A Review of Three Dimensional Process Flow in Surgical Treatment Planning
Shivangi Gaur1, Subhashini R1, M. Madhulaxmi2*, P.U. Abdul Wahab3
1 Post Graduate Student, Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and
Technical Sciences, Saveetha University, No 162, Poonamallee High Road, Vellappanchavadi, Chennai-600077, Tamil Nadu, India.
2 Professor, Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences,
Saveetha University, No 162, Poonamallee High Road, Vellappanchavadi, Chennai-600077, Tamil Nadu, India.
3 Professor, Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences,
Saveetha University, No 162, Poonamallee High Road, Vellappanchavadi, Chennai-600077, Tamil Nadu, India.
*Corresponding Author
Dr M. Madhulaxmi,
Reader, Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, No 162, Poonamallee High Road Vellappanchavadi, Chennai-600077 Tamil Nadu, India.
Tel: +91-73738-14000
E-mail: madhulaxmi11@gmail.com
Received: September 27, 2020; Accepted: October 06, 2020; Published: November 08, 2020
Citation:Shivangi Gaur, Subhashini R, M. Madhulaxmi, P.U. Abdul Wahab. A Review of Three Dimensional Process Flow in Surgical Treatment Planning Int J Dentistry Oral Sci. 2020;7(11):969-971. doi: dx.doi.org/10.19070/2377-8075-20000192
Copyright: M. Madhulaxmi©2020. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Abstract
Surgeons usually depend on their surgical training as well as medical imaging techniques such as magnetic resonance imaging (MRI) or computed tomography (CT) for the planning any surgical treatment process. Due to the anatomical complexity of the surgery site in head and neck region, 2D images are sometimes not sufficient to successfully analyze the structural details. In such cases a 3D printed model of the patient’s anatomy enables customized preoperative planning. 3D printing technology is getting more and more attention especially in the craniofacial region. This article reviews the scope of this technology in maxillofacial surgery. 3D printing technology, also known as rapid prototyping or additive manufacturing or solid-freeform technology, was first demonstrated in the year 19861.. Since then this technique has attracted significant attention, especially in maxillofacial surgery, due to the incredible ability to create complex constructs with highest possible precision. Reconstruction and rehabilitation using this technology offers precise and durable patient-specific models for various surgical applications.
2.Introduction
3.Applications
4.Workflow
5.Materials Used
6.Conclusion
7.Refereces
Keywords
Rapid Prototyping; Additive Manufacturing; Surgical Planning; Preoperative Surgical Planning; 3D Printing.
Introduction
Surgeons usually face the challenging task of carrying out surgeries
on complex anatomical structures in the head and neck region.
Advances in medical imaging such as multi-detector computed tomography
(MDCT) and magnetic resonance imaging (MRI) have
made radiological diagnosis more informative and less invasive.
MRI, CT and MDCT provide high resolution two-dimensional
images, yet are constrained in their capacity to precisely delineate
complex 3D structures.
3D reconstruction techniques offer a better understanding of
structural complexity by allowing rotation and separation of layers
in the 3D model.
Applications
Surgical applications of 3D technology can be listed as:
1. Acquiring accurate anatomic prototypes which ease preoperative
planning and improve postoperative facial contour symmetry [2,3]
2. Inspection of anatomy preoperatively, practice different surgical
techniques and thereby reducing the operating time and minimizing
errors [4, 19]
3. Virtually planning 5
4. Printing pre-contoured grafts and plates to improve surgical
outcomes 6
5. 3D constructed prostheses [7,8]
6. Cutting-edge simulation models to enhance surgical education [9]
The concept of 3D printing can be summarized as [10, 11]
Figure 1.
Workflow
The work flow behind 3D printing is summarized as [12-14];
1. Capture anatomic structures using imaging techniques like magnetic
resonance imaging (MRI) and computed tomography (CT)
2. Save the scan images in Digital Imaging and Communications
in Medicine (DICOM) format
3. Use Computer-Aided Design (CAD) software to create a virtual
3D prototype
4. Use Standard Tessellation Language (STL) that allows for 3D
printing
5. Select appropriate printing technique 20 like stereolithography
(SLA), fused deposition modelling (FDM), selective laser sintering
(SLS), bioprinting (laser-assisted, inkjet, extrusion)
6. Post-printing modification of the object to achieve final product.
Materials Used
Autogenous graft are considered as the gold standard for bone
grafting as it has osteoinductive, osteoconductive and osteogenic
properties 15. Some disadvantages include donor-site morbidity,
limited quantities, postoperative pain, resorption, wound infection,
increased blood loss and prolonged anaesthesia time 16 as
well as lack of delivering ideal geometry. Tissue engineering is
hence a potential tool combining material science, engineering
and biology to restore, replace or improve biological functions
of the body.
Scores of biodegradable polymers have been investigated for maxillofacial
defect repair including polyglycolic acid (PGA), polylactic
acid (PLA) and copolymer of PGA and PLA (PLGA) 17. This
copolymer PLGA has osteoconductive properties in vivo and can
be cleared by metabolic processes. When large PLGA prosthesis
undergoes mechanical strain bulk degradation happens, releasing
lactic acid and glycolic acid resulting in drop of pH and tissue loss
18. Another polymer investigated for craniofacial reconstruction
is poly(ε-caprolactone) (PCL), it has good biocompatibility and
mechanical properties.
Other materials used are poly (propylene fumarate) (PPF) polymer,
mesenchymal stem cells on a polyamide/hydroxyapatite scaffold, PEEK (poly ether ether ketone) etc.
Successful 3D printing from radiologic images is a multidisciplinary
science. Accurate anatomical models require close interaction
between radiologists and physicians. In terms of its surgical
application, there is a need to design randomised clinical trials that
prove the advantages of adopting 3D planning over the classical
surgical treatment planning. A possible limitation to use is the
time needed to produce a 3D-printed model 19.
Conclusion
In synopsis, the use of additive manufacturing technology in oral
and maxillofacial surgery has good potential and can be utilized
for careful surgical treatment planning. The generation of custom
made implants might will address the downsides of current treatment
strategies by creation of exact prototypes for fitting in the
defect. Patient specific implants can thereby transform research,
treatment methodology, and educational streams of dentistry
ameliorating oral health care. 3D printing has a high potential for
education in all disciplines of surgery.
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