Rapid prototyping-assisted maxillofacial reconstruction

Figures & data

Table I. Historical development of rapid prototyping and relevant medical uses (24,28–31).

Year	Inventors	Developments
1967	Herbert Voelcker	proposed an idea to do ‘interesting things’ with the automatic and computer-controlled machine tools (RP was born)
1970s	Herbert Voelcker	introduced mathematical theory and algorithms for solid modeling
1984	Charles Hull	invented 3D models
1986	Charles Hull	invented stereolithography (SLA)
1987	Carl Deckard	invented selective laser sintering (SLS)
	Brix and Lambrecht	used a 3D model in health care
1988	Scott Crump	invented fused deposition modeling (FDM)
1991	Helisys Inc.	sold the first system of laminated object manufacturing (LOM)
1991	A maxillofacial surgery clinic in Vienna	first used RP models of human anatomy in maxillofacial surgery
1992	Stratasys Company	sold the first FDM-based machine
	DTM Corporation	sold the first selective laser sintering (SLS) system
1993	Massachusetts Institute of Technology (MIT)	patented ‘3-dimensional printing techniques’
1995	Z Corporation Company	developed actual 3D printers
1998	3D Systems Company	introduced a 3D printer called ThermoJet
2005	Z Corporation	invented a 3D printer called Spectrum Z510
2010	3D Systems Company	manufactured Urbee car
	Anthony Atala	printed trachea
2011	Shapeways and Continuum Fashion	printed bikini
	University of Southampton	manufactured aircraft
2012	Scottish scientists	printed artificial heart
	Children's National Medical Center in Washington	printed artificial liver tissue
	LayerWise	printed transplant jaw
	Anthony Atala	printed blood vessels
2013	A 3D printing company in Texas, USA	printed metal pistol
	Scott Hollister	printed trachea splint
	Organovo Company	printed micro liver
2014	Philipp Günther Inc.	printed AIRBALL
	Mikael Genberg	printed moonhouse
	Jonathan Cook	printed 3D smart watch
	Darryl D’Lima	printed biological ointment

Figure 1. RP process chain showing main process steps. Adapted from reference (48) with permission of Rapid Prototyping Journal, Emerald, Copyright 2009.

Figure 2. Overview of RP technologies. Adapted from reference (50) with permission of Macromolecular Materials and Engineering, John Wiley and Sons, Copyright 2008.

Figure 3. Schematic of two types of SLA setups. (A) A bottom-up system with a scanning laser. (B) A top-down setup with digital light projection (DLP). DLP is a method to illuminate the resin. A 2D pixel pattern is projected onto the coated glass plate with a digital mirror device (DMD), and then a complete resin is cured immediately. Adapted from reference (54) with permission of UTpublications, University of Twente, Copyright 2010.

Figure 4. Schematic of the SLS technology. Adapted from reference (48) with permission of Rapid Prototyping Journal, Emerald, Copyright 2009.

Figure 5. Schematic of the FDM technology. Adapted from reference (70) with permission of Biomaterials, Elsevier, Copyright 2002.

Figure 6. Schematic of the LOM technology. (A) Heating. (B) Bonding. Adapted from reference (72) with permission of Manufacturing Practices, Indian Institute of Technology Delhi, Copyright 2012.

Figure 7. Schematic of the 3DP technology. Adapted from reference (48) with permission of Rapid Prototyping Journal, Emerald, Copyright 2009.

Table II. Comparison of selected RP technologies (48–52,74–77).

	SLA	SLS	FDM	LOM	3DP
Materials	Photopolymers (acrylic and epoxy resins)	Metals, sand, thermoplastics (PA12, PC, PS)	Thermoplastics (ABS, PC, ABS-PC-blend, PPSU)	Foils (paper, polymers, metals, ceramics)	Thermoplastics, cement, cast sand
System type	Liquid-based	Powder-based	Solid-based	Solid-based	Powder-based
Forming technique	Laser/light-based	Laser/heat based	Heat and extrusion/nozzle-based	Lamination	Adhesives/molding
Part size/(mm)	600 × 600× 500	700 × 380× 550	600 × 500× 600	550 × 800× 500	508 × 610× 406
Layer thickness	0.03–0.25 mm	0.1–0.15 mm	0.127–0.254 mm	0.015–0.12 mm	0.178–0.356 mm
Cooling-off/curing time	No cooling-off or curing time up to 30 min	Depending on geometry and bulk	No cooling-off or curing time	Depending on geometry	No cooling-off or curing time
Precision	< 0.05 mm	0.05–0.1 mm	0.1 mm	0.15 mm	0.1/600 × 540 dpi
Advantages	Good surface finish, can be made transparent, high mechanical strength	Good mechanical strength, broad range of materials	Good mechanical strength, fast fabrication time, low toxicity	Produces relatively large parts	Fast fabrication time, low toxicity, capability of being colored, relative material variety
Disadvantages	Limitations to material selection (epoxy and acrylic resin), post-cure required	Elevated temperatures, local high energy input, uncontrolled porosity, toxic gases	Elevated temperatures, small range of bulk materials, rough surface finish, support structure must be removed	Model with thin walls; hollow objects cannot be made by this method	Large tolerance, lower strength models, rough surface finish, material must be in powder form, weak bonding between powder particles, might require post-processing
Applications	Creation of conceptual, geometric, and functional prototypes	Creation of visual and functional prototypes, tools for injection pressing, hard tools and electrical discharge machining (EDM) electrodes	Production of functional prototypes and for precision casting technology	Conceptual design	Mechanical engineering, aeronautics and shipbuilding, architecture, precise design of implants, selection of instruments
Cost ($/kg)	From 160	From 190	From 60	From 190	From 30
Relative sample cost^a	Medium	Medium-high	Low-medium	Medium-high	Low
Commercially available since	1987	1991	1991	1990	1998

^aCost depends on the number, size, and complexity of samples.

Figure 8. (A) Precontoured mandibular reconstruction plate placing over the right mandible with ameloblastoma, (B) Reconstruction plate bridging the gap following tumor resection. Adapted from reference (15) with permission of Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, Elsevier, Copyright 2009.

Figure 9. (A) General view of the implant-bearing skull. Implants are fixed with miniplates for mandibular defect. (B) The drill holes for screw insertion were made after positioning of the implants using a common bone drill. Adapted from reference (157) with permission of Journal of Cranio-Maxillofacial Surgery, Elsevier, Copyright 2010.

Figure 10. Preoperative planning for patients with craniomaxillofacial post-traumatic deformity. (A) Resinous craniofacial model manufactured using a rapid prototyping device. (B) Preshaping of titanium mesh or plates on rapid prototyping models. (C) Preoperative view of the patient. (D) Postoperative view of the patient. (E) Preoperative mouth opening of the patient. (F) Postoperative mouth opening of the patient. (G) Preoperative occlusion. (H) Postoperative occlusion. Adapted from reference (162) with permission of Journal of Oral and Maxillofacial Surgery, Elsevier, Copyright 2014.

Figure 11. (A) Appearance of face before treatment of left side blowout orbital fracture where lowered left eyeball, restricted upward movement, and narrowed palpebral fissure are observed. (B) Computer tomography image of the left orbit with sagittal plane reconstruction with arrow indicating the damaged orbital floor. (C) Physical (solid) model of left orbital floor with formed titanium mesh. Adapted from reference (173) with permission of Journal of Cranio-Maxillofacial Surgery, Elsevier, Copyright 2009.

Figure 12. (A) Preoperative view. (B) Computer-aided design. The unaffected right mandible was mirrored to the left (red). The discrepancy between the mirrored right mandible and the native left mandible (green) was extracted (blue). For additional compensation of the atrophied soft tissue, the outer surface was expanded by 1.5 mm. (C) Postoperative view with the facial symmetry reconstructed. Adapted from reference (169) with permission of British Journal of Oral and Maxillofacial Surgery, Elsevier, Copyright 2009.

Figure 13. (A) Patient's preoperative frontal view. (B) Frontal view of centric occlusion with transverse maxillary cant and maxilla midline deviation. (C) Preoperative 3D model reconstructed based on CT scanning. (D) Postoperative frontal view: the patient's maxillary transverse cant and midline deviation were corrected as the preoperative surgical design. (E) Postoperative 3D model reconstructed based on CT scanning. Adapted from reference (192) with permission of Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, Elsevier, Copyright 2010.

Figure 14. (A) Initial facial view. (B) Initial facial smiling. (C) Pretreatment intraoral photograph. (D) Final facial view. (E) Final facial smiling. (F) Final intraoral photograph. Adapted from reference (231) with permission of Head and Face Medicine, BioMed Central, Copyright 2014.

Figure 15. (A) Picture of patient taken with 3dMDfaceTM. (B) Color model made with the ZPrinter^® 450 (Z Corporation, Burlington, MA) and a high performance composite material. (C) Clay sculpture on model. (D) Patient with final prosthesis and glasses. Adapted from reference (238) with permission of Journal of Prosthodontics, John Wiley and Sons, Copyright 2011.

Figure 16. (A) Patient with facial malformation. (B) A margin 2 mm wide was measured and cut. (C) A layer of the virtual preliminary prostheses 0.5 mm thick was subtracted (a) and the subtracted layer of 0.5 mm magnified (b). (D) Rapid prototype wax prosthesis. (E) Finished wax prosthesis with surface texture, follicular orifices, and adaptable margin. (F) Patient with final silicone prosthesis. Adapted from reference (239) with permission of British Journal of Oral and Maxillofacial Surgery, Elsevier, Copyright 2010.

Figure 17. (A) Initial appearance of patient's face with injury from accidental gunshot. (B) Final prosthesis on patient. Adapted from reference (41) with permission of Journal of Rehabilitation Research and Development, U.S. Department of Veterans Affairs, Copyright 2010.

Figure 18. Solutions for technical challenges faced by advanced RP-assisted maxillofacial reconstruction.

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