Clinical experience of full custom-made artificial bones for the maxillofacial region

Abstract

Introduction: Autologous, allogeneic, and artificial bones are clinically applied as graft materials for bone reconstruction, with each having their own advantages and disadvantages. Although artificial bones with various shapes are currently available, a product with a morphology that may be freely modified by operators has not yet been developed. In the present study, we developed a full custom-made artificial bone, and applied it to form the maxillofacial region. We herein report treatment outcomes.

Methods: An artificial bone was prepared on a 3-dimensional solid model, and data of its shape was collected on CT. A full custom-made artificial bone was prepared by laminating α-tricalcium phosphate powder using an aqueous polysaccharide curing solution and the ink-jet powder-laminating device, Z406 3D Printer (DICO, USA). Subjects comprised patients who underwent maxillofacial plasty using this artificial bone between March 2006 and September 2009.

Results: Maxillofacial plasty using the full custom-made artificial bone was applied to 23 regions in 20 patients (14 females and 6 males). The recipient region was the maxilla in 3, mandibular ramus in 13, mental region in 7, and frontal bone in 1. Postoperative courses were favorable in 18 out of the 23 regions; however, the fit was insufficient in 2 regions and the recipient regions were exposed within 1 year after surgery. Three regions were exposed 1 year or more after surgery.

Conclusion: We developed a novel reconstruction method using a full custom-made artificial bone. Its fit with the recipient bone was considered to be important, since an ill fit between the recipient and artificial bones potentially resulting in the artificial bone being detached. Therefore, fixation is important in order to prevent the detachment, and careful course observations are required when an ill fit is concerned during the follow-up period.

Keywords: Artificial bones; Complication; Full custom-made; Oral-maxillofacial region.

Fig. 1

(A) An artificial bone with a planned shape was simulated by applying contrast medium-containing wax to the 3-dimensional solid plaster model. (B) The simulated model was imaged using helical CT. (C) CAD data was extracted from the DICOM data of CT.

Fig. 2

(A) CAD data of an artificial bone. (B) CAD data of an artificial bone was output by a 3-dimensional printer. (C) A fabricated artificial bone.

Fig. 3

(A) Preoperative frontal view. A concave deformity was noted in the left mandibular body. (B) Preoperative 3-dimensional CT.

Fig. 4

(A) Intraoperative findings. The artificial bone was fixed to the recipient bone with absorbable sutures. (B) Postoperative 3-dimensional CT.

Fig. 5

Outcomes 2 years after surgery. (A) Facial photograph. (B) 3-dimensional CT.

Fig. 6

Mental plasty case. (A) Retrogression of the mental region was observed in a preoperative photograph of the lateral face. (B) Cephalometric radiography (lateral view).

Fig. 7

Intraoperative photograph. (A) The artificial bone was fixed to the recipient bone with absorbable sutures. (B) Postoperative cephalometric radiogram.

Fig. 8

(A) Facial outcomes at 8 years after surgery. (B) 3-dimensional CT.

Fig. 9

(A) Facial outcomes at 5 years after surgery. (B) CT. The arrow indicates grafted artificial bones. The fit of the left artificial bone was not as favorable as that on the right side; however, no abnormal finding was noted in the skin or oral cavity.

Fig. 10

(A) A fistula appeared in the skin at 5 years and 11 months after surgery. (B) CT showed that the artificial bone had completely detached from the recipient bone (arrow).