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Table of Contents
REVIEW ARTICLE
Year : 2022  |  Volume : 13  |  Issue : 4  |  Page : 19-23  

Three-dimensional printing in the field of oral and maxillofacial surgery


1 Department of Oral and Maxillofacial Surgery, CODS, Davangere, Karnataka, India
2 Department of Oral Implantology, CODS, Davangere, Karnataka, India
3 Department of Oral Pathology, Lenora Institute of Dental Sciences, Rajahmundry, Andhra Pradesh, India
4 Eversmile Dental Care Orthodontic Centre, Mumbai, Maharashtra, India
5 Department of Oral and Maxillofacial Surgery, SGT University, Gurugram, Haryana, India
6 Oral and Maxillofacial Surgeon, Jyoti Kendra General Hospital, Ludhiana, Punjab, India

Date of Submission06-Apr-2020
Date of Acceptance04-Jan-2021
Date of Web Publication20-Aug-2022

Correspondence Address:
Dr. D S Yashavanth Kumar
Department of Oral and Maxillofacial Surgery, CODS, Davangere, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njms.NJMS_43_20

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   Abstract 


Advanced imaging techniques and modalities coupled with computer-assisted surgical planning and simulation has been in use in the field of medicine. However, it is worth noting that it is now being frequently used for the evaluation and exploration of the craniofacial structures. It had gained ingress in the planning as well as forecasting of the surgical outcomes of oral and maxillofacial surgical interventions. Numerous surgical guides and devices which are tailor-made can be fabricated using three-dimensional (3D) printing technology. The article is intended to put forth an overview of 3D printing technology and its applications in the field of oral and maxillofacial surgery.

Keywords: Orthognathic surgery, reconstructive surgery, three-dimensional printing


How to cite this article:
Yashavanth Kumar D S, Christopher SD, Mallegowda H, Dave V, Gulia SK, Bhanot R. Three-dimensional printing in the field of oral and maxillofacial surgery. Natl J Maxillofac Surg 2022;13, Suppl S1:19-23

How to cite this URL:
Yashavanth Kumar D S, Christopher SD, Mallegowda H, Dave V, Gulia SK, Bhanot R. Three-dimensional printing in the field of oral and maxillofacial surgery. Natl J Maxillofac Surg [serial online] 2022 [cited 2022 Dec 7];13, Suppl S1:19-23. Available from: https://www.njms.in/text.asp?2022/13/4/19/353953




   Introduction Top


It is a well-known fact that a three-dimensional (3D) object can be fabricated in 3D printing by incremental addition of multiple layers of material with the aid of a computer. In the field of medicine, an anatomical area can be fabricated by slicing it into several thin layers and the geometric data are used to build each layer sequentially by the manufacturing equipment. Hence, 3D printing is also popularly recognized as additive manufacturing (AM), rapid prototyping, layered manufacturing, or solid freeform fabrication.[1],[2],[3]

David E. H. Jones in 1974 laid out the concept of 3D printing. However, Charles Hull first engineered 3D printing technology in 1984 and termed it Stereo Lithography.[4] 3D printers were very expensive and were not readily available. In the 21st century, a significant reduction in the costs of the 3D printers allowed them to be affordable to the general market.[5] Following its application in the military, food industry, and arts, it has gained responsiveness in the field of surgery. Brix and Lambrecht (1985) are considered to be the pioneer in the usage of Stereo Lithography in the field of oral and maxillofacial surgery.[6] Mankovich et al. employed in craniofacial deformities to simulate the bony anatomy of the cranium using computed tomography (CT).[7]


   Advantages and Disadvantages Top


3D printing noticeably has an edge over conventional subtractive manufacturing techniques. Its superior efficiency, passivity, flexibility, and superior material utilization are its benefits over the other techniques.[8] The biggest shortcoming with 3D printing includes its high cost[9] [Figure 1].
Figure 1: Advantages and disadvantages of three-dimensional printing

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   Clinical Applications Top


Literature reveals that 3D-printed objects that are used for clinical applications can be grouped into five categories. They can be employed for obtaining anatomic models, surgical guides, occlusal splints, patient-specific implants, facial epithesis [Figure 2].
Figure 2: Clinical applications of three-dimensional printing

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Considering the fact that 3D printing can discriminate traumatic and pathologic defects more effectively, it can play a pivotal role in the diagnosis and treatment planning of clinical scenarios pertaining to the maxillofacial region. The adjunctive role played by 3D printing facilitates precise decision-making. A huge advantage with 3D printing is its capability to provide spatial relationships to surrounding anatomical structures, particularly when one encounters pathologies in the maxillofacial region.[10] The critical information obtained by 3D printing can minimize operative complications.[11] 3D printing can produce models rapidly with acceptable accuracy and structural details to allow for better outcomes and reduced operating durations.[12]

3D customized reconstruction of orbital wall defects with titanium mesh can be used in patients with orbital wall fractures. In the pre-operative phase, titanium mesh or plate can be adapted precisely on the 3D printed replica which would aid in improving the precision of the procedure as well as shortening the duration of surgical procedure.[13],[14] Post-operative enophthalmos or diplopia which is frequently encountered when there is the inaccurate reconstruction of orbital walls can be avoided by using 3D printed titanium mesh which is fabricated using the contralateral orbital anatomy as a guide.

3D printing technology shows some clinically noticeable inaccuracies that need to be eliminated in the diagnosis and treatment planning for orthognathic surgeries.[15] 3D models aid in accomplishing preplanned tasks for performing accurate osteotomies and accurate positioning of the malpositioned jaw. Printing of cutting guides for osteotomies and 3D printed patient-specific fixating plates for accurate positioning of jaws, greatly reduce mistakes made due to human error.[16] Similarly, literature is replete with articles indicating that better esthetic and functional outcomes can be accomplished with the aid of 3D printing in comparison to the traditional prosthetics. AM is mainly used for hard-tissue reconstruction. However, it is useful in soft-tissue contouring such as auricular reconstruction in patients using the contralateral ear. There are documented scientific papers on the fabrication of prosthetic nose, ears, eyes, and face in the recent past with aid of 3D printing.[17],[18],[19]

Literature shows that 3D printing is useful in the treatment of patients with Temporomandibular Joint Disorders associated with total condylar resorption.[20] Mehra et al. employed 3D printing for measuring the exact proportions of the bone that needs to be harvested in a patient treated for bone grafting and TMJ prostheses.[21]

3D printing acts as a tool to create dental implants with complicated geometries.[1] Drilling guides act as valuable adjuncts to transfer implants from their planned positions. Manufacturing a drilling guide by conventional methods is time-consuming and requires multiple patient visits and extensive laboratory work. All these shortcomings are eliminated by 3D printing.

Restoring acceptable esthetic and functional outcomes and facial symmetry are the main goals of maxillofacial reconstruction. 3D printing technology can be used in different aspects of facial reconstruction. 3D printed models provide high-accuracy prosthesis that can enhance the esthetics and psychological status of a patient suffering from scarring, deformation, or asymmetry.[16] Better anatomical understanding, proper plate adaptation, plate prebending, precise bone harvesting by utilizing negative templates of the defect, reduced bone-plate distance, decreased duration of surgery, less blood loss, and shortened duration of general anesthesia are the main advantages of using AM in maxillofacial reconstruction.[22],[23]


   Inferences Top


Numerous authors have advocated that there is an increase in precision and a reduction of the surgical time even though this parameter has seldom been precisely evaluated or measured. Hanasono and Skorackil indicated that 3D printing can reduce surgery duration up to 1.4 h.[24] Tarsitano et al. demonstrated that the use of 3D printing enabled their them to obtain a better morphological outcome in mandibular reconstruction.[25] Seruya et al. concluded that microsurgical craniofacial reconstruction using a computer-assisted fibula flap technique yielded significantly shorter ischemia times compared with conventional techniques.[26] The use of 3D printed occlusal splints enables optimal positioning of bone segments, in accordance with pre-operative planning, in orthognathic surgery.[27] Several studies that compared preoperative planning on virtual models and the real post-operative X-ray controls revealed that surgical guides permit a gain in precision, whether it is in reconstructive surgery, in orthognathic surgery or in dental implant surgery.[28],[29]

Literature shows that with 3D printing in addition to generating custom-made scaffolds in the desirable dimensions it is also possible to adjust the properties of these materials with regard to porosity, surface texture, and design. It is possible to add osteoinductive factors, like bone morphogenetic proteins for stimulating osteogenic differentiation to increase the integration of bone tissue into the printed scaffolds for better cell adhesion, proliferation, and vascularization.[30],[31]

It is also noteworthy that there are definitely some limitations with 3D printing. Surgical interventions may require larger surgical approaches due to the bulk of the guides and this may lead to higher morbidity.[32] Planning time coupled with the printing time may at times take several weeks if given to the company and may delay the surgical intervention, which may be detrimental particularly in cancer. In dealing with fast-growing tumors, resection margins should always be re-evaluated before using the cutting guides.[32]

In addition to the patients, medical trainees and residents can also benefit from 3D printed models.[11] In pre-operative counseling with patients, it is easier for the operator to explain the details pertaining to surgical interventions, and therefore, 3D printed models can aid in gaining informed consent.[33] CT/magnetic resonance imaging scans that are generally used to explain the surgical procedure for the patients are usually hard to understand particularly for uneducated patients. Because the specialty of oral and maxillofacial surgery deals with procedures that are life-saving, as well as those that enhance the quality of life by providing better function and esthetics 3D printing can be considered as a viable option.[34]


   Conclusion Top


The use of 3D printing models in the field of oral and maxillofacial surgery is increasing, as it provides for a much safer, less traumatic, and time-consuming treatment modality. In addition, it increases the standard of care of patients and hence, these techniques should be adapted more and more by clinicians. 3D printed replicas are considered to be more precise and cost-effective and this method may also eliminate the need for animal studies. As the technology develops, there will be an increase in its versatility and ease in its usage. Hence, it is advisable to become familiar with 3D printings. However, the author of the present article advocates that these benefits should however be evaluated more precisely by comparison with more conventional techniques on larger case series. The improved precision does not only come from the printed object itself but also from the pre-operative planning and its execution that is much more demanding than in conventional techniques.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Gupta H, Bhateja S, Arora G. 3D Printing and its applications in oral and maxillofacial surgery. J Surg Allied Sci 2019;1:48-52.  Back to cited text no. 16
    
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Hanasono M, Skoracki R. 117B: Improving the speed and accuracy of mandibular reconstruction using preoperative virtual planning and rapid prototype modeling. Plast Reconstr Surg 2010;125:80.  Back to cited text no. 24
    
25.
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