanium mandible implant
Figure 9
Figure 9
3D reconstruction of a mandible tumor and arch form reconstruction for adaptation of titanium mesh as graft space holder
Figure 10
Figure 10
3D reconstruction of a maxillary bone and arch form reconstruction for adaptation of titanium mesh as graft space holder
Figure 11
Figure 11
Maxillary defect reconstruction and the use of a titanium mesh as a temporary space holder for the graft[59]
Figure 12
Figure 12
(a and b) Midface reconstruction plan with fibula graft, (c) Dental implants placement in the fibula flap
Figure 13
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

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.
    1. 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.
    1. Lane JM, Sandhu HS. Current approaches to experimental bone grafting. Orthop Clin North Am. 1987;18:213–25.
    1. 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.
    1. 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.
    1. Parthasarathy J, Parthiban JK. TP08PUB117 Lake Buena Vista, FL, USA: Society of Manufacturing Engineers; 2008. Rapid Prototyping in Custom Fabrication of Titanium Mesh Implants for Large Cranial Defects. RAPID, May 20-22.
    1. 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.
    1. 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.
    1. 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.
    1. Chen JJ, Liu W, Li MZ, Wang CT. Digital manufacture of titanium prosthesis for cranioplasty. Int J Adv Manuf Technol. 2006;27:1148–52.
    1. 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.
    1. Cabraja M, Klein M, Lehmann TN. Long-term results following titanium cranioplasty of large skull defects. Neurosurg Focus. 2009;26:E10.
    1. 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.
    1. Parthasarathy J, Starly B, Raman S. Lake Buena Vista, FL, USA: Society of Manufacturing Engineers; 2008. Design of Patient-Specific Porous Titanium Implants for Craniofacial Applications. RAPID, May 20-22. TP08PUB116.
    1. 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.
    1. Parthasarathy J, Starly B, Raman S. Medical Manufacturing Year Book. 1 SME Drive Dearborn, MI: Society of Manufacturing Engineers; 2009. Patient specific craniofacial implants; pp. 39–43.
    1. 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.
    1. 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.
    1. 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.
    1. 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.
    1. Abdelaal OA, Darwish SM. Review of rapid prototyping techniques for tissue engineering scaffolds fabrication. Adv Structured Mater. 2013;29:33–54.
    1. 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.
    1. 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.
    1. 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.
    1. 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.
    1. 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.
    1. 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.
    1. 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.
    1. 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.
    1. 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.
    1. 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.
    1. Manning L. Additive manufacturing used to create first laser-sintered cranial implant geometry. Adv Mater Processes. 2012 Sep;:33–35.
    1. Scolozzi P. Maxillofacial reconstruction using polyetheretherketone patient-specific implants by “mirroring” computational planning. Aesthetic Plast Surg. 2012;36:660–5.
    1. 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.
    1. 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.
    1. 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.
    1. 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.
    1. 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.
    1. Dérand P, Hirsch JM. Virtual bending of mandibular reconstruction plates using a computer-aided design. J Oral Maxillofac Surg. 2009;67:1640–3.
    1. 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.
    1. 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.
    1. 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.
    1. [Last accessed on 2013 Jul 7]. Available from: .
    1. 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.
    1. 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.
    1. 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.
    1. 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.
    1. 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.
    1. Brown JS, Shaw RJ. Reconstruction of the maxilla and midface: Introducing a new classification. Lancet Oncol. 2010;11:1001–8.
    1. 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.
    1. 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.
    1. 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.
    1. 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.
    1. Kozakiewicz M, Elgalal M, Loba P, Komuński 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.
    1. 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.
    1. 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.
    1. 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.
    1. 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.
    1. 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.
    1. 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.
    1. 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.
    1. 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.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner