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

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          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.

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          Mechanical evaluation of porous titanium (Ti6Al4V) structures with electron beam melting (EBM).

          Jayanthi Parthasarathy, Binil Starly, Shivakumar Raman … (2010)
          Patient specific porous implants for the reconstruction of craniofacial defects have gained importance due to their better performance over their generic counterparts. The recent introduction of electron beam melting (EBM) for the processing of titanium has led to a one step fabrication of porous custom titanium implants with controlled porosity to meet the requirements of the anatomy and functions at the region of implantation. This paper discusses an image based micro-structural analysis and the mechanical characterization of porous Ti6Al4V structures fabricated using the EBM rapid manufacturing process. SEM studies have indicated the complete melting of the powder material with no evidence of poor inter-layer bonding. Micro-CT scan analysis of the samples indicate well formed titanium struts and fully interconnected pores with porosities varying from 49.75%-70.32%. Compression tests of the samples showed effective stiffness values ranging from 0.57(+/-0.05)-2.92(+/-0.17)GPa and compressive strength values of 7.28(+/-0.93)-163.02(+/-11.98)MPa. For nearly the same porosity values of 49.75% and 50.75%, with a variation in only the strut thickness in the sample sets, the compressive stiffness and strength decreased significantly from 2.92 GPa to 0.57 GPa (80.5% reduction) and 163.02 MPa to 7.28 MPa (93.54 % reduction) respectively. The grain density of the fabricated Ti6Al4V structures was found to be 4.423 g/cm(3) equivalent to that of dense Ti6Al4V parts fabricated using conventional methods. In conclusion, from a mechanical strength viewpoint, we have found that the porous structures produced by the electron beam melting process present a promising rapid manufacturing process for the direct fabrication of customized titanium implants for enabling personalized medicine. (c) 2009 Elsevier Ltd. All rights reserved.
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            Current approaches to experimental bone grafting.

            Steven Lane, H Sandhu (1987)
            A number of osteogenic, osteoinductive, and osteoconductive substances currently are being investigated for use in bone repair. It is conceivable that a selected combination of osteogenic cells, osteoinductive factors, and osteoconductive matrices can be combined and fabricated into an implantable material custom-suited to particular clinical demands. Consequently, it is crucial that potential graft substances be experimentally characterized in terms of their precise contribution to the bone-forming mechanisms. In this article, the authors review current areas of research in the realm of experimental grafting, including the current understanding of materials that manifest osteogenic, osteoinductive, or osteoconductive properties.
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              Reconstruction of the maxilla and midface: introducing a new classification.

              James S Brown, Richard J Shaw (2010)
              Most patients requiring midface reconstruction have had ablative surgery for malignant disease, and most require postoperative radiotherapy. This type of facial reconstruction attracts controversy, not only because of the many reconstructive options, but also because dental and facial prostheses can be very successful in selected cases. This Personal View is based on a new classification of the midface defect, which emphasises the increasing complexity of the problem. Low defects not involving the orbital adnexae can often be successfully treated with dental obturators. For the more extensive maxillary defects, there is consensus that a free flap is required. Composite flaps of bone and muscle harvested from the iliac crest with internal oblique or the scapula tip with latissimus dorsi can more reliably support the orbit and cheek than soft-tissue free flaps and non-vascularised grafts, and also enable an implant-borne dental or orbital prosthesis. Nasomaxillary defects usually require bone to augment the loss of the nasal bones, but orbitomaxillary cases can be managed more simply with local or soft-tissue free flaps. We review the current options and our own experience over the past 15 years in an attempt to rationalise the management of these defects.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ann Maxillofac Surg
                Journal ID (iso-abbrev): Ann Maxillofac Surg
                Journal ID (publisher-id): AMS
                Title: Annals of Maxillofacial Surgery
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 2231-0746
                ISSN (Electronic): 2249-3816
                Publication date (Print): Jan-Jun 2014
                Volume: 4
                Issue: 1
                Pages: 9-18
                Affiliations
                [1]Department of Engineering, Director Engineering MedCAD Inc. Dallas TX 75226, USA
                Author notes
                Address for correspondence: Dr. Jayanthi Parthasarathy, 1372 Todd Dr, Plano, TX 75023, USA. E-mail: jayanthip7@ 123456hotmail.com
                Article
                Publisher ID: AMS-4-9
                DOI: 10.4103/2231-0746.133065
                PMC ID: 4073471
                PubMed ID: 24987592
                SO-VID: 9f08d30a-9221-4811-9dac-f2ba5f34cd9b
                Copyright © Copyright: © Annals of Maxillofacial Surgery
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Invited Review Article

                Keywords: 3d modeling,implants,additive manufacturing,craniofacial surgery,porous titanium,peek implants,electron beam melting,patient specific implants,custom implants,cad cam surgery,cad cam implants
                Data availability:
                Keywords: 3d modeling, implants, additive manufacturing, craniofacial surgery, porous titanium, peek implants, electron beam melting, patient specific implants, custom implants, cad cam surgery, cad cam implants

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