Printed Titanium Implants in UK Cranio-Maxillofacial Surgery: Part II – Perceived performance (outcomes, logistics and costs)

Abstract Introduction and Aims This second part explores perceptions/understanding of clinical performance, turnaround and costs for printed titanium implants/plates in common procedures; evaluating both ‘in-house’ and ‘outsourced’ CAD-CAM pathways. Methods A cross-sectional study was conducted over 14 weeks; supported by the British Association of Oral and Maxillofacial Surgeons and a national trainee-led recruitment team. Results One-hundred and thirty-two participants took part (demographic data is reported in part I). For fibular-flap mandibular reconstruction, most (69-91%) perceived printed titanium as superior to intraoperatively/pre-operatively hand-bent plates for surgical duration, accuracy, dental restorability and aesthetics. There was less consensus over complications and plate-failure risks. Most perceived printed plates as superior to traditional wafer-based maxillary osteotomy for surgical duration (61%) and maxillary positioning (60%). For orbital floor repair, most perceived improved surgical duration (83%, especially higher-volume operators p = 0.009), precision (84%) and ease (69%) of placement. Rarely ( Perceived turnaround times and costs were variable, but greatest consensus for 2-segment fibular-flap reconstructions and orbital floor repair. Industry estimates were generally consistent between two company representatives but ‘manufacturing-only’ costs differed when using ‘in-house’ (departmental) designers. Conclusions Costs and turnaround times are questionable barriers since few understand ‘real-world’ figures. Designing ‘in-house’ can dramatically alter costs. Improved accuracy and surgical duration are common themes but biomechanical benefits are less-well understood. This study paints a picture of potentially routine applications and benefits of printed titanium, capacity for uptake, understanding amongst surgeons and areas for improvement.