Primary Orbital Reconstruction with Selective Laser Melting (SLM) of Patient-Specific Implants (PSIs): An Overview of 96 Surgically Treated Patients

Abstract

Contemporary advances in technology have allowed the transfer of knowledge from industrial laser melting systems to surgery; such an approach could increase the degree of accuracy in orbital restoration. The aim of this study was to examine the accuracy of selective laser melted PSIs (patient-specific implants) and navigation in primary orbital reconstruction. Ninety-six patients with orbital fractures were included in this study. Planned vs. achieved orbital volumes (a) and angles (b) were compared to the unaffected side (n = 96). The analysis included the overlay of post-treatment on planned images (iPlan 3.0.5, Brainlab®, Feldkirchen, Germany). The mean difference in orbital volume between the digitally planned orbit and the postoperative orbit was 29.16 cm3 (SD 3.54, presurgical) to 28.33 cm3 (SD 3.64, postsurgical, t = 5.00, df = 95.00; p < 0.001), resulting in a mean volume difference (planned vs. postop) of less than 1 cm3. A 3D analysis of the color mapping showed minor deviations compared to the mirrored unaffected side. The results suggested that primary reconstruction in complex orbital wall fractures can be routinely achieved with a high degree of accuracy by using selective laser melted orbital PSIs.

Comparison of Anatomical Preformed Titanium Implants and Patient-Specific CAD/CAM Implants in the Primary Reconstruction of Isolated Orbital Fractures—A Retrospective Study

“…In these cases, not only prefabricated titanium meshes but also CAD/CAM patient-specific implants can be used if the patient presents to the clinic at an early stage and the internal clinical procedures are clearly regulated [ 16 , 17 , 18 , 19 , 20 , 21 ]. In delayed, secondary orbital reconstruction, patient-specific CAD/CAM implants appear to be advantageous [ 22 , 23 , 24 ].…”

“…A 3D analysis with color mapping showed only minor deviations. However, a concrete description of the deviations at individual localizations could not be shown here [ 20 ]. The use of intraoperative navigation seemed to allow a further improvement of the positioning.…”

Computer-Aided Dynamics Intraoperative Navigation in Oral Medicine: A Review

“…Implant positioning using intraoperative navigation was more accurate, with less deviation in mediolateral and yaw, and the operative time for implant positioning was reduced by 17 minutes. Rana et al (2022) investigated the accuracy of patient-speci c implants for selective laser melting combined with intraoperative navigation in primary orbital reconstruction in 96 patients with orbital fractures. The mean volume difference between the planned orbit and the postoperative orbit was less than 1cm3.…”

Plasma Electrolytic Polished Patient-Specific Orbital Implants in Clinical Use—A Technical Note

“…Patient-specific implants (PSI) offer individual and exact options for reconstruction [ 1 ]. After 3D scanning (magnetic resonance imaging (MRI), computed tomography (CT) or cone beam computed tomography (CBCT)), PSIs are digitally planned and 3D printed using selective laser melting techniques (in case of titanium implants) [ 1 , 2 ]. Most often they are used for orbital wall reconstruction after trauma [ 2 ], but they are also frequently used for mandibular reconstruction [ 3 ] or even for orthognathic surgery [ 4 ].…”