Patient-Specific Titanium Mandibular Reconstruction Using Additive Manufacturing

2018 ◽  
Author(s):  
Xia Yan ◽  
Zhi Chao Feng ◽  
Changchun Li ◽  
Heming Wu ◽  
Chunbo Tang ◽  
...  
Keyword(s):  
Additive Manufacturing ◽  
Mandibular Reconstruction ◽  
Patient Specific

scholarly journals Improving mandibular reconstruction by using topology optimization, patient specific design and additive manufacturing?—A biomechanical comparison against miniplates on human specimen

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253002
Author(s):  
Jan J. Lang ◽  
Mirjam Bastian ◽  
Peter Foehr ◽  
Michael Seebach ◽  
Jochen Weitz ◽  
...  
Keyword(s):  
Topology Optimization ◽  
Additive Manufacturing ◽  
Dynamic Testing ◽  
Mandibular Reconstruction ◽  
Patient Specific ◽  
Reconstruction Process ◽  
Cadaveric Specimen ◽  
Custom Made ◽  
Significant Difference ◽  
Titanium Grade

In this study, topology optimized, patient specific osteosynthesis plates (TOPOS-implants) are evaluated for the mandibular reconstruction using fibula segments. These shape optimized implants are compared to a standard treatment with miniplates (thickness: 1.0 mm, titanium grade 4) in biomechanical testing using human cadaveric specimen. Mandible and fibula of 21 body donors were used. Geometrical models were created based on automated segmentation of CT-scans of all specimens. All reconstructions, including cutting guides for osteotomy as well as TOPOS-implants, were planned using a custom-made software tool. The TOPOS-implants were produced by electron beam melting (thickness: 1.0 mm, titanium grade 5). The fibula-reconstructed mandibles were tested in static and dynamic testing in a multi-axial test system, which can adapt to the donor anatomy and apply side-specific loads. Static testing was used to confirm mechanical similarity between the reconstruction groups. Force-controlled dynamic testing was performed with a sinusoidal loading between 60 and 240 N (reconstructed side: 30% reduction to consider resected muscles) at 5 Hz for up to 5 · 105 cycles. There was a significant difference between the groups for dynamic testing: All TOPOS-implants stayed intact during all cycles, while miniplate failure occurred after 26.4% of the planned loading (1.32 · 105 ± 1.46 · 105 cycles). Bone fracture occurred in both groups (miniplates: n = 3, TOPOS-implants: n = 2). A correlation between bone failure and cortical bone thickness in mandible angle as well as the number of bicortical screws used was demonstrated. For both groups no screw failure was detected. In conclusion, the topology optimized, patient specific implants showed superior fatigue properties compared to miniplates in mandibular reconstruction. Additionally, the patient specific shape comes with intrinsic guiding properties to support the reconstruction process during surgery. This demonstrates that the combination of additive manufacturing and topology optimization can be beneficial for future maxillofacial surgery.

scholarly journals Size Effects in Finite Element Modelling of 3D Printed Bone Scaffolds Using Hydroxyapatite PEOT/PBT Composites

Mathematics ◽  
2021 ◽  
Vol 9 (15) ◽  
pp. 1746
Author(s):  
Iñigo Calderon-Uriszar-Aldaca ◽  
Sergio Perez ◽  
Ravi Sinha ◽  
Maria Camara-Torres ◽  
Sara Villanueva ◽  
...  
Keyword(s):  
Finite Element ◽  
Additive Manufacturing ◽  
Tissue Regeneration ◽  
Finite Element Modelling ◽  
Bulk Material ◽  
Bone Tissue Regeneration ◽  
Patient Specific ◽  
Design Factor ◽  
Element Modelling ◽  
Uncertainty Sources

Additive manufacturing (AM) of scaffolds enables the fabrication of customized patient-specific implants for tissue regeneration. Scaffold customization does not involve only the macroscale shape of the final implant, but also their microscopic pore geometry and material properties, which are dependent on optimizable topology. A good match between the experimental data of AM scaffolds and the models is obtained when there is just a few millimetres at least in one direction. Here, we describe a methodology to perform finite element modelling on AM scaffolds for bone tissue regeneration with clinically relevant dimensions (i.e., volume > 1 cm3). The simulation used an equivalent cubic eight node finite elements mesh, and the materials properties were derived both empirically and numerically, from bulk material direct testing and simulated tests on scaffolds. The experimental validation was performed using poly(ethylene oxide terephthalate)-poly(butylene terephthalate) (PEOT/PBT) copolymers and 45 wt% nano hydroxyapatite fillers composites. By applying this methodology on three separate scaffold architectures with volumes larger than 1 cm3, the simulations overestimated the scaffold performance, resulting in 150–290% stiffer than average values obtained in the validation tests. The results mismatch highlighted the relevance of the lack of printing accuracy that is characteristic of the additive manufacturing process. Accordingly, a sensitivity analysis was performed on nine detected uncertainty sources, studying their influence. After the definition of acceptable execution tolerances and reliability levels, a design factor was defined to calibrate the methodology under expectable and conservative scenarios.

scholarly journals 3D Plotting of Silica/Collagen Xerogel Granules in an Alginate Matrix for Tissue-Engineered Bone Implants

Materials ◽  
2021 ◽  
Vol 14 (4) ◽  
pp. 830
Author(s):  
Sina Rößler ◽  
Andreas Brückner ◽  
Iris Kruppke ◽  
Hans-Peter Wiesmann ◽  
Thomas Hanke ◽  
...  
Keyword(s):  
Additive Manufacturing ◽  
Bone Regeneration ◽  
Material Properties ◽  
Viscoelastic Properties ◽  
Viscoelastic Behavior ◽  
Matrix Phase ◽  
Patient Specific ◽  
Active Player ◽  
Alginate Concentration ◽  
Alginate Matrix

Today, materials designed for bone regeneration are requested to be degradable and resorbable, bioactive, porous, and osteoconductive, as well as to be an active player in the bone-remodeling process. Multiphasic silica/collagen Xerogels were shown, earlier, to meet these requirements. The aim of the present study was to use these excellent material properties of silica/collagen Xerogels and to process them by additive manufacturing, in this case 3D plotting, to generate implants matching patient specific shapes of fractures or lesions. The concept is to have Xerogel granules as active major components embedded, to a large proportion, in a matrix that binds the granules in the scaffold. By using viscoelastic alginate as matrix, pastes of Xerogel granules were processed via 3D plotting. Moreover, alginate concentration was shown to be the key to a high content of irregularly shaped Xerogel granules embedded in a minimum of matrix phase. Both the alginate matrix and Xerogel granules were also shown to influence viscoelastic behavior of the paste, as well as the dimensionally stability of the scaffolds. In conclusion, 3D plotting of Xerogel granules was successfully established by using viscoelastic properties of alginate as matrix phase.

scholarly journals MRI and Additive Manufacturing of Nasal Alar Constructs for Patient-specific Reconstruction

2017 ◽  
Vol 7 (1) ◽  
Author(s):  
Dafydd O. Visscher ◽  
Maureen van Eijnatten ◽  
Niels P. T. J. Liberton ◽  
Jan Wolff ◽  
Mark B. M. Hofman ◽  
...  
Keyword(s):  
Additive Manufacturing ◽  
Patient Specific

Redesign of the Femoral Stem for a Total Hip Arthroplasty for Additive Manufacturing

2018 ◽  
Author(s):  
Bradley Hanks ◽  
Shantanab Dinda ◽  
Sanjay Joshi
Keyword(s):  
Additive Manufacturing ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Lattice Structure ◽  
Stress Shielding ◽  
Patient Specific ◽  
Hip Implants ◽  
Hip Implant ◽  
Total Hip ◽  
Multiple Materials

Total hip arthroplasty (THA) is an increasingly common procedure that replaces all or part of the hip joint. The average age of patients is decreasing, which in turn increases the need for more durable implants. Revisions in hip implants are frequently caused by three primary issues: femoral loading, poor fixation, and stress shielding. First, as the age of hip implant patients decreases, the hip implants are seeing increased loading, beyond what they were traditionally designed for. Second, traditional implants may have roughened surfaces but are not fully porous which would allow bone to grow in and through the implant. Third, traditional implants are too stiff, causing more load to be carried by the implant and shielding the bone from stress. Ultimately this stress shielding leads to bone resorption and implant loosening. Additive manufacturing (AM) presents a unique opportunity for enhanced performance by allowing for personalized medicine and increased functionality through geometrically complex parts. Much research has been devoted to how AM can be used to improve surgical implants through lattice structures. To date, the authors have found no studies that have performed a complete 3D lattice structure optimization in patient specific anatomy. This paper discusses the general design of an AM hip implant that is personalized for patient specific anatomy and proposes a workflow for optimizing a lattice structure within the implant. Using this design workflow, several lattice structured AM hip implants of various unit cell types are optimized. A solid hip implant is compared against the optimized hip implants. It appears the AM hip implant with a tetra lattice outperforms the other implant by reducing stiffness and allowing for greater bone ingrowth. Ultimately it was found that AM software still has many limitations associated with attempting complex optimizations with multiple materials in patient specific anatomy. Though software limitations prevented a full 3D optimization in patient specific anatomy, the challenges associated such an approach and limitations of the current software are discussed.

scholarly journals Additive manufacturing in medical sciences: past, present and the future

2018 ◽  
Vol 5 (1) ◽  
pp. 201
Author(s):  
Lakshya P. Rathore ◽  
Naina Verma
Keyword(s):  
Tissue Engineering ◽  
Additive Manufacturing ◽  
Biological Tissue ◽  
Patient Specific ◽  
Basic Fact ◽  
Medical Sciences ◽  
Novel Technique ◽  
Patient Specific Implants ◽  
Tissue Replacement ◽  
The Future

Additive manufacturing (AM) is a novel technique that despite having been around for more than 35 years, has been underutilized. Its great advantage lies in the basic fact that it is incredibly customizable. Since its use was recognized in various fields of medicine like orthopaedics, otorhinolaryngology, ophthalmology etc, it has proved to be one of the most promising developments in most of them. Customizable orthotics, prosthetics and patient specific implants and tracheal splints are few of its advantages. And in the future too, the combination of tissue engineering with AM is believed to produce an immense change in biological tissue replacement.

scholarly journals A Comprehensive 3D-Molded Bone Flap Protocol for Patient-Specific Cranioplasty

2021 ◽  
Author(s):  
Raphael Bertani ◽  
Caio Moreno Perret Novo ◽  
Pedro Henrique Freitas ◽  
Amanda Amorin Nunes ◽  
Thiago Nunes Palhares ◽  
...  
Keyword(s):  
Additive Manufacturing ◽  
Low Cost ◽  
Selective Laser Sintering ◽  
Operating Time ◽  
Ct Scanning ◽  
Patient Specific ◽  
Manufacturing Cost ◽  
Post Processing ◽  
Cross Sectional ◽  
Cranial Defect

Abstract We present a detailed step-by-step approach for the low-cost production and surgical implantation of cranial prostheses, aimed at restoring aesthetics, cerebral protection, and facilitating neurological rehabilitation. This protocol uses combined scan computed tomography (CT) cross-sectional images, in DICOM format, along with a 3D printing (additive manufacturing) setup. The in-house developed software InVesalius®️ is an open-source tool for medical imaging manipulation. The protocol describes image acquisition (CT scanning) procedures, and image post-processing procedures such as image segmentation, surface/volume rendering, mesh generation of a 3D digital model of the cranial defect and the desired prostheses, and their preparation for use in 3D printers. Furthermore, the protocol describes a detailed powder bed fusion additive manufacturing process, known as Selective Laser Sintering (SLS), using Polyamide (PA12) as feedstock to produce a 3-piece customized printed set per patient. Each set consists of a “cranial defect printout” and a “testing prosthesis” to assemble parts for precision testing, and a cranial “prostheses mold” in 2 parts to allow for the intraoperative modeling of the final implant cast using the medical grade Poly(methyl methacrylate) (PMMA) in a time span of a few min. The entire 3D processing time, including modelling, design, production, post-processing and qualification, takes approximately 42 h. Modeling the PMMA flap with a critical thickness of 4 mm by means of Finite Element Method (FEM) assures mechanical and impact properties to be slightly weaker than the bone tissue around it, a safety design to prevent fracturing the skull after a possible subsequent episode of head injury. On a parallel track, the Protocol seeks to provide guidance in the context of equipment, manufacturing cost and troubleshooting. Customized 3D PMMA prostheses offers a reduced operating time, good biocompatibility, and great functional and aesthetic outcomes. Additionally, it offers greater than 15-fold cost advantage over the usage of other materials, including metallic parts produced by additive manufacturing.

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