Computer-Aided Design and Manufacture and Rapid Prototyped Polymethylmethacrylate Reconstruction

Turgut, Gürsel; Özkaya, Özay; Kayal, Mahmut Ulvi

doi:10.1097/scs.0b013e31824dbcaf

Cited by 30 publications

(21 citation statements)

References 9 publications

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“…In the past 20 years or so, much has been achieved through research on the techniques to produce customized cranioplasty implants. 13,14,19,21,27,34,36,48,49,54,56 Nevertheless, these impressive techniques have generally remained in the respective laboratories and universities in which they were developed. This is because they require technical expertise as well as expensive, sophisticated software and machinery that are beyond the means of most surgeons and hospitals.…”

Section: Discussionmentioning

confidence: 99%

The feasibility of producing patient-specific acrylic cranioplasty implants with a low-cost 3D printer

Tan¹,

Ling²,

Dinesh³

2016

JNS

104

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T he reconstruction of a skull vault defect, termed cranioplasty, has a rich and fascinating history. For at least 5 millennia, surgeons have patched cranial defects with an immensely diverse range of materials ranging from fruit shells to sheep scapulae and man-made plastics. 42 Even today, the pursuit of the perfect cranioplasty material and technique continues.Skull defects are often the direct result of surgical decompressive craniectomy performed for acute neurosurgical emergencies. 23 The use of a patient's original bone flap for cranioplasty is theoretically sound and avoids the problems related to the use of bone from other sources, such as human cadavers (allografts) or animals (xenografts), or the use of synthetic materials. In practice, however, cranioplasty using these bone flaps, which have been stored for a period of time either in a surgically created subcutaneous pocket or in a medical freezer, is plagued with a not insignificant risk of infections and bony resorption. 8,11,22 With unnatural storage, the nature and content of these bone flaps are changed permanently, hindering successful reincorporation as part of the skull vault. Loss of osteogenesis probably plays a role; studies on human calvarial bone flaps have shown a diminution of osteoblasts after both subcutaneous 44 The feasibility of producing patient-specific acrylic cranioplasty implants with a low-cost 3D printer eddie t. w. tan, mrcsed, Ji min ling, mrcsed, and shree Kumar dinesh, FrcsDepartment of Neurosurgery, National Neuroscience Institute, Singapore obJective Commercially available, preformed patient-specific cranioplasty implants are anatomically accurate but costly. Acrylic bone cement is a commonly used alternative. However, the manual shaping of the bone cement is difficult and may not lead to a satisfactory implant in some cases. The object of this study was to determine the feasibility of fabricating molds using a commercial low-cost 3D printer for the purpose of producing patient-specific acrylic cranioplasty implants. methods Using data from a high-resolution brain CT scan of a patient with a calvarial defect posthemicraniectomy, a skull phantom and a mold were generated with computer software and fabricated with the 3D printer using the fused deposition modeling method. The mold was used as a template to shape the acrylic implant, which was formed via a polymerization reaction. The resulting implant was fitted to the skull phantom and the cranial index of symmetry was determined. results The skull phantom and mold were successfully fabricated with the 3D printer. The application of acrylic bone cement to the mold was simple and straightforward. The resulting implant did not require further adjustment or drilling prior to being fitted to the skull phantom. The cranial index of symmetry was 96.2% (the cranial index of symmetry is 100% for a perfectly symmetrical skull). coNclusioNs This study showed that it is feasible to produce patient-specific acrylic cranioplasty implants with a low-cost 3D printer. Further studies...

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Section: Discussionmentioning

confidence: 99%

The feasibility of producing patient-specific acrylic cranioplasty implants with a low-cost 3D printer

Tan¹,

Ling²,

Dinesh³

2016

JNS

104

View full text Add to dashboard Cite

show abstract

“…A cranial defect (CRD) may cause functional, psychological, and esthetic problems for patients, making reconstruction necessary. Cranioplasty, the surgical repair of a congenital or acquired CRD, is a widely practiced procedure that not only aims to restore both the structure and function of the missing cranial bone but can also improve a patient's neurological status [3,4].…”

Section: Introductionmentioning

confidence: 99%

Accuracy Assessment of Molded, Patient-Specific Polymethylmethacrylate Craniofacial Implants Compared to Their 3D Printed Originals

Chamo

Msallem

Sharma

et al. 2020

JCM

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The use of patient-specific implants (PSIs) in craniofacial surgery is often limited due to a lack of expertise and/or production costs. Therefore, a simple and cost-efficient template-based fabrication workflow has been developed to overcome these disadvantages. The aim of this study is to assess the accuracy of PSIs made from their original templates. For a representative cranial defect (CRD) and a temporo-orbital defect (TOD), ten PSIs were made from polymethylmethacrylate (PMMA) using computer-aided design (CAD) and three-dimensional (3D) printing technology. These customized implants were measured and compared with their original 3D printed templates. The implants for the CRD revealed a root mean square (RMS) value ranging from 1.128 to 0.469 mm with a median RMS (Q1 to Q3) of 0.574 (0.528 to 0.701) mm. Those for the TOD revealed an RMS value ranging from 1.079 to 0.630 mm with a median RMS (Q1 to Q3) of 0.843 (0.635 to 0.943) mm. This study demonstrates that a highly precise duplication of PSIs can be achieved using this template-molding workflow. Thus, virtually planned implants can be accurately transferred into haptic PSIs. This workflow appears to offer a sophisticated solution for craniofacial reconstruction and continues to prove itself in daily clinical practice.

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“…The ability to either prefabricate patient specific implants, or template these intra-operatively external to the patient, provided clear benefits by removing the risk of thermal necrosis or hypotension associated with the curing process of PMMA [74][75][76][77]. In addition, the nature of geometry generation becomes controlled through accepted physical design methodologies and computer-aided design (CAD), allowing for better form, fit and function [26,89,90]; which in turn leads to less chance of abnormal biomechanics and fit-based complications, without the need to shape or alter the implant by hand, as well as minimizing the complexity of the surgical procedure. This example can be considered in the case of easily alterable materials (PMMA, porous polyethylene, titanium mesh, etc.)…”

Section: Discussionmentioning

confidence: 99%

Cranioplasty and Craniofacial Reconstruction: A Review of Implant Material, Manufacturing Method and Infection Risk

et al. 2017

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Background: Analysis of current literature highlights a wide variation in reported infection risk for different materials in cranial repair. The purpose of these composite materials are to mimic natural bone and assist in restoring function (structurally and aesthetically) to the human skull. This review aims to examine the meta-data in order to provide an amalgamated overview of potential trends between implant material, manufacturing method and infection risk, in order to provide a core reference point for future studies surrounding emerging biomedical materials in the fields of cranioplasty by providing base point for understanding the capabilities and limitations of current technologies. Methods: A search for articles was conducted, with the following criteria seen as fundamental in providing an accurate picture of the current landscape: publication in the last decade, provision of a numerical value for both number of implants and infection cases, patient sample of 10+, adult patients, and cranioplasty/cranial repair. Results: A total of 41 articles were seen to meet the author's inclusion criteria. Average infection rates per material ranged between 2.04% and 10.98%. The results indicate that there is variation between materials in regards to total infection risk, however, depending on the materials compared, this value may be insignificant. Alternative risk factors associated with infection, including surgical time, revisions and previous infection, have a greater impact on infection potential than material variation. Comparison of fabrication methods did highlight a notable effect on average infection rate. Trends can be observed showing that materials with greater levels of surface interaction and active support of tissue ingrowth presented greater infection resistance. Such characteristics are due to the physical structures of the implants. Conclusions: It can be said that the manufacturing methods can influence biomedical materials to assist in minimizing implant infection risk.

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Computer-Aided Design and Manufacture and Rapid Prototyped Polymethylmethacrylate Reconstruction

Cited by 30 publications

References 9 publications

The feasibility of producing patient-specific acrylic cranioplasty implants with a low-cost 3D printer

The feasibility of producing patient-specific acrylic cranioplasty implants with a low-cost 3D printer

Accuracy Assessment of Molded, Patient-Specific Polymethylmethacrylate Craniofacial Implants Compared to Their 3D Printed Originals

Cranioplasty and Craniofacial Reconstruction: A Review of Implant Material, Manufacturing Method and Infection Risk

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