Additively manufactured versus conventionally pressed cranioplasty implants: An accuracy comparison

Abstract

This article compared the accuracy of producing patient-specific cranioplasty implants using four different approaches. Benchmark geometry was designed to represent a cranium and a defect added simulating a craniectomy. An 'ideal' contour reconstruction was calculated and compared against reconstructions resulting from the four approaches -'conventional', 'semi-digital', 'digital - non-automated' and 'digital - semi-automated'. The 'conventional' approach relied on hand carving a reconstruction, turning this into a press tool, and pressing titanium sheet. This approach is common in the UK National Health Service. The 'semi-digital' approach removed the hand-carving element. Both of the 'digital' approaches utilised additive manufacturing to produce the end-use implant. The geometries were designed using a non-specialised computer-aided design software and a semi-automated cranioplasty implant-specific computer-aided design software. It was found that all plates were clinically acceptable and that the digitally designed and additive manufacturing plates were as accurate as the conventional implants. There were no significant differences between the additive manufacturing plates designed using non-specialised computer-aided design software and those designed using the semi-automated tool. The semi-automated software and additive manufacturing production process were capable of producing cranioplasty implants of similar accuracy to multi-purpose software and additive manufacturing, and both were more accurate than handmade implants. The difference was not of clinical significance, demonstrating that the accuracy of additive manufacturing cranioplasty implants meets current best practice.

Clinical, industrial, and research perspectives on powder bed fusion additively manufactured metal implants

“…This alteration of supply chains and introduction of lean manufacturing is similar to the supply chain effects observed in more general manufacturing settings [65,66]. Crucially, plates manufactured using both fully and semiautomated digital workflows show superior accuracy to conventional hand-manufactured plates, reducing the need for adaption during surgery [67]. Greater surgical duration has been associated with poorer patient outcome [68], and whilst it is difficult to unpick the association between operative time, complications during surgery, and post-operative complications, the importance of minimising surgical time and related anaesthesia duration has been highlighted in several surgical fields [69,70].…”

Polylactic Acid Implant for Cranioplasty with 3-dimensional Printing Customization: A Case Report

“…The defect reconstruction with computerassisted 3D reconstruction allows more accurate anatomical form and it removes the time-consuming manual carving stage, although there is no clinical difference in outcome [10]. 3D reconstruction can provide the latest anatomical picture because the defect shape and soft tissue can change over time since DC is to infection.…”

Cranioplasty with three-dimensional customised mould for polymethylmethacrylate implant: a series of 11 consecutive patients with cost-effectiveness consideration

“…The use of 3D images facilitated the integration between medical staff and engineering. As observed in several articles [30,6,7,25,5,33,13,20,21,32,19], the various CAD/CAM techniques offer safe and satisfactory aesthetic results regardless of the implanted biomaterial, provided that an appropriate scienti c methodology is followed. In our experience, the ideal algorithm for mould production was observed when the surgeon adequately expressed his/her need to the engineering team via a medical phantom.…”

“…In the manufacturing process, the cost of material to produce moulds is similar to that of the prosthesis. By automating the interdisciplinary design of implants during their manufacture under validated systems, the application of 3D printing could be routinely used in clinical practice while continuously overcoming the limitations [20,21,34]. Product production, whether mould or implant, is achievable in less than 14 days.…”