Treatment of Facial Deformities using 3D Planning and Printing of Patient-Specific Implants

Summary

As technology develops and becomes more user-friendly, planning of operations and patient-specific surgical guides and fixation plates should be performed by the surgeon. We present a protocol for 3D planning of orthognathic skeletal movements and 3D planning and printing of patient-specific fixation plates and surgical guides.

Abstract

Technological advancements in surgical planning and patient-specific implants are constantly evolving. One can either adopt the technology to achieve better results, even in the less experienced hand, or continue without it. As technology develops and becomes more user-friendly, we believe it is time to allow the surgeon the option to plan his/her operations and create his/her own patient-specific surgical guides and fixation plates allowing him full control over the process. We present here a protocol for 3D planning of the operation followed by 3D planning and printing of surgical guides and patient-specific fixation implants. During this process we use two commercial computer-assisted design (CAD) software. We also use a fused deposition modeling printer for the surgical guides and a selective laser sintering printer for the titanium patient-specific fixation implants. The process includes computed tomography (CT) imaging acquisition, 3D segmentation of the skull and facial bones from the CT, 3D planning of the operations, 3D planning of patient-specific fixation implant according to the final position of the bones, 3D planning of surgical guides for performing an accurate osteotomy and preparing the bone for the fixation plates, and 3D printing of the surgical guides and the patient-specific fixation plates. The advantages of the method include full control over the surgery, planned osteotomies and fixation plates, significant reduction in price, reduction in operation duration, superior performance and highly accurate results. Limitations include the need to master the CAD programs.

Introduction

3D printing is an additive method based on gradual placement of layers from different materials, thus creating 3D objects. It was originally developed for rapid prototyping and was introduced in 1984 by Charles Hull, who is considered the inventor of the stereolithography method based on solidifying layers of photopolymer resin¹. Technological advancements in virtual planning of surgeries and planning and printing of patient-specific implants are constantly evolving. Innovations arise both in the field of computer assisted design (CAD) software and in 3D printing technologies². Simultaneous to developments in technology,....

Protocol

1. Repositioning of the jaws

NOTE: This section is performed using the imaging software (i.e., Dolphin).

1. Load the facial bones CT image DICOM files of the patient (Figure 1A) into the software by selecting the 3D button on the left and clicking Import New DICOM (Supplemental Figure 1). Enter the 3D editing mode by clicking 3D | Edit.
2. Orient the 3D image using.......

Discussion

3D planning and printing is one of the most rapidly evolving methods in the surgical field. It is not only a promising tool for the future, but a practical tool used nowadays for highly accurate surgical results and patient-specific solutions. It allows for highly accurate results and reduces the dependency on the surgeon’s experience¹⁰. It solves many of the disadvantages of previous old fashion surgical methods, but the costs delay the full implementation of the method^10<.......

Materials

Name	Company	Catalog Number	Comments
Dolphin imaging software	Dolphin Imaging Systems LLC (Patterson Dental Supply, Inc)		3D analysis and virtual planning of orthognathic surgeries
Geomagic Freeform	3D systems		Sculpted Engineering Design