A 3D-printed osseointegrated combined jaw and dental implant prosthesis – a case study

Abstract

Purpose This paper aims to present a new design in the area of basal osseointegrated implant (BOI) for oral and maxillofacial surgery using a patient-specific computer-aided design (CAD) and additive manufacturing (AM) approach. The BOI was designed and fabricated according to the patient’s specific requirement, of maxilla stabilisation and dental fixation, a capacity not currently available in conventional BOI. The combination of CAD and AM techniques provides a powerful approach for optimisation and realisation of the implant in a design which helps to minimise blood loss and surgery time, translating into better patient outcomes and reduced financial burdens on healthcare providers. Design/methodology/approach The current study integrates the capabilities of conventional medical imaging techniques, CAD and metal AM to realise the BOI. The patient’s anatomy was scanned using a 128-slice spiral computed tomography scanner into a standard Digital Imaging and Communication in Medicine (DICOM) data output. The DICOM data are processed using MIMICS software to construct a digital representative patient model to aid the design process, and the final customised implant was designed using Creo software. The final, surgically implanted BOI was fabricated using direct metal laser sintering in titanium (Ti-64). Findings The current approach assisted us to design BOI customised to the patient’s unique anatomy to improve patient outcomes. The design realises a nerve relieving option and placement of porous structure at the required area based up on the analysis of patient bone structural data. Originality/value The novelty in this work is that developed BOI comprises a patient-specific design that allows for custom fabrication around the patients' nerves, provides structural support to the compromised maxilla and comprises a dual abutment design, with the capacity of supporting fixation of up to four teeth. Conventional BOIs are only available for a signal abutment capable of holding one or two teeth only. Given the customised nature of the design, the concept could easily be extended to explore a greater number of fixation abutments, abutment length/location, adjusted dental fixation size or greater levels of maxilla support. The study highlights the significance of CAD packages to construct patient-specific solution directly from medical imaging data, and the efficiency of metal AM to translate designs into a functional implant.

Additive Manufacturing of 3D Anatomical Models—Review of Processes, Materials and Applications

“…Most publications about medical models produced with additive manufacturing methods concern the topic of the skeletal system. Apart from this, subgroups were additionally distinguished due to the large number of articles on single structures: the skull [ 4 , 5 ], facial skeleton [ 6 , 7 , 8 ], which apart from reconstructive surgery also includes dentistry and orthodontics [ 9 , 10 ] and the thoracic/rib region. The circulatory system, including publications concerning only the heart or other structures [ 11 , 12 ], and articles concerning the kidneys [ 13 , 14 , 15 ] and liver [ 16 , 17 ], can be classified as more recent publications.…”

“…The next stage concerns the design in CAD programs, but it is not a mandatory element. CAD is most often used in the design of guiding instruments [ 10 ], for reconstructions in the craniofacial area, where a template is designed for cutting the bones of the arrow/scapula [ 6 , 7 , 8 ] or when the parallel process of designing the casting mould is taken for the production of models imitating soft tissues in the casting process [ 17 , 22 ]. The methodology at this stage is divided into two paths, depending on the design assumptions, available funds and manufacturing technology.…”

3D Printing Technology for Fighting COVID-19 Pandemic

“…Craniofacial plates/mesh, made of Ti-6Al-4V, fabricated using EBM technology has shown promising results for skull reconstruction (Wang and Qi 2020;Park et al 2016), Ti-6Al-4V jaw, dental and subperiosteal implant fabricated using DMLS technology demonstrated successful (Jardini et al 2016), dental screw (Tedesco et al 2017) and mandibular implant (Chen et al 2017), spinal implant (Phan et al 2016) and sternum implant (Dzian et al 2018), hip (Wong et al 2015) and knee implant, bone implant (Shuang et al 2016), extravascular stent (Wang et al 2019). Reprinted under copyright CCBY-NC-ND 4.0 license osteointegration circumventing bone regeneration therapies (Malyala et al 2017;Mangano et al 2020). Titanium spinal implant fabricated using EBM and DMLS have enabled reconstruction of cervical spine (Xu et al 2016;Willemsen et al 2019), titanium sternal implant fabricated using DMLS offers progressive treatment for sternal cancer or total sternectomy (Dzian et al 2018), Titanium hip implant fabricated using EBM for successful Hemipelvic Arthroplasty (Zhao et al 2018).…”

Healthcare Applications of 3D Printing in Human Implants: A Review

“…S K Malyala et al reported the development of a basal osseo-integrated implant that has the ability to be patient specific and provided mass customization for nerves treatment. They reported the analysis of the structure that worked as support for the dental patients [22]. In 2017, AIIMS performed the diagnosis of a patient who needed an immediate implant surgery.…”

“…This paper addresses the design requirements for an implant to study GI dysmotility and also presents a miniaturized wireless implant capable of modulating GI motility. Santosh Kumar Malyala et al [22] Osseo-integrated Implant…”