Personalization of surgery with 3D printing technology: A new frontier

A 29 yr old male†, with a secondary posttraumatic deformity of the face (Fig. 1A), presented to the outpatient department of Trauma Surgery & Critical Care, JPNATC, All India Institute of Medical Sciences, New Delhi, India, in November 2016, with complaints of inability to eat and difficulty in speech. A 3D skull image (Fig. 1B) showed missing maxillary alveolus segment. The patient was counselled for reconstruction using iliac crest or free fibula followed by artificial teeth, which would in all take of two years for operative procedures. However, the patient wanted an alternative option to avoid creating another defect site for bone grafting. An innovative virtual surgical plan using digital planning to fabricate a patient-specific implant (Fig. 2) was conceptualized. This involved planning and designing of patient-specific titanium implant with provision to support artificial teeth. The case was unique sufficient soft tissue was used to cover the implant such that with just one surgery (Fig. 3), the patient was rehabilitated in just three months with artificial teeth (Fig. 4). This case was followed up for two years post-surgery for function, form and quality-of-life evaluation.

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Fig. 1 Pre-operative diagnostic images. (A) Clinical picture demonstrating the area of the maxillary defect before surgery. (B) Reconstruction of preoperative 3D skull image to gain a general impression of post traumatic maxillary deficiency (arrows).

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Fig. 2 The designed patient-specific implant (PSI). (A) Surgical simulation of computed tomography (CT) data followed by designing of a template (in grey colour) over the remaining bone for support. Metal struts are extruded for denture fabrication postoperatively. (B) Larger segment and (C) smaller segment of the final patient-specific implant.

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Fig. 3 Intraoperative photo following fixation of PSI to the midface.

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Fig. 4 Postoperative images. (A) CT data demonstrating the fixed PSI in proper facial relations. (B) Three months postoperative, clinical image demonstrating complete facial and dental rehabilitation.

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Incorporating 3D planning for the rehabilitation of secondary defects can bring about decreased operative time, less reconstructive surgeries, predictable outcomes and hence economic viability. A separate 3D printing laboratory would aid in planning and to personalize surgery.