Rapid prototyping and patient-specific pre-contoured reconstruction plate for comminuted fractures of the mandible

In the last years, cardiovascular diagnosis, surgical planning and intervention have taken advantages from 3D modelling and rapid prototyping techniques. The starting data for the whole process is represented by medical imagery, in particular, but not exclusively, computed tomography (CT) or multi-slice CT (MCT) and magnetic resonance imaging (MRI). On the medical imagery, regions of interest, i.e. heart chambers, valves, aorta, coronary vessels, etc., are segmented and converted into 3D models, which can be finally converted in physical replicas through 3D printing procedure. In this work, an overview on modern approaches for automatic and semiautomatic segmentation of medical imagery for 3D surface model generation is provided. The issue of accuracy check of surface models is also addressed, together with the critical aspects of converting digital models into physical replicas through 3D printing techniques. A patient-specific 3D modelling and printing procedure (Figure 1), for surgical planning in case of complex heart diseases was developed. The procedure was applied to two case studies, for which MCT scans of the chest are available. In the article, a detailed description on the implemented patient-specific modelling procedure is provided, along with a general discussion on the potentiality and future developments of personalized 3D modelling and printing for surgical planning and surgeons practice.

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A Patient-Specific Surgical Simulation System for Spinal Screw Insertion Composed of Virtual Roentgenogram, Virtual C-Arm, and Rapid Prototyping

The Journal of the Korean Orthopaedic Association ◽

10.4055/jkoa.2001.36.2.161 ◽

2001 ◽

Vol 36 (2) ◽

pp. 161 ◽

Cited By ~ 3

Author(s):

Jin Sup Yeom ◽

Won Sik Choy ◽

Whoan Jeang Kim ◽

Ha Yong Kim ◽

Jong Won Kang ◽

...

Keyword(s):

Rapid Prototyping ◽

Surgical Simulation ◽

Simulation System ◽

Patient Specific ◽

Screw Insertion

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A rapid prototyping-based methodology for patient-specific contouring of osteotomy plates

Rapid Prototyping Journal ◽

10.1108/rpj-09-2018-0257 ◽

2019 ◽

Vol 25 (5) ◽

pp. 888-894

Author(s):

Behnam Gomari ◽

Farzam Farahmand ◽

Hassan Farkhondeh

Keyword(s):

Rapid Prototyping ◽

Locking Plate ◽

Patient Specific ◽

Osteotomy Site ◽

Content Type ◽

Tibial Plate ◽

Important Challenge ◽

Surgical Application ◽

Bone Fragments ◽

Plate Spring

Purpose An important challenge of the osteotomy procedures, particularly in the case of large and complex corrections, is the fixation of the osteotomy site. The purpose of this study is to propose a practical and cost-effect methodology for the plate adapting problem of osteotomy surgery. Design/methodology/approach A novel patient-specific plate contouring methodology, based on rapid prototyping (RP) and multi-point forming (MPF) techniques, was developed and evaluated. In this methodology, a female mold is fabricated by RP, based on the geometry of the osteotomy site and estimation of the plate spring back. The mold is then used to configure a MPF die, which is then used for press forming of the factory-made locking plate. The applicability of the methodology was assessed in two case studies. Findings The results of implementing the methodology on a femoral and a tibial locking plate indicated very good conformity with the underlying bone, in both the frontal and sagittal planes. The surgical application of the pre-operatively contoured tibial plate facilitated the plate locating and screw inserting procedures, and provided a secure fixation for bone fragments. Practical implications The results are promising and provide a proof of concept for the feasibility and applicability of the proposed methodology in clinical practice, as a complementary to the existing surgical preplanning and patient-specific instrument preparations. Originality/value The advantageous features of RP and the MPF were used to provide a solution for the plate adapting problem of osteotomy surgery.

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Computer-Assisted Mandibular Reconstruction using a Patient-Specific Reconstruction Plate Fabricated with Computer-Aided Design and Manufacturing Techniques

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0034-1371356 ◽

2014 ◽

Vol 7 (2) ◽

pp. 158-166 ◽

Cited By ~ 45

Author(s):

Frank Wilde ◽

Carl-Peter Cornelius ◽

Alexander Schramm

Keyword(s):

Computer Aided Design ◽

Mandibular Reconstruction ◽

Patient Specific ◽

Computer Assisted ◽

Reconstruction Plate ◽

Fibula Flap ◽

Computer Aided ◽

Cad Cam ◽

Aided Design ◽

Five Axis

We investigated the workflow of computer-assisted mandibular reconstruction that was performed with a patient-specific mandibular reconstruction plate fabricated with computer-aided design and computer-aided manufacturing (CAD/CAM) techniques and a fibula flap. We assessed the feasibility of this technique from virtual planning to the completion of surgery. Computed tomography (CT) scans of a cadaveric skull and fibula were obtained for the virtual simulation of mandibular resection and reconstruction using ProPlan CMF software (Materialise®/DePuy Synthes®). The virtual model of the reconstructed mandible provided the basis for the computer-aided design of a patient-specific reconstruction plate that was milled from titanium using a five-axis milling machine and CAM techniques. CAD/CAM techniques were used for producing resection guides for mandibular resection and cutting guides for harvesting a fibula flap. Mandibular reconstruction was simulated in a cadaveric wet laboratory. No problems were encountered during the procedure. The plate was fixed accurately to the residual bone without difficulty. The fibula segments were attached to the plate rapidly and reliably. The fusion of preoperative and postoperative CT datasets demonstrated high reconstruction precision. Computer-assisted mandibular reconstruction with CAD/CAM-fabricated patient-specific reconstruction plates appears to be a promising approach for mandibular reconstruction. Clinical trials are required to determine whether these promising results can be translated into successful practice and what further developments are needed.

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Preoperative Planning of Virtual Osteotomies Followed by Fabrication of Patient Specific Reconstruction Plate for Secondary Correction and Fixation of Displaced Bilateral Mandibular Body Fracture

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0036-1572492 ◽

2016 ◽

Vol 9 (2) ◽

pp. 188-193 ◽

Cited By ~ 9

Author(s):

Andreas Thor

Keyword(s):

Trauma Surgery ◽

Computer Software ◽

Open Bite ◽

Patient Specific ◽

Facial Skeleton ◽

Reconstruction Plate ◽

Virtual Planning ◽

Patient Specific Implants ◽

Body Fracture ◽

Mandibular Body

This paper describes the course of treatment of a severely diplaced bilateral mandibular body fracture, where the first osteosynthesis failed. The subject developed an open bite due to a posterior rotation of the distal part of the mandible and anterior rotation of the proximal parts of the mandible. This situation was evaluated with CBCT and the facial skeleton was segmented using computer software. Correct occlusion was virtually established by bilateral virtual osteotomies in the fracture areas of the mandible. After segmentation, the mandible was virtually rotated back into position and the open bite was closed. A patient specific mandibular reconstruction plate was outlined and fabricated from the new virtual situation and the plate was thereafter installed utilizing the preoperative plan. Osteotomy- and drill-guides was used and thus simplified the surgery resulting in uneventful healing. Virtual planning and patient specific implants and guides were valuable in this case of secondary reconstructive trauma surgery.

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