Full-Digital Workflow for Fabricating a Custom-Made Direct Metal Laser Sintering (DMLS) Mandibular Implant: A Case Report

Abstract

Direct Laser Metal Sintering (DLMS) is an additive manufacturing (AM) technique that is capable of manufacturing metal parts according to a three-dimensional (3D) design made using computer-assisted-design (CAD) software, thanks to a powerful laser beam that melts selectively micro-powder layers, one on top of the other, until the desired object is generated. With DMLS, it is now possible to fabricate custom-made titanium implants for oral and maxillofacial applications. We present the case of a 67-year-old woman diagnosed with a squamous cell carcinoma of the mandible. The patient underwent subtotal mandibular resection; conventional reconstruction procedures failed to rehabilitate the function of the mandible. A prosthesis replacing the resected mandible was designed and fabricated using a digital workflow. The extensive bone defect was rehabilitated with a prosthesis replacing the mandibular bone and supporting a morse-taper dental prosthesis. The masticatory function was reestablished.

Digital Workflow in Maxillofacial Prosthodontics—An Update on Defect Data Acquisition, Editing and Design Using Open-Source and Commercial Available Software

“…However, the digital workflow was only used for removable prostheses for maxillary and midface defects (obturators). The mandibular defects were restored preferably through patient-specific implants [73,74] or surgical reconstruction techniques. No digital workflow description on Cantor and Curtis class I, II, III and IV prosthetic restorations has been found so far.…”

Additively manufactured metallic biomaterials

“…Lower operative time and increased post-operative recovery were the two most significant advantages in the case of additively manufactured implants. Grecchi et al [ 343 ] additively manufactured a full mandibular customed prosthesis and implanted it in a 67-year-old patient. Traditional reconstruction techniques were difficult due to the state of the patient's mandible.…”

Computed Tomography as a Characterization Tool for Engineered Scaffolds with Biomedical Applications

“…One of the most attractive advantages of AM techniques in the field of regenerative medicine is represented by the high reproducibility of the scaffolds' architectural features and the possibility to progress to the point where customized scaffold designs based on patients' needs can be fabricated. A computer-assisted design (CAD) software used in AM allows for importing medical CT/NMR files and creating scaffolds suitable as a shape and dimensions for the patient defect [86,87]. Laboratory CT finds its usefulness in determining the fabrication system's accuracy [88] or quality control for the 3D manufactured scaffold [89][90][91][92] as well as post-in vivo evaluation of the new tissue ingrowth [93][94][95].…”