Patient-Specific Titanium Mandibular Reconstruction Using Additive Manufacturing

Background: The application of additive manufacturing (AM) technology has been widely used in medical fields, such as craniomaxillofacial surgery. Ti6AI4V ELI is a highly durable and fracture resistant titanium alloy that has been developed for manufacturing medical implants. With the support of medical imaging and the use of computer-aided design (CAD), clinicians are able to manufacture patient-specific Ti6AI4V ELI titanium implants by applying AM technology. Methods: Major steps in directly designing and manufacturing of 3D customized titanium implants were discussed. Furthermore Pre-operative preparations, surgical procedures and post-operative treatment outcomes were compared among patients who received mandibular reconstruction using a customized 3D titanium implant, titanium reconstruction plates, or vascularized autologous fibular grafting. Findings: The approach of using a customized titanium implant significantly improved surgical efficiency and precision. As compared to mandibular reconstruction using the other two conventional approaches, patients received the customized implant showed a significantly higher facial appearance satisfaction with no post-operative complications within the duration of average 12-month follow-up. Patients underwent mandibular reconstruction using a customized titanium implant displayed improved mandibular contour symmetry, restored occlusal function, normal range of mouth opening and no temporomandibular joint related pain. This was in contrast to increased risk of unilateral facial asymmetry, limited mouth opening, decreased chewing function as well as implant loosening observed in patients received the other two conventional approaches. Interpretation: In conclusion, advances in AM technology have enabled the production of customized implants which are highly implicated in dental surgery. Funding Statement: This work is supported by the Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD) and AK Medical Holdings Limited. Declaration of Interests: The authors declare no potential conflicts of interest with respect to the authorship and/or publication of this article. Ethics Approval Statement: Informed consent for participation in the study was obtained from participates according to the policy of Stomatological Hospital of Jiangsu Ethical Review Board and anonymizing data was used for analysis. Approval for this study was obtained from Stomatological Hospital of Jiangsu Ethical Review Board (No. PJ2016-003-01).