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3D printing technology for corrective jaw surgery
on July 30, 2015
Yesterday, a rep from a medical 3D printing company came to share some new developments concerning the use of 3D printing to aid corrective jaw surgery. 3D printing has come a long way and has permeated through many industries. So far, for orthognathic surgery, I have mainly used 3D printing to print out a patient’s skull to plan and try the surgery on the model. What this company is now doing it to print customized fixation plates to replace the standard plates that we normally use. In addition, these customized plates also replace the occlusal splints that we use to locate the jaws to the planned position. So, what do all these mean to the patient? The greatest advantage is greater precision and shorter operating time, which translates to a lower morbidity and quicker recovery. To understand the advantages offered by customized 3D printed fixation plates, I need to explain how we plan and perform the surgery.
The traditional approach..
After a diagnosis is made, I will work out a surgical plan. For example, if the upper jaw is too retruded and the lower jaw too protrusive, I will plan the surgical movements on the computer. The surgery is done on the bone in software which will then simulate the facial appearance. Depending on the degree of deformity and the desired outcome, I will move the segments of the jaw bones according. The program will then calculate the amount of movement needed. For example, to achieve the desire facial appearance, I may need to move the upper jaw forward by 8mm horizontally and downwards 4mm vertically. There may also be a tilting of the upper jaw to one side by a 5 degree rotation. There will also be corresponding figures generated for the lower jaw. To transfer this surgical plan to the actual surgery, we create “surgical splints” which register the position of the teeth of the upper and lower jaws relative to each other. These surgical splints can be made by 3D printing or more traditionally, in a dental laboratory. If the latter, I will need to make impressions of the patient’s teeth and cast plaster models which are then mounted on a jaw simulator, aka articulator. These plaster models are then cut and move according to the dimensions generated by the software, and the splints are then made manually on the articulator. During the surgery, the bone is cut and the segments of the jaws are mobilized and moved to the planned position. To fix them in the planned position, the splints are placed between the teeth and that will position the jaws accordingly. Titanium fixation plates are then used to fix the bone segments together in their new position. The plates need to be bent and twisted to match the shape of the bone surfaces as they need to be closely adapted to the bone. This can be a rather time consuming process, depending on the contours of the patient’s jaw bone. Once the plates are secured, the splints are removed and the patient can open and close his mouth immediately after surgery.
3D printed fixation plates
The 3D printed fixation plates replace both the surgical splints as well as the standard titanium fixation plates. After the surgery is planned on the program, the fixation plate is planned on the software to fix the jaw in the planned position. A 3D printed cutting guide is also printed to guide the bone cuts to be made in the same way as planned on the computer. This 3D printed plate conforms to the bone contour and completely eliminates the process of manually bending plates during the surgery. Furthermore, the accuracy of the 3D printing allows the plate to replace the surgical splints as the printed plate can be used as the locating device by matching the plate to the bone contour instead of matching the splint to the biting surfaces of the teeth. By using this technology, we can, at least theoretically, replicate the surgical plan on the computer more accurately onto the patient for a better outcome. Eliminating the time spent adapting standard plates to the bone contours may save half an hour of operating time and that can translate to a lower morbidity rate as well as cost.
Current limitations...
However, the cost of printing custom fixation plates is high and whatever costing savings obtained by shortening surgery time is negated by the high cost of printing medical grade implants. The technology is at its infancy and companies are still recouping their investments in research and setup. I believe that eventually, when the technology gains momentum, the cost will come down and will eventually be the primary way corrective jaw surgery will be done.
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