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Maintz M, Tourbier C, de Wild M, Cattin PC, Beyer M, Seiler D, Honigmann P, Sharma N, Thieringer FM. Patient-specific implants made of 3D printed bioresorbable polymers at the point-of-care: material, technology, and scope of surgical application. 3D Print Med 2024; 10:13. [PMID: 38639834 PMCID: PMC11031859 DOI: 10.1186/s41205-024-00207-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/04/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Bioresorbable patient-specific additive-manufactured bone grafts, meshes, and plates are emerging as a promising alternative that can overcome the challenges associated with conventional off-the-shelf implants. The fabrication of patient-specific implants (PSIs) directly at the point-of-care (POC), such as hospitals, clinics, and surgical centers, allows for more flexible, faster, and more efficient processes, reducing the need for outsourcing to external manufacturers. We want to emphasize the potential advantages of producing bioresorbable polymer implants for cranio-maxillofacial surgery at the POC by highlighting its surgical applications, benefits, and limitations. METHODS This study describes the workflow of designing and fabricating degradable polymeric PSIs using three-dimensional (3D) printing technology. The cortical bone was segmented from the patient's computed tomography data using Materialise Mimics software, and the PSIs were designed created using Geomagic Freeform and nTopology software. The implants were finally printed via Arburg Plastic Freeforming (APF) of medical-grade poly (L-lactide-co-D, L-lactide) with 30% β-tricalcium phosphate and evaluated for fit. RESULTS 3D printed implants using APF technology showed surfaces with highly uniform and well-connected droplets with minimal gap formation between the printed paths. For the plates and meshes, a wall thickness down to 0.8 mm could be achieved. In this study, we successfully printed plates for osteosynthesis, implants for orbital floor fractures, meshes for alveolar bone regeneration, and bone scaffolds with interconnected channels. CONCLUSIONS This study shows the feasibility of using 3D printing to create degradable polymeric PSIs seamlessly integrated into virtual surgical planning workflows. Implementing POC 3D printing of biodegradable PSI can potentially improve therapeutic outcomes, but regulatory compliance must be addressed.
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Affiliation(s)
- Michaela Maintz
- Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, Basel, Switzerland
- Department of Biomedical Engineering, Medical Additive Manufacturing Research Group (Swiss MAM), University of Basel, Hegenheimermattweg 167C, Allschwil, Switzerland
- Institute for Medical Engineering and Medical Informatics IM², University of Applied Sciences and Arts Northwestern Switzerland FHNW, Hofackerstrasse 30, Muttenz, Switzerland
| | - Céline Tourbier
- Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, Basel, Switzerland.
- Department of Biomedical Engineering, Medical Additive Manufacturing Research Group (Swiss MAM), University of Basel, Hegenheimermattweg 167C, Allschwil, Switzerland.
| | - Michael de Wild
- Institute for Medical Engineering and Medical Informatics IM², University of Applied Sciences and Arts Northwestern Switzerland FHNW, Hofackerstrasse 30, Muttenz, Switzerland
| | - Philippe C Cattin
- Department of Biomedical Engineering, Center of Medical Image Analysis and Navigation (CIAN), University of Basel, Hegenheimermattweg 167C, Allschwil, Basel, Switzerland
| | - Michel Beyer
- Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, Basel, Switzerland
- Department of Biomedical Engineering, Medical Additive Manufacturing Research Group (Swiss MAM), University of Basel, Hegenheimermattweg 167C, Allschwil, Switzerland
| | - Daniel Seiler
- Institute for Medical Engineering and Medical Informatics IM², University of Applied Sciences and Arts Northwestern Switzerland FHNW, Hofackerstrasse 30, Muttenz, Switzerland
| | - Philipp Honigmann
- Department of Biomedical Engineering, Medical Additive Manufacturing Research Group (Swiss MAM), University of Basel, Hegenheimermattweg 167C, Allschwil, Switzerland
- Department of Orthopaedic Surgery and Traumatology, Hand- and peripheral Nerve Surgery, Kantonsspital Baselland, Bruderholz| Liestal| Laufen, Switzerland
- Biomedical Engineering and Physics, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Neha Sharma
- Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, Basel, Switzerland
- Department of Biomedical Engineering, Medical Additive Manufacturing Research Group (Swiss MAM), University of Basel, Hegenheimermattweg 167C, Allschwil, Switzerland
| | - Florian M Thieringer
- Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, Basel, Switzerland
- Department of Biomedical Engineering, Medical Additive Manufacturing Research Group (Swiss MAM), University of Basel, Hegenheimermattweg 167C, Allschwil, Switzerland
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Zhuang H, Zhu B, Zhu L, You Y, Zhang J, Bu S. Streamlining complex mandibular fracture treatment: Integration of virtual surgical planning and short-segment drilling guides. J Craniomaxillofac Surg 2024; 52:397-405. [PMID: 38458893 DOI: 10.1016/j.jcms.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/06/2023] [Accepted: 11/23/2023] [Indexed: 03/10/2024] Open
Abstract
This study aimed to evaluate the feasibility and accuracy of a combined virtual surgical planning (VPS) and short-segment drilling guides (SSDGs) workflow for the treatment of complex mandibular fractures. Consecutive patients with complex mandibular fractures underwent treatment using the VPS and SSDGs workflow from August 2020 to April 2022. Various mandibular landmarks were compared between the preoperative virtual surgical plan and postoperative data, including condylar distance (CoD), mandibular angle width (GoL-GoR), GoMeGo angle (∠GoL-Me-GoR), the difference in mandibular angles between the left and right sides (Δ∠Co-Go-Me), and the difference in length between the left and right mandibular body (ΔGo-Me). Additionally, preoperative preparation time and surgical duration were retrospectively analyzed and compared to conventional surgery. All 14 consecutive patients with complex mandibular fractures achieved successful reduction using the VPS and SSDGs workflow. Three-dimensional comparison revealed a mean deviation distance of 0.91 ± 0.50 mm and a root-mean-square deviation of 1.75 ± 0.47 mm between the preoperative designed mandible model and the postoperative mandible model. The percentage of points with deviation distances less than 2 mm, 1 mm, and 0.5 mm between preoperative and postoperative models were 78.47 ± 8.87 %, 60.02 ± 14.28 %, and 38.64 ± 15.48 %, respectively. There were no significant differences observed in CoD, GoL-GoR, ∠GoL-Me-GoR, Δ∠Co-Go-Me, and ΔGo-Me between preoperative virtual surgical planning and postoperative measurements. Furthermore, no significant differences were found in the injury-to-surgery interval, admission-to-surgery interval, and surgical duration between the workflow and conventional surgery. The combined VPS and SSDGs workflow proved to be an accurate and feasible method for treating complex mandibular fractures. It offers advantages such as minimal preoperative preparation time and the ability to precise transfer screw positions of the pre-bent reconstruction plate during surgery. This approach is particularly suitable for managing complex mandibular fractures.
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Affiliation(s)
- Hai Zhuang
- Department of Stomatology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, PR China.
| | - Bowen Zhu
- Department of Stomatology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, PR China.
| | - Liuning Zhu
- Department of Stomatology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, PR China.
| | - Ying You
- Department of Stomatology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, PR China.
| | - Jisheng Zhang
- Department of Stomatology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, PR China.
| | - Shoushan Bu
- Department of Stomatology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, PR China.
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Franke A, Sequenc AF, Sembdner P, Seidler A, Matschke JB, Leonhardt H. Three-dimensional measurements of symmetry for the mandibular ramus. Ann Anat 2024; 253:152229. [PMID: 38367950 DOI: 10.1016/j.aanat.2024.152229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 01/30/2024] [Accepted: 02/13/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND The study examines a sample of patients presenting for viscerocranial computer tomography that does not display any apparent signs of asymmetry, assesses the three-dimensional congruency of the mandibular ramus, and focuses on differences in age and gender. METHODS This cross-sectional cohort study screened viscerocranial CT data of patients without deformation or developmental anomalies. Segmentations were obtained from the left and right sides and superimposed according to the best-fit alignment. Comparisons were made to evaluate three-dimensional congruency and compared between subgroups according to age and gender. RESULTS Two hundred and sixty-eight patients were screened, and one hundred patients met the inclusion criteria. There were no statistical differences between the left and right sides of the mandibular ramus. Also, there were no differences between the subgroups. The overall root mean square was 0.75 ± 0.15 mm, and the mean absolute distance from the mean was 0.54 ± 0.10 mm. CONCLUSION The mean difference was less than one millimetre, far below the two-millimetre distance described in the literature that defines relative symmetry. Our study population displays a high degree of three-dimensional congruency. Our findings help to understand that there is sufficient three-dimensional congruency of the mandibular ramus, thus contributing to facilitating CAD-CAM-based procedures based on symmetry for this specific anatomic structure.
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Affiliation(s)
- Adrian Franke
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Germany.
| | | | - Philipp Sembdner
- Chair of Virtual Product Development, Institute of Machine Elements and Machine Design, TU Dresden, Germany
| | - Alexander Seidler
- Chair of Virtual Product Development, Institute of Machine Elements and Machine Design, TU Dresden, Germany
| | - Jan Bernard Matschke
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Germany
| | - Henry Leonhardt
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Germany
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Liu Z, Zhong Y, Lyu X, Zhang J, Huang M, Liu S, Zheng L. Accuracy of the modified tooth-supported 3D printing surgical guides based on CT, CBCT, and intraoral scanning in maxillofacial region: A comparison study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101853. [PMID: 38555078 DOI: 10.1016/j.jormas.2024.101853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 03/27/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Tooth-supported surgical guides have demonstrated superior accuracy compared with bone-supported guides. This study aimed to modify the fabrication of tooth-supported guides for compatibility with tumor resection procedures and investigate their accuracy. METHODS Patients with tumors who underwent osteotomy with the assistance of modified tooth- or bone-supported surgical guides were included. Virtual surgical planning (VSP) was employed to align three dimensional (3D) models extracted from intraoperative computed tomography (CT) images. The distances and angular deviations between the actual osteotomy plane and preoperative plane were recorded. A comparative analysis of osteotomy discrepancies between tooth-supported and bone-supported guides, as well as among tooth-supported guides based on CT, cone-beam CT (CBCT), or intraoral scanner (IOS) was conducted. The factors influencing the precision of the guides were analyzed. RESULTS Sixty patients with 81 resection planes were included in this study. In the tooth-supported group, the mean deviations in the osteotomy plane and angle were 1.39 mm and 4.30°, respectively, whereas those of the bone-supported group were 2.16 mm and 4.95°. In the tooth-supported isotype guide groups, the mean deviations of the osteotomy plane were 1.39 mm, 1.47 mm, 1.23 mm across CT, CBCT, and IOS, respectively. The accuracy of the modified tooth-supported guides remained consistent regardless of number and position of the teeth supporting the guide and location of the osteotomy lines. CONCLUSIONS The findings indicate that the modified tooth-supported surgical guides demonstrated high accuracy in the maxillofacial region, contributing to a reduction in the amount of surgically detached soft tissue.
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Affiliation(s)
- Zezhao Liu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - Yiwei Zhong
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - Xiaoming Lyu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - Jie Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - Mingwei Huang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - Shuming Liu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - Lei Zheng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China.
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Marschall JS, Oppenheim MA, Kushner GM. Can a Point-of-Care 3D Printing Workflow Produce Accurate and Successful Results for Craniomaxillofacial Trauma? J Oral Maxillofac Surg 2024; 82:207-217. [PMID: 38012957 DOI: 10.1016/j.joms.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/21/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Computer-aided design and manufacturing (CAD/CAM) is having a profound impact on craniomaxillofacial surgery, and point-of-care (POC) solutions for repairing facial trauma are starting to emerge. PURPOSE The purpose of this study was to demonstrate the success and accuracy of a POC 3D printing workflow for craniomaxillofacial trauma. STUDY DESIGN, SETTING, SAMPLE A retrospective cohort study was undertaken to analyze subjects presenting to a level 1 trauma center after sustaining facial trauma and were then treated using the POC 3D printing workflow. Subjects were excluded if they were not treated with the POC 3D printing workflow, were lost to follow-up, or if clinical data were incomplete. PREDICTOR VARIABLE Predictor variables included the cause of trauma (mechanism), location of the mandibular fracture, type of fracture, mandibular severity score, and repair error (ie, root mean square error (RMSE) value for planned vs actual outcome). MAIN OUTCOME VARIABLE(S) The primary outcome variables were case success and case error. Success was defined as clinical and radiographic evidence of bony stability at 3 months. Case accuracy was calculated overlaying preoperative plan data to postoperative data generating a numerical value (RMSE value, mm). COVARIATES Covariates included age (years), gender (male/female), surgery time (mins), and CAD/CAM time (preoperative). ANALYSES Descriptive statistics were calculated for each variable. Dependence between rates or counts was established using the Wilcoxon rank sum or Fisher's exact test. Linear regression model was computed to discern how predictor variables influence RMSE. A P value < .05 was considered statistically significant. RESULTS The sample included 27 subjects (19 male/8 female). The average age of all subjects was 46.4 ± 18.0 years. Common mechanisms of injury were assault (33%) and self-inflicted gunshots (SIGSW; 30%), and the average severity score for mandible injury was (13.5 ± 3.3). Ninety-three percent of cases were deemed successful. The average repair accuracy (RMSE value) was 3.4 ± 1.8 mm. A linear regression model indicated those injured by a fall (β-coefficient 1.99; P = .010), motor vehicle collision (β-coefficient 1.49; P = .043), or SIGSW (β-coefficient 2.82; P < .001) correlated with RMSE. CONCLUSION AND RELEVANCE In-house CAD/CAM technologies can be utilized at the POC to repair complex facial trauma accurately and successfully.
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Affiliation(s)
- Jeffrey S Marschall
- Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Iowa Hospital and Clinics, Iowa City, IA.
| | | | - George M Kushner
- Professor and Chairman, Department of Oral and Maxillofacial Surgery, University of Louisville, Louisville, KY
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He X, Barnett LM, Jeon J, Zhang Q, Alqahtani S, Black M, Shannahan J, Wright C. Real-Time Exposure to 3D-Printing Emissions Elicits Metabolic and Pro-Inflammatory Responses in Human Airway Epithelial Cells. TOXICS 2024; 12:67. [PMID: 38251022 PMCID: PMC10818734 DOI: 10.3390/toxics12010067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 01/23/2024]
Abstract
Three-dimensional (3D) printer usage in household and school settings has raised health concerns regarding chemical and particle emission exposures during operation. Although the composition of 3D printer emissions varies depending on printer settings and materials, little is known about the impact that emissions from different filament types may have on respiratory health and underlying cellular mechanisms. In this study, we used an in vitro exposure chamber system to deliver emissions from two popular 3D-printing filament types, acrylonitrile butadiene styrene (ABS) and polylactic acid (PLA), directly to human small airway epithelial cells (SAEC) cultured in an air-liquid interface during 3D printer operation. Using a scanning mobility particle sizer (SMPS) and an optical particle sizer (OPS), we monitored 3D printer particulate matter (PM) emissions in terms of their particle size distribution, concentrations, and calculated deposited doses. Elemental composition of ABS and PLA emissions was assessed using scanning electron microscopy coupled with energy dispersive X-ray spectroscopy (SEM-EDX). Finally, we compared the effects of emission exposure on cell viability, inflammation, and metabolism in SAEC. Our results reveal that, although ABS filaments emitted a higher total concentration of particles and PLA filaments emitted a higher concentration of smaller particles, SAEC were exposed to similar deposited doses of particles for each filament type. Conversely, ABS and PLA emissions had distinct elemental compositions, which were likely responsible for differential effects on SAEC viability, oxidative stress, release of inflammatory mediators, and changes in cellular metabolism. Specifically, while ABS- and PLA-emitted particles both reduced cellular viability and total glutathione levels in SAEC, ABS emissions had a significantly greater effect on glutathione relative to PLA emissions. Additionally, pro-inflammatory cytokines including IL-1β, MMP-9, and RANTES were significantly increased due to ABS emissions exposure. While IL-6 and IL-8 were stimulated in both exposure scenarios, VEGF was exclusively increased due to PLA emissions exposures. Notably, ABS emissions induced metabolic perturbation on amino acids and energy metabolism, as well as redox-regulated pathways including arginine, methionine, cysteine, and vitamin B3 metabolism, whereas PLA emissions exposures caused fatty acid and carnitine dysregulation. Taken together, these results advance our mechanistic understanding of 3D-printer-emissions-induced respiratory toxicity and highlight the role that filament emission properties may play in mediating different respiratory outcomes.
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Affiliation(s)
- Xiaojia He
- Chemical Insights Research Institute, UL Research Institutes, Marietta, GA 30067, USA; (X.H.); (L.M.B.); (J.J.); (Q.Z.); (M.B.)
| | - Lillie Marie Barnett
- Chemical Insights Research Institute, UL Research Institutes, Marietta, GA 30067, USA; (X.H.); (L.M.B.); (J.J.); (Q.Z.); (M.B.)
| | - Jennifer Jeon
- Chemical Insights Research Institute, UL Research Institutes, Marietta, GA 30067, USA; (X.H.); (L.M.B.); (J.J.); (Q.Z.); (M.B.)
| | - Qian Zhang
- Chemical Insights Research Institute, UL Research Institutes, Marietta, GA 30067, USA; (X.H.); (L.M.B.); (J.J.); (Q.Z.); (M.B.)
| | - Saeed Alqahtani
- School of Health Sciences, Purdue University, West Lafayette, IN 47907, USA; (S.A.); (J.S.)
- Advanced Diagnostic and Therapeutics Technologies Institute, Health Sector, King Abdulaziz City for Science and Technology (KACST), Riyadh 12354, Saudi Arabia
| | - Marilyn Black
- Chemical Insights Research Institute, UL Research Institutes, Marietta, GA 30067, USA; (X.H.); (L.M.B.); (J.J.); (Q.Z.); (M.B.)
| | - Jonathan Shannahan
- School of Health Sciences, Purdue University, West Lafayette, IN 47907, USA; (S.A.); (J.S.)
| | - Christa Wright
- Chemical Insights Research Institute, UL Research Institutes, Marietta, GA 30067, USA; (X.H.); (L.M.B.); (J.J.); (Q.Z.); (M.B.)
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Cho RY, Byun SH, Park SY, On SW, Kim JC, Yang BE. Patient-specific plates for facial fracture surgery: A retrospective case series. J Dent 2023; 137:104650. [PMID: 37544353 DOI: 10.1016/j.jdent.2023.104650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 07/24/2023] [Accepted: 08/02/2023] [Indexed: 08/08/2023] Open
Abstract
OBJECTIVES Surgeons often encounter challenges when treating maxillofacial fractures using conventional methods that involve trimming or bending ready-made titanium plates for open reduction and internal fixation (ORIF) since it can be time-consuming, imprecise, and inconvenient. This retrospective case series aimed to introduce a novel bone reduction method that utilizes virtual planning, patient-specific surgical guides, and titanium plates. METHODS Seven patients with mandibular symphysis or subcondylar fractures resulting from facial trauma underwent cone-beam computed tomography (CBCT) or facial CT scans, and their medical histories were documented. Virtual surgery was conducted based on three-dimensional (3D) stereolithography images derived from CT scans using the FaceGide software (MegaGen, Daegu, Korea). ORIF was performed using patient-specific surgical guides and plates that were designed, printed, and milled. Radiographic, clinical, and occlusal evaluations were conducted at two weeks and six weeks postoperatively. Subsequently, 3D images from virtual surgery and postoperative CT scans were compared. RESULTS The comparison of 3D virtual surgery and postoperative images revealed minimal surface differences of less than 1 mm. T-scan evaluations indicated that there were no statistically significant differences between the two- and six-week postoperative assessments. Favorable clinical outcomes were observed. CONCLUSION This novel method demonstrated stable outcomes in terms of occlusion and healing, with no notable complications. Consequently, this approach may serve as a viable alternative to conventional methods. CLINICAL SIGNIFICANCE Facial fracture surgery that utilizes patient-specific surgical guides and plates within a digital workflow can facilitate meticulous surgical planning, reducing the risk of complications and minimizing operation time.
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Affiliation(s)
- Ran-Yeong Cho
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
| | - Soo-Hwan Byun
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
| | - Sang-Yoon Park
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
| | - Sung-Woon On
- Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; Division of Oral and Maxillofacial Surgery, Department of Dentistry, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea
| | - Jong-Cheol Kim
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; Mir Dental Hospital, Daegu 41940, Republic of Korea
| | - Byoung-Eun Yang
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea.
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Alhabshi MO, Aldhohayan H, BaEissa OS, Al Shehri MS, Alotaibi NM, Almubarak SK, Al Ahmari AA, Khan HA, Alowaimer HA. Role of Three-Dimensional Printing in Treatment Planning for Orthognathic Surgery: A Systematic Review. Cureus 2023; 15:e47979. [PMID: 38034130 PMCID: PMC10686238 DOI: 10.7759/cureus.47979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Three-dimensional (3D) printing refers to a wide range of additive manufacturing processes that enable the construction of structures and models. It has been rapidly adopted for a variety of surgical applications, including the printing of patient-specific anatomical models, implants and prostheses, external fixators and splints, as well as surgical instrumentation and cutting guides. In comparison to traditional methods, 3D-printed models and surgical guides offer a deeper understanding of intricate maxillofacial structures and spatial relationships. This review article examines the utilization of 3D printing in orthognathic surgery, particularly in the context of treatment planning. It discusses how 3D printing has revolutionized this sector by providing enhanced visualization, precise surgical planning, reduction in operating time, and improved patient communication. Various databases, including PubMed, Google Scholar, ScienceDirect, and Medline, were searched with relevant keywords. A total of 410 articles were retrieved, of which 71 were included in this study. This article concludes that the utilization of 3D printing in the treatment planning of orthognathic surgery offers a wide range of advantages, such as increased patient satisfaction and improved functional and aesthetic outcomes.
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Affiliation(s)
- Manaf O Alhabshi
- Oral and Maxillofacial Surgery, King Abdullah Medical City, Jeddah, SAU
| | | | - Olla S BaEissa
- General Dentistry, North of Riyadh Dental Clinic, Second Health Cluster, Riyadh, SAU
- General Dentistry, Ibn Sina National College, Jeddah, SAU
| | | | | | | | | | - Hayithm A Khan
- Oral and Maxillofacial Surgery, Ministry of Health, Jeddah, SAU
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Kende PP, Sarda AS, Landge J, Wadewale M, Kri M, Ranganath S. Pre-adjusted Three-Dimensional Plate Employing Printing versus Conventional Plate in the Management of Mandibular Fractures - A Comparative Study. Ann Maxillofac Surg 2023; 13:163-166. [PMID: 38405567 PMCID: PMC10883210 DOI: 10.4103/ams.ams_197_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 08/25/2023] [Accepted: 09/21/2023] [Indexed: 02/27/2024] Open
Abstract
Introduction The aim of this study was to compare the efficacy of pre-adjusted three-dimensional (3D) plating system employing 3D printing with conventional 3D plating in the management of mandibular fractures. Materials and Methods A randomised, clinical trial was conducted where the study sample (n = 20) was divided into two groups. In Group 1, 3D plate and in Group 2, pre-bent 3D plate was fixed to the fracture site. The parameters assessed were number of bends required for adaptation, duration of fixation, pain, occlusal stability, reduction in lingual splaying and post-operative complications. Results Statistically significant difference was seen for the number of bends required (P = 0.000, P < 0.01) and duration of fracture fixation (P = 0.001, P < 0.01). There was statistically significant difference between the values of pain during the adaptation of 3D plate (P = 0.033, P < 0.05). Discussion The application of pre-adjusted 3D plate is superior to conventional 3D plating in terms of reducing number of bends, duration of fixation and pain during adaptation.
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Affiliation(s)
- Prajwalit P Kende
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Mumbai, Maharashtra, India
| | - Ashish Sunilkumar Sarda
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Mumbai, Maharashtra, India
| | - Jayant Landge
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Mumbai, Maharashtra, India
| | - Maroti Wadewale
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Mumbai, Maharashtra, India
| | - Mrimingsi Kri
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Mumbai, Maharashtra, India
| | - Suleka Ranganath
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Mumbai, Maharashtra, India
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Impact of 3D printed models on quantitative surgical outcomes for patients undergoing robotic-assisted radical prostatectomy: a cohort study. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:1401-1408. [PMID: 36749368 DOI: 10.1007/s00261-023-03815-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/13/2023] [Accepted: 01/13/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Three-dimensional (3D) printed anatomic models can facilitate presurgical planning by providing surgeons with detailed knowledge of the exact location of pertinent anatomical structures. Although 3D printed anatomic models have been shown to be useful for pre-operative planning, few studies have demonstrated how these models can influence quantitative surgical metrics. OBJECTIVE To prospectively assess whether patient-specific 3D printed prostate cancer models can improve quantitative surgical metrics in patients undergoing robotic-assisted radical prostatectomy (RARP). METHODS Patients with MRI-visible prostate cancer (PI-RADS V2 ≥ 3) scheduled to undergo RARP were prospectively enrolled in our IRB approved study (n = 82). Quantitative surgical metrics included the rate of positive surgical margins (PSMs), operative times, and blood loss. A qualitative Likert scale survey to assess understanding of anatomy and confidence regarding surgical approach was also implemented. RESULTS The rate of PSMs was lower for the 3D printed model group (8.11%) compared to that with imaging only (28.6%), p = 0.128. The 3D printed model group had a 9-min reduction in operating time (213 ± 42 min vs. 222 ± 47 min) and a 5 mL reduction in average blood loss (227 ± 148 mL vs. 232 ± 114 mL). Surgeon anatomical understanding and confidence improved after reviewing the 3D printed models (3.60 ± 0.74 to 4.20 ± 0.56, p = 0.62 and 3.86 ± 0.53 to 4.20 ± 0.56, p = 0.22). CONCLUSIONS 3D printed prostate cancer models can positively impact quantitative patient outcomes such as PSMs, operative times, and blood loss in patients undergoing RARP.
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Snyder E, Trabia M, Trabelsi N. An approach for simultaneous reduction and fixation of mandibular fractures. Comput Methods Biomech Biomed Engin 2022:1-13. [PMID: 35901285 DOI: 10.1080/10255842.2022.2105143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This article presents a new approach for the design of a flexible V-shaped miniplate for mandibular fractures, which combines simultaneous fracture reduction and fixation. A Computerized Tomography (CT) based finite element model was developed to assess the reliability of this design. Muscle and mastication forces were included to replicate post-surgery loading. The V-plate is compared with a standard, linear miniplate, typically used for mandibular fixation. The results indicate that the proposed design can support the fracture while inducing limited fracture displacement, in addition to reducing the duration of the surgery due to fracture reduction by tightening the wire.
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Affiliation(s)
- Ethan Snyder
- Department of Mechanical Engineering, University of Nevada, Las Vegas, United States of America
| | - Mohamed Trabia
- Department of Mechanical Engineering, University of Nevada, Las Vegas, United States of America
| | - Nir Trabelsi
- Department of Mechanical Engineering, Shamoon College of Engineering, Be'er Sheva, Israel
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Zoabi A, Redenski I, Oren D, Kasem A, Zigron A, Daoud S, Moskovich L, Kablan F, Srouji S. 3D Printing and Virtual Surgical Planning in Oral and Maxillofacial Surgery. J Clin Med 2022; 11:jcm11092385. [PMID: 35566511 PMCID: PMC9104292 DOI: 10.3390/jcm11092385] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 02/01/2023] Open
Abstract
Compared to traditional manufacturing methods, additive manufacturing and 3D printing stand out in their ability to rapidly fabricate complex structures and precise geometries. The growing need for products with different designs, purposes and materials led to the development of 3D printing, serving as a driving force for the 4th industrial revolution and digitization of manufacturing. 3D printing has had a global impact on healthcare, with patient-customized implants now replacing generic implantable medical devices. This revolution has had a particularly significant impact on oral and maxillofacial surgery, where surgeons rely on precision medicine in everyday practice. Trauma, orthognathic surgery and total joint replacement therapy represent several examples of treatments improved by 3D technologies. The widespread and rapid implementation of 3D technologies in clinical settings has led to the development of point-of-care treatment facilities with in-house infrastructure, enabling surgical teams to participate in the 3D design and manufacturing of devices. 3D technologies have had a tremendous impact on clinical outcomes and on the way clinicians approach treatment planning. The current review offers our perspective on the implementation of 3D-based technologies in the field of oral and maxillofacial surgery, while indicating major clinical applications. Moreover, the current report outlines the 3D printing point-of-care concept in the field of oral and maxillofacial surgery.
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Affiliation(s)
- Adeeb Zoabi
- Department of Oral and Maxillofacial Surgery, Galilee College of Dental Sciences, Galilee Medical Center, Nahariya 2210001, Israel; (A.Z.); (I.R.); (D.O.); (A.K.); (A.Z.); (S.D.); (L.M.); (F.K.)
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Idan Redenski
- Department of Oral and Maxillofacial Surgery, Galilee College of Dental Sciences, Galilee Medical Center, Nahariya 2210001, Israel; (A.Z.); (I.R.); (D.O.); (A.K.); (A.Z.); (S.D.); (L.M.); (F.K.)
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Daniel Oren
- Department of Oral and Maxillofacial Surgery, Galilee College of Dental Sciences, Galilee Medical Center, Nahariya 2210001, Israel; (A.Z.); (I.R.); (D.O.); (A.K.); (A.Z.); (S.D.); (L.M.); (F.K.)
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Adi Kasem
- Department of Oral and Maxillofacial Surgery, Galilee College of Dental Sciences, Galilee Medical Center, Nahariya 2210001, Israel; (A.Z.); (I.R.); (D.O.); (A.K.); (A.Z.); (S.D.); (L.M.); (F.K.)
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Asaf Zigron
- Department of Oral and Maxillofacial Surgery, Galilee College of Dental Sciences, Galilee Medical Center, Nahariya 2210001, Israel; (A.Z.); (I.R.); (D.O.); (A.K.); (A.Z.); (S.D.); (L.M.); (F.K.)
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Shadi Daoud
- Department of Oral and Maxillofacial Surgery, Galilee College of Dental Sciences, Galilee Medical Center, Nahariya 2210001, Israel; (A.Z.); (I.R.); (D.O.); (A.K.); (A.Z.); (S.D.); (L.M.); (F.K.)
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Liad Moskovich
- Department of Oral and Maxillofacial Surgery, Galilee College of Dental Sciences, Galilee Medical Center, Nahariya 2210001, Israel; (A.Z.); (I.R.); (D.O.); (A.K.); (A.Z.); (S.D.); (L.M.); (F.K.)
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Fares Kablan
- Department of Oral and Maxillofacial Surgery, Galilee College of Dental Sciences, Galilee Medical Center, Nahariya 2210001, Israel; (A.Z.); (I.R.); (D.O.); (A.K.); (A.Z.); (S.D.); (L.M.); (F.K.)
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Samer Srouji
- Department of Oral and Maxillofacial Surgery, Galilee College of Dental Sciences, Galilee Medical Center, Nahariya 2210001, Israel; (A.Z.); (I.R.); (D.O.); (A.K.); (A.Z.); (S.D.); (L.M.); (F.K.)
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
- Correspondence:
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Medical 3D Printing with a focus on Point-of-Care in Cranio- and Maxillofacial Surgery. A systematic review of literature. ANNALS OF 3D PRINTED MEDICINE 2022. [DOI: 10.1016/j.stlm.2022.100059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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14
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Truscott A, Zamani R, Akrami M. Comparing the use of conventional and three-dimensional printing (3DP) in mandibular reconstruction. Biomed Eng Online 2022; 21:18. [PMID: 35305669 PMCID: PMC8934485 DOI: 10.1186/s12938-022-00989-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 03/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background There are a number of clinical disorders that require mandibular reconstruction (MR). Novel three-dimensional (3D) printing technology enables reconstructions to be more accurate and beneficial to the patient. However, there is currently no evidence identifying which techniques are better suited for MR, based on the type of clinical disorder the patient has. In this study, we aim to compare 3D techniques with conventional techniques to identify how best to reconstruct the mandible based on the clinical cause that necessitates the reconstructive procedure: cancerous or benign tumours, clinical disorders, infection or disease and trauma or injury. Methods PubMed, Scopus, Embase and Medline were searched to identify relevant papers that outline the clinical differences between 3D and conventional techniques in MR. Data were evaluated to provide a clear outline of suitable techniques for surgery. Results 20 of 2749 papers met inclusion criteria. These papers were grouped based on the clinical causes that required MR into four categories: malignant or benign tumour resection; mandibular trauma/injury and other clinical disorders. Conclusions The majority of researchers favoured 3D techniques in MR. However, due to a lack of standardised reporting in these studies it was not possible to determine which specific techniques were better for which clinical presentations.
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15
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Short-Segment Drilling Guides for the Management Comminuted Mandibular Fractures. J Craniofac Surg 2022; 33:e724-e726. [PMID: 35275871 DOI: 10.1097/scs.0000000000008637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/21/2022] [Indexed: 10/18/2022] Open
Abstract
ABSTRACT Treatment of a severely comminuted mandibular fracture is challenging. This technical note describes a novel office-based workflow, combining virtual surgery planning with short-segment drilling guides. The authors reduced the comminuted mandibular fractures via virtual surgery planning. Then, the reconstructed mandible model was printed using an in-house 3D printer. Next, the reconstruction plate was preformed according to the shape of the mandibular model surface, and the position of the screw hole in the mandibular surface was determined. Finally, hand-made short-segment drilling guides for screw position transfer were fabricated with temporary resin. During the operation, the authors reset the guides for the drill to make screw holes as planned. After the hole was drilled, the pre-bent plate was applied to the mandible. The fracture was expected to be reduced, when tightening the screws. In our workflow, by using short and simple operative procedures, the authors were able to achieve precise reduction and reduce the operation time.
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Panesar K, Susarla SM. Mandibular Fractures: Diagnosis and Management. Semin Plast Surg 2021; 35:238-249. [PMID: 34819805 DOI: 10.1055/s-0041-1735818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Accurate evaluation, diagnosis, and management of mandibular fractures is essential to effectively restore an individual's facial esthetics and function. Understanding of surgical anatomy, fracture fixation principles, and the nuances of specific fractures with respect to various patient populations can aid in adequately avoiding complications such as malocclusion, non-union, paresthesia, and revision procedures. This article reviews comprehensive mandibular fracture assessment, mandibular surgical anatomy, fracture fixation principles, management considerations, and commonly encountered complications. In addition, this article reviews emerging literature examining 3-dimensional printing and intraoperative imaging.
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Affiliation(s)
- Kanvar Panesar
- Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, Washington
| | - Srinivas M Susarla
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Washington.,Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, Washington.,Divisions of Plastic and Craniofacial Surgery and Oral-Maxillofacial Surgery, Craniofacial Center, Seattle Children's Hospital, Seattle, Washington
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17
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In-house 3D Model Printing for Acute Cranio-maxillo-facial Trauma Surgery: Process, Time, and Costs. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3804. [PMID: 34549000 PMCID: PMC8448031 DOI: 10.1097/gox.0000000000003804] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/12/2021] [Indexed: 11/25/2022]
Abstract
Three-dimensional (3D) printing is used extensively in cranio-maxillo-facial (CMF) surgery, but its usage is limited in the setting of acute trauma specifically, as delays in outsourcing are too great. Therefore, we developed an in-house printing solution. The purpose of this study was to describe this process for surgeons treating acute CMF trauma. This series describes the printing process, time required, and printing material costs involved for in-house printing applied to a variety of acute CMF trauma cases involving the upper, middle, and lower thirds of the face and skull. All consecutive patients requiring in-house 3D printed models in a level 1 trauma center for acute trauma surgery in mid-2019 were identified and analyzed. Nine patients requiring the printing of 12 in-house models were identified. The overall printing time per model ranged from 2 hours, 36 minutes to 26 hours, 54 minutes (mean = 7h 55 min). Filament cost was between $0.20 and $2.65 per model (mean = $0.95). This study demonstrates that in-house 3D printing can be done in a relatively short period of time, therefore allowing 3D printing usage for various acute facial fracture treatments. The rapid improvements in the usability of 3D software and printing technology will likely contribute to further adoption of these technologies by CMF-trauma surgeons.
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18
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Khonsari RH, Adam J, Benassarou M, Bertin H, Billotet B, Bouaoud J, Bouletreau P, Garmi R, Gellée T, Haen P, Ketoff S, Lescaille G, Louvrier A, Lutz JC, Makaremi M, Nicot R, Pham-Dang N, Praud M, Saint-Pierre F, Schouman T, Sicard L, Simon F, Wojcik T, Meyer C. In-house 3D printing: Why, when, and how? Overview of the national French good practice guidelines for in-house 3D-printing in maxillo-facial surgery, stomatology, and oral surgery. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 122:458-461. [PMID: 34400375 DOI: 10.1016/j.jormas.2021.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 08/11/2021] [Indexed: 01/04/2023]
Abstract
3D-printing is part of the daily practice of maxillo-facial surgeons, stomatologists and oral surgeons. To date, no French health center is producing in-house medical devices according to the new European standards. Based on all the evidence-based data available, a group of experts from the French Society of Stomatology, Maxillo-Facial Surgery and Oral Surgery (Société Française de Chirurgie Maxillofaciale, Stomatologie et Chirurgie Orale, SFSCMFCO), provide good practice guidelines for in-house 3D-printing in maxillo-facial surgery, stomatology, and oral surgery. Briefly, technical considerations related to printers and CAD software, which were the main challenges in the last ten years, are now nearly trivial questions. The central current issues when planning the implementation of an in-house 3D-printing platform are economic and regulatory. Successful in-house 3D platforms rely on close collaborations between health professionals and engineers, backed by regulatory and logistic specialists. Several large-scale academic projects across France will soon provide definitive answers to governance and economical questions related to the use of in-house 3D printing.
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Affiliation(s)
- Roman Hossein Khonsari
- Service de chirurgie maxillofaciale et chirurgie plastique, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris; Faculté de médecine, Université de Paris; Paris, France.
| | | | - Mourad Benassarou
- Service de chirurgie maxillofaciale et stomatologie, Hôpital Universitaire Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Faculté de médecine, Sorbonne Université; Paris, France
| | - Hélios Bertin
- Service de chirurgie maxillofaciale et stomatologie, Centre Hospitalier Universitaire Hôtel-Dieu; Faculté de médecine, Université de Nantes; Nantes, France
| | | | - Jebrane Bouaoud
- Service de chirurgie maxillofaciale et stomatologie, Hôpital Universitaire Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Faculté de médecine, Sorbonne Université; Paris, France
| | - Pierre Bouletreau
- Service de chirurgie maxillofaciale, stomatologie, chirurgie orale et chirurgie plastique de la face, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; Faculté de Médecine, Université Claude Bernard Lyon I; Lyon, France
| | - Rachid Garmi
- Service de chirurgie maxillofaciale, plastique et reconstructrice, chirurgie orale et implantologie, Centre Hospitalier Universitaire Caen Normandie; Université de Caen Normandie; Caen, France
| | - Timothée Gellée
- Service de chirurgie maxillofaciale et stomatologie, Unité de chirurgie orale, Hôpital Universitaire Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris; Faculté de médecine, Sorbonne Université; Paris, France
| | - Pierre Haen
- Service de chirurgie maxillofaciale, Hôpital d'Instruction des Armées Laveran; Marseille, France
| | - Serge Ketoff
- Service de chirurgie maxillofaciale, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Géraldine Lescaille
- Service de chirurgie maxillofaciale et stomatologie, Unité de chirurgie orale, Hôpital Universitaire Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris; Faculté de médecine, Sorbonne Université; Paris, France
| | - Aurélien Louvrier
- Service de chirurgie maxillofaciale, stomatologie et odontologie, Centre Hospitalier Régional Universitaire de Besançon; Faculté de Médecine, Université de Franche-Comté; Besançon, France
| | - Jean-Christophe Lutz
- Service de chirurgie maxillofaciale et stomatologie, Centre Hospitalier Universitaire de Strasbourg; Faculté de Médecine, Université de Strasbourg; Strasbourg, France
| | - Masrour Makaremi
- Département d'orthopédie dento-faciale, UFR des sciences odontologiques, Bordeaux, France
| | - Romain Nicot
- Service de chirurgie maxillofaciale et stomatologie, Centre Hospitalier Régional Universitaire de Lille; Faculté de Médecine Henri Warembourg, Université de Lille; Lille, France
| | - Nathalie Pham-Dang
- Service de chirurgie maxillofaciale et chirurgie plastique, Centre Hospitalier Universtiaire de Clermont-Ferrand; Faculté de Médecine, Université de Clermont Auvergne; Clermont-Ferrand, France
| | - Morgan Praud
- Service de chirurgie maxillofaciale et stomatologie, Centre Hospitalier Universitaire Hôtel-Dieu; Faculté de médecine, Université de Nantes; Nantes, France
| | | | - Thomas Schouman
- Service de chirurgie maxillofaciale et stomatologie, Hôpital Universitaire Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Faculté de médecine, Sorbonne Université; Paris, France
| | - Ludovic Sicard
- Service de chirurgie orale, Hôpital Bretonneau, Assistance Publique - Hôpitaux de Paris; Faculté d'odontologie, Université de Paris; Paris, France
| | - François Simon
- Service de d'otorhinolaryngologie et chirurgie cervico-faciale pédiatrique, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris; Faculté de médecine, Université de Paris; Paris, France
| | - Thomas Wojcik
- Service de chirurgie maxillofaciale et stomatologie, Centre Hospitalier Régional Universitaire de Lille; Faculté de Médecine Henri Warembourg, Université de Lille; Lille, France
| | - Christophe Meyer
- Service de chirurgie maxillofaciale, stomatologie et odontologie, Centre Hospitalier Régional Universitaire de Besançon; Faculté de Médecine, Université de Franche-Comté; Besançon, France
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- Service de chirurgie maxillofaciale et chirurgie plastique, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris; Faculté de médecine, Université de Paris; Paris, France; BONE 3D, Paris, France; Service de chirurgie maxillofaciale et stomatologie, Hôpital Universitaire Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Faculté de médecine, Sorbonne Université; Paris, France; Service de chirurgie maxillofaciale et stomatologie, Centre Hospitalier Universitaire Hôtel-Dieu; Faculté de médecine, Université de Nantes; Nantes, France; ENNOIA, Besançon, France; Service de chirurgie maxillofaciale, stomatologie, chirurgie orale et chirurgie plastique de la face, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; Faculté de Médecine, Université Claude Bernard Lyon I; Lyon, France; Service de chirurgie maxillofaciale, plastique et reconstructrice, chirurgie orale et implantologie, Centre Hospitalier Universitaire Caen Normandie; Université de Caen Normandie; Caen, France; Service de chirurgie maxillofaciale et stomatologie, Unité de chirurgie orale, Hôpital Universitaire Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris; Faculté de médecine, Sorbonne Université; Paris, France; Service de chirurgie maxillofaciale, Hôpital d'Instruction des Armées Laveran; Marseille, France; Service de chirurgie maxillofaciale, Groupe Hospitalier Paris Saint-Joseph, Paris, France; Service de chirurgie maxillofaciale, stomatologie et odontologie, Centre Hospitalier Régional Universitaire de Besançon; Faculté de Médecine, Université de Franche-Comté; Besançon, France; Service de chirurgie maxillofaciale et stomatologie, Centre Hospitalier Universitaire de Strasbourg; Faculté de Médecine, Université de Strasbourg; Strasbourg, France; Département d'orthopédie dento-faciale, UFR des sciences odontologiques, Bordeaux, France; Service de chirurgie maxillofaciale et stomatologie, Centre Hospitalier Régional Universitaire de Lille; Faculté de Médecine Henri Warembourg, Université de Lille; Lille, France; Service de chirurgie maxillofaciale et chirurgie plastique, Centre Hospitalier Universtiaire de Clermont-Ferrand; Faculté de Médecine, Université de Clermont Auvergne; Clermont-Ferrand, France; Méthodologie, Sorbonne Université; Paris, France; Service de chirurgie orale, Hôpital Bretonneau, Assistance Publique - Hôpitaux de Paris; Faculté d'odontologie, Université de Paris; Paris, France; Service de d'otorhinolaryngologie et chirurgie cervico-faciale pédiatrique, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris; Faculté de médecine, Université de Paris; Paris, France
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Zhao L, Zhang X, Guo Z, Long J. Use of modified 3D digital surgical guides in the treatment of complex mandibular fractures. J Craniomaxillofac Surg 2021; 49:282-291. [PMID: 33581958 DOI: 10.1016/j.jcms.2021.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/02/2020] [Accepted: 01/31/2021] [Indexed: 11/27/2022] Open
Abstract
The objective of this study was to evaluate the use of 3D modified digital surgical guide plates combined with preformed titanium plates in the treatment of complex mandibular fractures. Patients with complex mandibular fractures were randomized into three groups. Group A was treated with a combination of 3D modified digital surgical guide plates and preformed titanium plates, Group B was treated with preformed titanium plates only, and Group C was treated conventionally. The key design point of the guide plates is the "slot" structure, which is crucial for accurately locating the preformed titanium plate. Clinical outcomes, including facial symmetry, surgical accuracy, and maximum deviation were quantitatively assessed postoperatively. Twenty-two patients were recruited for this study, eight for Group A, six for Group B, and eight for Group C. Group A exhibited better postoperative clinical outcomes. Among three groups, significant improvements were found in Group A for facial symmetry (S1 [0.74 ± 0.17 mm, P < 0.001], S2 [0.86 ± 0.21 mm, P = 0.004], S3 [0.92 ± 0.26 mm, P < 0.001], S4 [0.32 ± 0.09 mm, P < 0.001], S5 [0.47 ± 0.16 mm, P = 0.042], S6 [0.35 ± 0.04 mm, P = 0.001], S10 [0.50 ± 0.31 mm, P = 0.048], S11 [0.97 ± 0.29 mm, P = 0.018]) and surgical accuracy (T1 [R, 0.56 ± 0.18 mm, P = 0.021], T1 [L, 0.60 ± 0.30 mm, P = 0.022], T2 [L, 0.76 ± 0.21 mm, P = 0.006], T4 [R, 0.37 ± 0.15 mm, P < 0.001], T4 [L, 0.40 ± 0.15 mm, P = 0.001], T8 [R, 0.40 ± 0.15 mm, P = 0.007], T8 [L, 0.31 ± 0.29 mm, P = 0.001], T9 [L, 0.51 ± 0.33 mm, P = 0.042], T10 [R, 0.58 ± 0.28 mm, P = 0.049], T10 [L, 0.53 ± 0.34 mm, P = 0.046], T11 [R, 0.54 ± 0.13 mm, P = 0.021], T12 [0.45 ± 0.16 mm, P = 0.003]). The ideal postoperative effect was found in Group A with maximum deviation analysis. 3D printed modified digital surgical guide plates can effectively improve treatment outcomes in complex mandibular fractures.
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Affiliation(s)
- Luyang Zhao
- The State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, 610041, PR China; Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, 610041, PR China; National Engineering Laboratory for Oral Regenerative Medicine, Chengdu, 610041, PR China
| | - Xiaojie Zhang
- Stomatology Hospital, Zhejiang University School of Medicine, 310000, PR China
| | - Zeyou Guo
- The State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, 610041, PR China; Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, 610041, PR China; National Engineering Laboratory for Oral Regenerative Medicine, Chengdu, 610041, PR China
| | - Jie Long
- The State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, 610041, PR China; Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, 610041, PR China; Engineering Research Center of Oral Translational Medicine, Ministry of Education, Chengdu, 610041, PR China.
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Nosrat A, Verma P, Glass S, Vigliante CE, Price JB. Non-Hodgkin Lymphoma Mimicking Endodontic Lesion: A Case Report with 3-dimensional Analysis, Segmentation, and Printing. J Endod 2021; 47:671-676. [PMID: 33493549 DOI: 10.1016/j.joen.2021.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/04/2021] [Accepted: 01/12/2021] [Indexed: 12/29/2022]
Abstract
Non-Hodgkin lymphoma (NHL) of the oral cavity can present with pain, swelling and radiolucent lesion mimicking endodontic diseases. This article reports on a case of diffuse large B-cell lymphoma initially diagnosed and treated as periodontal disease and then endodontic disease in the maxillary anterior and premolar area of a 40-year old female. A cone beam computed tomography (CBCT) image of the lesion was taken. The lesion was segmented using Mimics software (Materialise NV, Lueven, Belgium). Three-dimensional models of the tumor were printed. During the surgical phase teeth #4, 6, and 7 were extracted and biopsy samples were obtained. Histopathologic examination showed invasive sheets of large, atypical, basophilic cells strongly and diffusely positive for CD20. Three-dimensional analysis, segmentation, and printing of radiolucent lesions of the jaws assists with differential diagnosis and efficient treatment. Oral health professionals can play a crucial role in the early detection and diagnosis of oral NHL, thereby preventing extensive loss of function and esthetics, and even saving lives.
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Affiliation(s)
- Ali Nosrat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, Baltimore, Maryland; Private Practice, Centerville Endodontics, Centreville, Virginia.
| | - Prashant Verma
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, Baltimore, Maryland; Private Practice, Centerville Endodontics, Centreville, Virginia
| | - Sarah Glass
- Department of Oral Diagnostic Sciences, School of Dentistry, Virginia Commonwealth University, Richmond, Virginia
| | - Craig E Vigliante
- Private Practice, Potomac Surgical Arts, PC, Leesburg, Virginia; Reston Advanced Oral and Cosmetic Facial Surgery, LLC, Reston, Virginia
| | - Jeffery B Price
- Department of Oncology and Diagnostic Sciences, School of Dentistry, University of Maryland, Baltimore, Maryland
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21
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Candido I, da Silva CV, Santos Garcia E, da Silva AF, Fernandes Poleti TF, Gialain I, Borba A. The usefulness of a facial digital biobank for ameloblastoma resection and fracture fixation - A case report. Ann Maxillofac Surg 2021; 11:325-328. [PMID: 35265508 PMCID: PMC8848715 DOI: 10.4103/ams.ams_73_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 09/20/2021] [Accepted: 09/28/2021] [Indexed: 11/04/2022] Open
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22
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Costan VV, Nicolau A, Sulea D, Ciofu ML, Boișteanu O, Popescu E. The Impact of 3D Technology in Optimizing Midface Fracture Treatment-Focus on the Zygomatic Bone. J Oral Maxillofac Surg 2020; 79:880-891. [PMID: 33279472 DOI: 10.1016/j.joms.2020.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/01/2020] [Accepted: 11/02/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE In the context of the ongoing development and expanding availability of 3-dimensional (3D) printing, there is increasing interest in designing simplified workflows that would encourage more medical practitioners to include 3D printing in their current practice. The purpose of this study is to present our experience regarding the use of 3D printing in the preoperative planning and management of acute midface trauma, an area less explored by existing studies. METHODS We performed a retrospective case series study including admitted patients who underwent surgical repair of midface fractures, in which 3D-printed stereolithic models were used preoperatively for shaping the osteosynthesis material. We recorded standard information about the patients, imaging method used, and type of midface fracture. We also logged the details and durations of each main step in the preoperative 3D printing workflow and documented the durations and outcomes of each surgical procedure. RESULTS We identified 29 cases of midface fractures that benefited of a preoperative stereolithic model. From the 2 main methods of obtaining the virtual model, mirroring and virtual fracture reduction, the longest duration was recorded in a case in which the later method was used. The longest stereolithic model printing time was found in a complex midface fracture case. All the prebent osteosynthesis material was used intraoperatively and fitted the reduced fracture sites, also serving as an intraoperative guide for correct fracture reduction. The particularities, benefits, as well as the possible challenges associated with the application of 3D printing in acute trauma cases are discussed. CONCLUSIONS Our 3D printing protocol was applicable and rendered favorable outcomes in the acute midface trauma setting. Proper understanding of the steps involved in achieving the stereolithic model is key for the adaptation of 3D printing to the current management of acute midface trauma.
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Affiliation(s)
- Victor Vlad Costan
- Associate Professor, Department of Oral and Maxillofacial Surgery, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Andrei Nicolau
- University Assistant, Department of Oral and Maxillofacial Surgery, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Daniela Sulea
- University Assistant, Department of Oral and Maxillofacial Surgery, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.
| | - Mihai Liviu Ciofu
- Lecturer, Department of Oral and Maxillofacial Surgery, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Otilia Boișteanu
- Lecturer, Department of Oral and Maxillofacial Surgery, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Eugenia Popescu
- Professor, Department of Oral and Maxillofacial Surgery, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
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23
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Serrano C, Fontenay S, van den Brink H, Pineau J, Prognon P, Martelli N. Evaluation of 3D printing costs in surgery: a systematic review. Int J Technol Assess Health Care 2020; 36:1-7. [PMID: 32489157 DOI: 10.1017/s0266462320000331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The use of three-dimensional (3D) printing in surgery is expanding and there is a focus on comprehensively evaluating the clinical impact of this technology. However, although additional costs are one of the main limitations to its use, little is known about its economic impact. The purpose of this systematic review is to identify the costs associated with its use and highlight the first quantitative data available. METHODS A systematic literature review was conducted in the PubMed and Embase databases and in the National Health Service Economic Evaluation Database (NHS EED) at the University of York. Studies that reported an assessment of the costs associated with the use of 3D printing for surgical application and published between 2009 and 2019, in English or French, were included. RESULTS Nine studies were included in our review. Nine types of costs were identified, the three main ones being printing material costs (n = 6), staff costs (n = 3), and operating room costs (n = 3). The printing cost ranged from less than U.S. dollars (USD) 1 to USD 146 (in USD 2019 values) depending on the criteria used to calculate this cost. Three studies evaluated the potential savings generated by the use of 3D printing technology in surgery, based on operating time reduction. CONCLUSION This literature review highlights the lack of reliable economic data on 3D printing technology. Nevertheless, this review makes it possible to identify expenditures or items that should be considered in order to carry out more robust studies.
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Affiliation(s)
- Carole Serrano
- University Paris-Saclay, GRADES, Faculty of Pharmacy, 5 rue Jean-Baptiste Clément, 92290Châtenay-Malabry, France
| | - Sarah Fontenay
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 rue Leblanc, 75015Paris, France
| | - Hélène van den Brink
- University Paris-Saclay, GRADES, Faculty of Pharmacy, 5 rue Jean-Baptiste Clément, 92290Châtenay-Malabry, France
| | - Judith Pineau
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 rue Leblanc, 75015Paris, France
| | - Patrice Prognon
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 rue Leblanc, 75015Paris, France
| | - Nicolas Martelli
- University Paris-Saclay, GRADES, Faculty of Pharmacy, 5 rue Jean-Baptiste Clément, 92290Châtenay-Malabry, France
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 rue Leblanc, 75015Paris, France
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Lu T, Shao Z, Liu B, Wu T. Recent advance in patient-specific 3D printing templates in mandibular reconstruction. J Mech Behav Biomed Mater 2020; 106:103725. [PMID: 32250956 DOI: 10.1016/j.jmbbm.2020.103725] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/22/2020] [Accepted: 03/01/2020] [Indexed: 11/16/2022]
Abstract
Patient-specific 3D printing template is used in mandibular defect reconstruction with multiple deficiencies. During the operation, the template can accurately transfer the preoperative design, assisting surgeons to complete the surgery with high efficiency and accuracy. The template design has been continuously improved to obtain good application for miscellaneous classification and description. This review attempted to preliminarily analyse and summarise recent advancements in personalized 3D printing templates in mandibular reconstruction from the aspects of functional classification, existing problems, improved strategies and post-surgery evaluation by reviewing studies and through our combined clinical work and experience on hundreds of reconstruction surgeries.
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Affiliation(s)
- Tingwei Lu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine, Ministry of Education, Wuhan University, Hubei Province, China; Department of Oral and Maxillofacial-Head & Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, PR China
| | - Zhe Shao
- The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine, Ministry of Education, Wuhan University, Hubei Province, China
| | - Bing Liu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine, Ministry of Education, Wuhan University, Hubei Province, China.
| | - Tianfu Wu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine, Ministry of Education, Wuhan University, Hubei Province, China.
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Orbit in a Box: A Simplified Technique for Patient-Specific Virtually Planned Orbital Floor Reconstruction. J Craniofac Surg 2020; 31:1117-1119. [PMID: 31934963 DOI: 10.1097/scs.0000000000006158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Possibilities for the reconstruction of orbital floor fractures have been extensive for years with regard to materials, methods and differential indications and are inconsistent worldwide. With the spread of CAD/CAM techniques, new and mostly time-consuming possibilities for orbital floor reconstructions have been added. METHODS The simple and time-efficient CT-to-patient-specific implant workflow presented here shows that a "form-box" can be created from a patient's computer tomography data set using planning software and a 3D printer. The box is then used to form a patient-specific implant for orbital floor reconstruction: here polydioxanone foil was used, for which stable thermoplastic deformability has been demonstrated for 3D reconstructions. RESULTS Patient-specific thermoplastic shaping of polydioxanone is feasible in a theoretical clinical setting, though its thermoplastic shaping is not yet certified for clinical use. However, a flexible adaptation of the "form-box" design to other materials is possible by setting a single planning parameter. CONCLUSIONS The simple structure of the box and its straightforward planning/fabrication process with widely available low-cost materials offer the possibility that a surgeon without a 3D specialist can produce a "form-box" for next day surgery if needed.
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Marschall JS, Dutra V, Flint RL, Kushner GM, Alpert B, Scarfe W, Azevedo B. In-House Digital Workflow for the Management of Acute Mandible Fractures. J Oral Maxillofac Surg 2019; 77:2084.e1-2084.e9. [DOI: 10.1016/j.joms.2019.05.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/02/2019] [Accepted: 05/31/2019] [Indexed: 10/26/2022]
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Witowski J, Wake N, Grochowska A, Sun Z, Budzyński A, Major P, Popiela TJ, Pędziwiatr M. Investigating accuracy of 3D printed liver models with computed tomography. Quant Imaging Med Surg 2019; 9:43-52. [PMID: 30788245 DOI: 10.21037/qims.2018.09.16] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background The aim of this study was to evaluate the accuracy of three-dimensional (3D) printed liver models developed by a cost-effective approach for establishing validity of using these models in a clinical setting. Methods Fifteen patients undergoing laparoscopic liver resection in a single surgical department were included. Patient-specific, 1-1 scale 3D printed liver models including the liver, tumor, and vasculature were created from contrast-enhanced computed tomography (CT) images using a cost-effective approach. The 3D models were subsequently CT scanned, 3D image post-processing was performed, and these 3D computer models (MCT) were compared to the original 3D models created from the original patient images (PCT). 3D computer models of each type were co-registered using a point set registration method. 3D volume measurements of the liver and lesions were calculated and compared for each set. In addition, Hausdorff distances were calculated and surface quality was compared by generated heatmaps. Results The median liver volume in MCT was 1,281.84 [interquartile range (IQR) =296.86] cm3, and 1,448.03 (IQR =413.23) cm3 in PCT. Analysis of differences between surfaces showed that the median value of mean Hausdorff distances for liver parenchyma was 1.92 mm. Bland-Altman plots revealed no significant bias in liver volume and diameters of hepatic veins and tumor location. Median errors of all measured vessel diameters were smaller than CT slice height. There was a slight trend towards undersizing anatomical structures, although those errors are most likely due to source imaging. Conclusions We have confirmed the accuracy of 3D printed liver models created by using the low-cost method. 3D models are useful tools for pre-operative planning and intra-operative guidance. Future research in this field should continue to move towards clinical trials for assessment of the impact of these models on pre-surgical planning decisions and perioperative outcomes.
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Affiliation(s)
- Jan Witowski
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
| | - Nicole Wake
- Center for Advanced Imaging Innovation and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Health, NYU School of Medicine, New York, NY, USA
| | - Anna Grochowska
- Chair of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Zhonghua Sun
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Australia
| | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
| | | | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
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