Three-dimensional printed patient-specific implants – The future work horse

A 26 yr old male† presented to the department of Oral and Maxillofacial Surgery, AB Shetty Memorial Institute of Dental Sciences, Mangaluru, India, in 2019, with a complaint of mild swelling over lower jaw (Figs 1 and 2). After clinical, radiological and histological investigations, it was diagnosed as mural ameloblastoma of the lower jaw and surrounding soft tissue (Figs 3-5). Wide excision with reconstruction was carried out using a 3D printed mandible made of titanium with dental implant heads for future rehabilitation (Figs 6 and 7). Intraoperatively, a guide was used to carry out mandibular resection (Fig. 6) following which 3D printed patient-specific implant (PSI) was adapted. Post-operative cone-beam computed tomography revealed correct contour of the implant with the mandible (Fig. 8). On the eighth post-operative day, the patient's was able to open his mouth normally.

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Fig. 1 Pre-operative frontal profile. White arrow indicates the area with mild swelling.

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Fig. 2 Mild intra-oral swelling over mandible (arrow).

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Fig. 3 Pre-operative cone-beam computed tomographic images (axial and coronal cuts) revealing multi-locular expansile lesions in ramus and body of the mandible.

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Fig. 4 Ameloblastic islands invading the bone (H and E stain, ×4). Inset: Peripheral tall, columnar cells with reverse polarity and inner cells with stellate reticulum (black arrows, ×10).

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Fig. 5 Black arrows pointed towards ameloblastic islands with mural proliferation in soft tissues (H and E stain, ×4; inset, ×10).

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Fig. 6 Images show the surface markings for incision on the neck, soft tissue dissection to expose the affected mandible with safe surgical margins and placement of resection guide to facilitate accurate mandibular resection.

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Fig. 7 Images show the resected mandible using guide and placement of three-dimensional printed mandible.

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Fig. 8 Post-operative cone-beam computed tomographic images (axial and three-dimensional) showing exact contour of the implant with mandible.

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Cranio-maxillofacial surgery is one among the few pioneering medical fields to use the PSIs because of the complexity associated with reconstructing the defects. Use of PSIs will revolutionize the field of reconstruction in cranio-maxillofacial surgery since it reduces the intra-operative time and eliminates the donor site morbidity while maintaining the function and aesthetics. The only short coming is that it is not economical. Further research is essential to develop materials and techniques to overcome the issue.