A group of researchers from Korean hospitals have carried out a retrospective study to verify the effectiveness and safety of patient-specific 3D printed titanium implants on maxillofacial bones.
在研究期间总共观察到16例患者，每例接受各种颌面缺损的重建手术。这些患者安装了定制的钛植入物，并在多个月的时间内接受了长期随访。
Out of the 28 implants fitted, only one failed to unite successfully with the bone while the others showed “satisfactory” outcomes for the treatment of various oral and maxillofacial defects.
3D printing maxillofacial implants
3D printing has been used to produce雷竞技官网登录提高患者预后的指南for some time, and has more recently began to be leveraged on an experimental basis to create facial grafts that can be implanted into patients’ skulls. For instance, scientists atTexas A&M Universityhave developed anovel 3D printed scaffoldthat directly facilitates bone cell growth after surgery.
Regarding more end-use applications, theQuébec Industrial Research Centre(CRIQ) has deployed aGE AdditiveArcam Q10 3D printer to expedite its production of患者特异性下颌植入物，而研究人员在Paulista University， 有3D printed a facial prosthetic对于巴西癌症幸存者来说，其中包括她的整个右眼。
More recently,加拿大卫生部approved itsfirst Canadian-made 3D printed medical implant，一种可定制的下颌板，用于面部重建手术，主要针对口服患者。
The retrospective study
Autogenous bone grafting or implant placement is the primary method used to treat oral and maxillofacial defects, and while they are extensively biocompatible there can be issues regarding donor-site morbidity, surgical failure, and difficulty in reoperation.
数字技术的快速进步已经在该领域或口腔颌面外科手术中开辟了新的途径，3D打印可以更快，准确地进行手术，尤其是关于已经验证的钛材料，这些钛材料作为牙科植入物的生物相容性。
The maxillofacial titanium implants used in the surgeries that the study recorded were 3D printed via electron beam melting (EBM) and selective laser sintering (SLS) processes. 28 implants were 3D printed in total and then inserted into the maxilla (dominant portion of the face), the mandible (lower jaw) or zygoma (cheek/temple) of 16 different patients.
The patients in question, of which seven were women and nine were men, ranged in age from nine years old to 78. A total of 28 defect areas were operated on, including five mandibular segments, nine zygomas, ten mandibular bodies, angles, or chins, and four maxillary areas.
A long-term follow-up process was then conducted, varying in length per patient from eight to 79 months. The study primarily analyzed the bone fusion of the titanium implant body, but also recorded postoperative infection, implant malunion, functional results, patient satisfaction, subsidence, osteolysis around the implants, and any complications that arose.
The study found that of the 28 implants, only one failed to unite with the bone. CBCT analysis showed that bone fusion at six months after surgery was 96.5 percent. The study also observed no osteolysis – a progressive condition where bone tissue is destroyed – or subsidence around the titanium implants.
根据这项研究，参加试验的患者在整个美学和功能上都对他们的手术结果满意。虽然，由于对植入物的出现不满意，五个患有che骨重建的患者中有两名接受了修订手术。
Reviewing the implants
The design of the bone-to-implant interface of the 3D printed implants was either a mesh or solid based on whether stability was required. As the rough surface of the mesh titanium implant was found to be more likely to integrate into the patient’s bone, this one was preferred.
SLS enables additive manufacturing with metals such as titanium at a high sintering temperature, however, owing to limited dimensional accuracy and poor surface roughness, process improvements are being made to improve its properties. EBM uses an electron beam instead of a laser beam to sinter or to fuse the materials. EBM can be used to fabricate complex geometries by scanning each cross-sectional layer selectively, unlike SLS.
The implants 3D printed via EBM were more expensive than those 3D printed using SLS, however there was found to be no difference in the clinical results regarding the type of implant interface or the 3D printing method.
The follow-up appointments found that three out of the 16 patients experienced complications such as screw fractures and aesthetic dissatisfaction, however all of these were eventually resolved and post-operative recovery was found to be satisfactory in all patients.
根据患者的经验，该研究提出了使用3D印刷钛患者特异性植入物的准则。简而面部骨整形术患者先前的骨骼制剂过多。
Additionally, the guidelines say that 3D printed titanium implants should also be used in cases of high aesthetic requirements such as correcting skeletal asymmetry, for areas that require functional load bearing such as the mandible, and when simultaneous reconstruction with dental implants is required.
有关该研究的更多信息，请参见标题为：“Reconstruction of maxillofacial bone defects using patient-specific long-lasting titanium implants,”published in the Nature journal. The study was co-authored by H. Lim, Y. Choi, W. Choi, I. Song, and U. Lee.
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特色图片显示肿瘤诱导的下颌骨缺陷的钛重建。图像通过自然。
