Simultaneous Computer-Aided Design/Computer-Aided Manufacture Bimaxillary Orthognathic Surgery and Mandibular Reconstruction Using Selective-Laser Sintered Titanium Implant

Abstract

This patient report describes simultaneous bimaxillary orthognathic surgery and mandibular reconstruction by means of three-dimensional (3D) planning, 3D printed biocompatible surgical wafers, and 3D selective-laser sintered titanium implant. A 26-year-old male patient presented with a left mandibular defect secondary to trauma. The whole body of the mandible on the left hand side was deficient with a narrow connection with the remaining left condyle. He had undergone orthodontic treatment for 18 months and was ready to undergo bimaxillary orthognathic surgery. Advanced cranio-maxillofacial software was used in processing his cone beam computer tomography scan data, and e-casts of his upper and lower dental arches. Bimaxillary surgery was planned with Le Fort 1 maxillary impaction and mandibular advancement to achieve a class 1 incisor relationship. Intermediate and final surgical wafers were designed following the planned movements and printed using biocompatible resin. The deficient left side of the mandible was reconstructed by means of mirror imaging the contra-lateral right side into the deficient left side with the aim of restoring normal facial symmetry. Biomedical software was then used in designing a reconstruction plate that connected the condylar head and the mandible following the planned bimaxillary surgery and mandibular continuity symmetry reconstruction. The plate was printed in titanium following state-of the-art selective laser sintering technology. The bimaxillary surgery and mandibular reconstruction were done simultaneously as planned along with an iliac-crest bone graft. This patient confirms the advantages of 3D computer-aided design/computer-aided manufacture technologies in optimizing clinical outcomes for cranio-maxillofacial reconstruction, especially when conducting two simultaneous clinical procedures.

Porous Titanium Implants: A Review

“…[123] The usefulness of three-dimensional planning based on CT scans and applied to an SLS manufactured titanium implant was confirmed by a report of Hatamleh et al, who described a simultaneous bimaxillary orthognathic surgery and mandibular reconstruction. [124] Intermediate and final surgical wafers were designed following the planned movements and printed using biocompatible resin. Biomedical software was then used to design a reconstruction titanium plate that connected the condylar head and the mandible following the planned bimaxillary surgery and mandibular continuity symmetry reconstruction.…”

“…[124] Intermediate and final surgical wafers were designed following the planned movements and printed using biocompatible resin. [124] A fundamental issue in the application of titanium implants is the surface properties and biocompatibility. The bimaxillary surgery and mandibular reconstruction were done simultaneously, as planned, along with an iliac-crest bone graft.…”

Surface characteristics and biocompatibility of cranioplasty titanium implants following different surface treatments

“…Patient-specific extra-oral titanium implants (PSI) are increasingly used in reconstructing missing bones of the head and neck secondary to trauma or ablative surgery, thus restoring normal continuity of hard tissues, providing support and protection and restoring aesthetics of overlying soft tissues [8][9][10][11]. The PSI's include cranioplasty or skull plates [12][13][14], orbital floor implants [15][16][17], and mandibular tumour resection and reconstruction [18][19][20][21][22][23].…”

Patient-Specific Surgical Implant Using Cavity-Filled Approach for Precise and Functional Mandible Reconstruction

“…Mirroring is one of the most widely used reconstruction techniques, and several research studies proved that the mirror technique successfully restored the facial symmetry [26,27]. Hatamleh et al [28] also consolidated the mirror restoration method with selective laser sintering for bimaxillary surgery and mandibular reconstruction. The concerned patient reported the capabilities of 3D CAD/CAM technologies in improving surgical results for cranio-maxillofacial reconstruction.…”