A novel 3D template for mandible and maxilla reconstruction: Rapid prototyping using stereolithography

ABSTRACT

Introduction: Replication of the exact three-dimensional (3D) structure of the maxilla and mandible is now a priority whilst attempting reconstruction of these bones to attain a complete functional and aesthetic rehabilitation. We hereby present the process of rapid prototyping using stereolithography to produce templates for modelling bone grafts and implants for maxilla/mandible reconstructions, its applications in tumour/trauma, and outcomes for primary and secondary reconstruction. Materials and Methods: Stereolithographic template-assisted reconstruction was used on 11 patients for the reconstruction of the mandible/maxilla primarily following tumour excision and secondarily for the realignment of post-traumatic malunited fractures or deformity corrections. Data obtained from the computed tomography (CT) scans with 1-mm resolution were converted into a computer-aided design (CAD) using the CT Digital Imaging and Communications in Medicine (DICOM) data. Once a CAD model was constructed, it was converted into a stereolithographic format and then processed by the rapid prototyping technology to produce the physical anatomical model using a resin. This resin model replicates the native mandible, which can be thus used off table as a guide for modelling the bone grafts. Discussion: This conversion of two-dimensional (2D) data from CT scan into 3D models is a very precise guide to shaping the bone grafts. Further, this CAD can reconstruct the defective half of the mandible using the mirror image principle, and the normal anatomical model can be created to aid secondary reconstructions. Conclusion: This novel approach allows a precise translation of the treatment plan directly to the surgical field. It is also an important teaching tool for implant moulding and fixation, and helps in patient counselling.

KEY WORDS:

Rapid prototyping - stereolithography - three dimensional (3D) template

 

Conflicts of interest

There are no conflicts of interest.

• REFERENCES

• 1 D’souza KM, Aras MA. Applications of computer-aided design/computer-assisted manufacturing technology in dental implant planning. J Dent Implant 2012; 2: 37-41
• 2 Voitik AJ. CT data and its CAD and CAM utility in implant planning: Part I. J Oral Implantol 2002; 28: 302-3
• 3 Gibson I, Rosen DW, Stucker B. Additive Manufacturing Technologies. Springer; 2010: p. 238
• 4 Winder J, Bibb R. Medical rapid prototyping technologies: State of the art and current limitations for application in oral and maxillofacial surgery. J Oral Maxillofac Surg 2005; 63: 1006-15
• 5 Mankovich NJ, Cheeseman AM, Stoker NG. The display of three-dimensional anatomy with stereolithographic models. J Digit Imaging 1990; 3: 200-3
• 6 Jones R, Haufe P, Sells E, Iravani P, Olliver V, Palmer C. et al RepRap - the replicating rapid prototyper. Robotica 2011; 29: 177-91
• 7 Brown GA, Milner B, Firoozbakhsh K. Application of computer-generated stereolithography and interpositioning template in acetabular fractures: A report of eight cases. J Orthop Trauma 2002; 16: 347-52
• 8 Powers DB, Edgin WA, Tabatchnick L. Stereolithography: A historical review and indications for use in the management of trauma. J Craniomaxillofac Trauma 1998; 4: 16-23
• 9 Rose EH, Norris MS, Rosen JM. Application of high-tech three dimensional imaging and computer-generated models in complex facial reconstruction with vascularized bone grafts. Plast Reconstr Surg 1993; 91: 252-64
• 10 Rahimov C, Farzaliyev I. Virtual bending of titanium reconstructive plates for mandibular defect bridging: Review of three clinical cases. Craniomaxillofac Trauma Reconstr 2011; 4: 223-34
• 11 Succo G, Berrone M, Battiston B, Tos P, Goia F, Appendino P. et al Step-by-step surgical technique for mandible reconstruction using free fibula flap: Application of digital technology in virtual surgical planning. Eur Arch Otorhinolaryngol 2015; 272: 1491-501
• 12 Lal K, White GS, Morea DN, Wright RF. Use of stereolithographic templates for surgical and prosthodonticimplant planning and placement. Part I. The concept. J Prosthodont 2006; 15: 51-8
• 13 Chang PS, Parker TH, Patrick Jr CW, Miller MJ. The accuracy of stereolithography in planning craniofacial bone replacement. J Craniofac Surg 2003; 14: 164-70
• 14 Cunningham Jr LL, Madsen MJ, Peterson G. Stereolithographic modeling technology applied to tumor resection. J Oral Maxillofac Surg 2005; 63: 873-8