Reconstruction of mandible using a computer-designed 3D-printed patient-specific titanium implant: a case report

Abstract

Reconstruction of mandibular defects after trauma or tumor resection is one of the most challenging problems facing maxillofacial surgeons. Historically, various autografts and alloplastic materials have been used in the reconstruction of these types of defects. The use of individualized designed biomaterials has opened new possibilities in reconstructive surgery, and now, it is possible to use the patient’s computed tomography (CT) to construct patient-specific implants (PSIs). A case of a large mandibular tumor resection and reconstruction of the defect using a customized 3D-printed titanium implant is described. The treatment had excellent postoperative esthetic and functional results without complications.

Conclusion

Because titanium implants are customizable, easily workable especially with help of 3D virtual planning techniques, bioinert, and nonporous, they represent an ideal alloplastic material for mandibular reconstruction.

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References

  1. 1.

    Snell RS (2003) Clinical anatomy, 7th edition, vol. 4, Pearls

  2. 2.

    Wang DM, Wang CT, Qu AL, Xu XL, Zhang CP (2007) Design and biomechanical analysis of a novel mandibular prosthesis. IFMBE Proc 14(5):2797–2799

    Article  Google Scholar 

  3. 3.

    Atilgan S, Erol B, Yardimeden A, Yaman F, Ucan MC, Gunes N, Atalay Y, Kose I (2010) A three dimensional analysis of reconstruction plates used in different mandibular defects a 3D analysis of reconstruction plates used in different mandibular defects. Biotechnol & Biotechnol Eq 24(2):1893–1896

    Article  Google Scholar 

  4. 4.

    Singare S, Bingheng LDL, Yanpu L, Zhenyu G, Yaxiong L (2004) Design and fabrication of custom mandible titanium tray based on rapid prototyping. Journal of Medical Engineering and Physics 26:671–676

    Article  Google Scholar 

  5. 5.

    Armentani E, Caputo F, Citarella R (2010) FEM sensitivity analyses on the stress levels in a human mandible with a varying ATM modeling complexity. The Open Mechanical Engineering Journal:8–15

  6. 6.

    Lanza A, Laino L, Rossiello L, Perillo L, Ermo AD, Cirillo N (2008) Giant cell tumor of the jaw mimicking bone malignancy on three dimensional computed tomography (3D-CT) reconstruction. Open Dent J 2:73–77

    Article  Google Scholar 

  7. 7.

    Boyne P (1997) Osseous reconstruction of the maxilla and the mandible: surgical techniques using titanium mesh and bone mineral. Chicago, Quintessence

  8. 8.

    Chaudhary N, Lovald ST, Wagner J, Khraishi T, Baack B (2008) Experimental and numerical modeling of screws used for rigid internal fixation of mandibular fractures. Modelling and Simulation in Engineering 2008:1–11

    Article  Google Scholar 

  9. 9.

    Tessier P (1982) Autogenous bone grafts taken from the calvarium for facial and cranial applications. Clin Plast Surg 9(4):531–538

    CAS  Article  Google Scholar 

  10. 10.

    Maas CS, Merwin GE, Wilson J, Frey MD, Maves MD (1990) Comparison of biomaterials for facial bone augmentation. Arch Otolaryngol Head Neck Surg 116(5):551–556

    CAS  Article  Google Scholar 

  11. 11.

    Jockisch KA, Brown SA, Bauer TW, Merritt K (1992) Biological response to choppedcarbon-fiber–reinforced PEEK. J Biomed Mater Res 26(2):133–146

    CAS  Article  Google Scholar 

  12. 12.

    West Chester PA (2004) PSI–patient specific implants, Synthes Inc

  13. 13.

    Boccaccio A, Lamberti L, Pappalettere C, Cozzani M, Sicilianie G (2006) Comparison of different orthodontic devices for mandibular symphyseal distraction osteogenesis: a finite element study, Am J Orthod Dentofac Orthop, pp. 260–269

  14. 14.

    Matros E, Albornoz CR, Rensberger M et al (2014) Computer-assisted design and computer-assisted modeling technique optimization and advantages over traditional methods of osseous flap reconstruction. Reconstr Microsurg 30(5):289–296

    Google Scholar 

  15. 15.

    Hou JS, Chen M, Pan CB et al (2012) Application of CAD/CAM-assisted technique with surgical treatment in reconstruction of the mandible. J Craniomaxillofac Surg 40(8):–432, 7

  16. 16.

    Wurm G, Tomancok B, Pogady P et al (2004) Cerebrovascular stereolithographic biomodeling for aneurysm surgery. J Neurosurg 100(1):139–145

    Article  Google Scholar 

  17. 17.

    Ciocca L, Mazzoni S, Fantini M et al (2012) CAD/CAM guided secondary mandibular reconstruction of a discontinuity defect after ablative cancer surgery. J Craniomaxillofac Surg 40:511–e515

    Article  Google Scholar 

  18. 18.

    Logan H, Wolfaardt J, Boulanger P et al (2013) Exploratory benchtop study evaluating the use of surgical design and simulation in fibula free flap mandibular reconstruction. J Otolaryngol Head Neck Surg 24(42):42

    Article  Google Scholar 

  19. 19.

    Darwich K, Darwich MA (2015) Virtual planning of surgical mandibular reconstruction using digital images and finite elements technique - a case study. Damascus university journal for medical sciences 31(1):125–134

    Google Scholar 

  20. 20.

    Hanasono MM, Skoracki RJ (2013) Computer-assisted design and rapid prototype modeling in microvascular mandible reconstruction. The Laryngoscope 123:597–604

    Article  Google Scholar 

  21. 21.

    Van Baar GJC, Forouzanfar T, Liberton N, Winters HAH, Leusink FKJ (2018) Accuracy of computer-assisted surgery in mandibular reconstruction: a systematic review. Oral Oncol 84:52–60

    Article  Google Scholar 

  22. 22.

    Mascha F, Winter K, Pietzka S, Heufelder M, Schramm A, Wilde F (2017) Accuracy of computer-assisted mandibular reconstructions using patient-specific implants in combination with CAD/CAM fabricated transfer keys. J Cranio-Maxillofac Surg 45:1884–1897

    Article  Google Scholar 

  23. 23.

    Tack P, Victor J, Gemmel P, Annemans L (2016) 3D-printing techniques in a medical setting: a systematic literature review. Biomed Eng Online 15:115

    Article  Google Scholar 

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Correspondence to Khaldoun Darwich.

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Darwich, K., Ismail, M.B., Al-Mozaiek, M.Y.AS. et al. Reconstruction of mandible using a computer-designed 3D-printed patient-specific titanium implant: a case report. Oral Maxillofac Surg 25, 103–111 (2021). https://doi.org/10.1007/s10006-020-00889-w

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Keywords

  • Mandibular reconstruction
  • 3D-printed titanium implant
  • Ameloblastoma
  • Patient-specific implant PSI
  • CAD–CAM
  • Virtual surgical planning