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Integrative and multi-disciplinary framework for the 3D rehabilitation of large mandibular defects

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The restoration of mandibular defects, especially large deformities is regarded as the most challenging surgical procedure owing to complicated anatomy and the requirement of customized design. Presently, the commercially available reconstruction plates with standard shapes and sizes are frequently utilized. However, these typical plates exhibit several disadvantages, including high cost, poor performance, etc. They are ineffective and do not exactly match the bone contours. Besides, trial and miss approach and several revisions associated with these plates involve significant effort and time. To overcome these issues, a framework based on the integration of design, analysis, evaluation, and fabrication phases have been developed and implemented. The objective was the attainment of a cost-effective, reliable, and sturdy design for the mandibular implant. A customized plate merged with a mesh structure matching the patient bone contours as well as guide and support the growth of neighboring bones was the crux of this mandible implant. The proposed methodology was made of three primary pillars: technology unification, multi-disciplinary notion, and a quality emphasis. A lattice structure, instead of a solid framework was utilized to reconstruct the large mandibular defect. Indeed, the various porous structures were analyzed to finally derive the appropriate lattice structure. The scans from computer tomography were utilized to model the customized plate and scaffold framework, while electron beam melting was used to fabricate the implant. Moreover, the proposed implant design was analyzed using finite element analysis as well as the fabricated specimen was validated for mechanical and structural behavior. The biomechanical analysis outcome revealed lower stresses (214.77 MPa) as well as well-connected structures involving proper porosity and robust mechanical properties. The cost analysis also established that the employment of the proposed design would result in a lesser burden on the patient as compared to the existing practices.

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  1. 1.

    Carlsen A, Marcussen M (2016) Spontaneous fractures of the mandible concept & treatment strategy. Med Oral Patol Oral Cir Bucal 21(1):e88–e94

  2. 2.

    Dabrowski B, Swieszkowski W, Godlinski D, Kurzydlowski KJ (2010) Highly porous titanium scaffolds for orthopaedic applications. J Biomed Mater Res B Appl Biomater 95(1):53–61

  3. 3.

    Jiang J, Xu X, Stringer J (2018) Support structures for additive manufacturing: a review. J Manuf Mater Process 2(4):64

  4. 4.

    Jiang J, Xu X, Stringer J (2019) Optimisation of multi-part production in additive manufacturing for reducing support waste. Virtual Phys Prototyp 14(3):219–228

  5. 5.

    Ford S, Despeisse M (2016) Additive manufacturing and sustainability: an exploratory study of the advantages and challenges. J Clean Prod 137:1573–1587

  6. 6.

    Chua CK, Wong CH, Yeong WY (2017) Standards, quality control, and measurement sciences in 3D printing and additive manufacturing. Academic Press

  7. 7.

    Otsuki B, Takemoto M, Fujibayashi S, Neo M, Kokubo T, Nakamura T (2006) Pore throat size and connectivity determine bone and tissue ingrowth into porous implants: three-dimensional micro-CT based structural analyses of porous bioactive titanium implants. Biomaterials. 27:5892–5900

  8. 8.

    Onal E, Frith J, Jurg M, Wu X, Molotnikov A (2018) Mechanical properties and in vitro behavior of additively manufactured and functionally graded Ti6Al4V porous scaffolds. Metals 8(4):200

  9. 9.

    Li X, Luo Y, Wang C, Zhang W, Li Y (2012) Fabrication and in vivo evaluation of Ti6Al4V implants with controlled porous structure and complex shape. Front Mech Eng 7:66–71

  10. 10.

    Parthasarathy J (2013) 3D modeling, custom implants and its future perspectives in craniofacial surgery. Ann Maxillofac Surg 4(1):9

  11. 11.

    Erk KA, Dunand DC, Shull KR (2008) Titanium with controllable pore fractions by thermoreversible gelcasting of TiH2. Acta Mater 56(18):5147–5157

  12. 12.

    Li J, Habibovic P, Vandendoel M, Wilson C, Dewijn J, Vanblitterswijk C, Degroot K (2007) Bone ingrowth in porous titanium implants produced by 3D fiber deposition. Biomaterials 28(18):2810–2820

  13. 13.

    Anurag R, Kumar SR, Joshi KK, Sahoo AK, Das RK (2018) Machining of Ti-6Al-4V ELI alloy: a brief review. IOP Conf Ser Mater Sci Eng 390:012112

  14. 14.

    Materialise Mimics, https://www.materialise.com/en/medical/software/mimics

  15. 15.

    Platform: Integrated Simulation System | ANSYS, https://www.ansys.com/products/platform

  16. 16.

    LightSpeed VCT, https://www.gehealthcare.com/courses/lightspeed-vct

  17. 17.

    Moiduddin K, Anwar S, Ahmed N, Ashfaq M, Al-Ahmari A (2017) Computer assisted design and analysis of customized porous plate for mandibular reconstruction. IRBM 38(2):78–89

  18. 18.

    Moiduddin K, Darwish S, Al-Ahmari A, ElWatidy S, Mohammad A, Ameen W (2017) Structural and mechanical characterization of custom design cranial implant created using additive manufacturing. Electron J Biotechnol 29:22–31

  19. 19.

    Alassaf MH, Li W, Joshi AS, Hahn JK (2014) Computer-based planning system for mandibular reconstruction. Stud Health Technol Inform 196:6–10

  20. 20.

    Mohammadhosseini A, Masood SH, Fraser D, Jahedi M, Gulizia S (2017) Flexural behaviour of titanium cellular structures produced by Electron beam melting. Mater Today Proc 4(8):8260–8268

  21. 21.

    Yang Y, Wang G, Liang H, Gao C, Peng S, Shen L, Shuai C (2018) Additive manufacturing of bone scaffolds. Int J Bioprint 5(1)

  22. 22.

    Cansizoglu O, Harrysson O, Cormier D, West H, Mahale T (2008) Properties of Ti–6Al–4V non-stochastic lattice structures fabricated via electron beam melting. Mater Sci Eng A 492:468–474

  23. 23.

    Horn TJ, Harrysson OLA, Marcellin-Little DJ, West HA, Lascelles BDX, Aman R (2014) Flexural properties of Ti6Al4V rhombic dodecahedron open cellular structures fabricated with electron beam melting. Addit Manuf 1–4:2–11

  24. 24.

    Harrysson OL, Cansizoglu O, Marcellin-Little DJ, Cormier DR, West HA II (2008) Direct metal fabrication of titanium implants with tailored materials and mechanical properties using electron beam melting technology. Mater Sci Eng C 28:366–373

  25. 25.

    Bragdon CR, Jasty M, Greene M, Rubash HE, Harris WH (2004) Biologic fixation of total hip implants: insights gained from a series of canine studies. J Bone Joint Surg 86:105–117

  26. 26.

    Mour M, Das D, Winkler T, Hoenig E, Mielke G, Morlock MM, Schilling AF (2010) Advances in porous biomaterials for dental and orthopaedic applications. Materials. 3(5):2947–2974

  27. 27.

    Markhoff J, Wieding J, Weissmann V, Pasold J, Jonitz-Heincke A, Bader R (2015) Influence of different three-dimensional open porous titanium scaffold designs on human osteoblasts behavior in static and dynamic cell investigations. Materials 8(8):5490–5507

  28. 28.

    S. Materialise: Structures module, https://www.materialise.com/en/software/magics/modules/structures-module

  29. 29.

    Atilgan S, Erol B, Yardimeden A, Yaman F, Ucan MC, Gunes N, Atalay Y, Kose I (2010) A three dimensional analysis of reconstruction plates used in different mandibular defects. Biotechnol Biotechnol Equip 24(2):1893–1896

  30. 30.

    Vajgel A, Camargo IB, Willmersdorf RB, de Melo TM, Laureano Filho JR, Vasconcellos RJ (2013) Comparative finite element analysis of the biomechanical stability of 2.0 fixation plates in atrophic mandibular fractures. J Oral Maxillofac Surg 71(2):335–342

  31. 31.

    Silva GC, Mendonça JA, Lopes LR, Landre J (2010) Stress patterns on implants in prostheses supported by four or six implants: a three-dimensional finite element analysis. Int J Oral Maxillofac Implants 25(2):239–246

  32. 32.

    Arcam: Ti6Al4V ELI titanium alloy. http://www.arcam.com/wp-content/uploads/Arcam-Ti6Al4V-ELI-Titanium-Alloy.pdf

  33. 33.

    Martin B (1993) Aging and strength of bone as a structural material. Calcif Tissue Int 53(1):S34–S40

  34. 34.

    Wang X, Puram S (2004) The toughness of cortical bone and its relationship with age. Ann Biomed Eng 32(1):123–135

  35. 35.

    Simonovics J, Bujtár P, Váradi K (2013) Effect of preloading on lower jaw implant. Biomech, Hung

  36. 36.

    Szucs A, Bujtár P, Sándor GKB, Barabás J (2010) Finite element analysis of the human mandible to assess the effect of removing an impacted third molar. J Can Dent Assoc 76:a72

  37. 37.

    Meriç G, Erkmen E, Kurt A, Eser A, Ozden AU (2012) Biomechanical comparison of two different collar structured implants supporting 3-unit fixed partial denture: a 3-D FEM study. Acta Odontol Scand 70(1):61–71

  38. 38.

    Canullo L, Pace F, Coelho P, Sciubba E, Vozza I (2011) The influence of platform switching on the biomechanical aspects of the implant-abutment system. A three dimensional finite element study. Med Oral Patol Oral Cir Bucal 16(6):e852–e856

  39. 39.

    Narra N, Valášek J, Hannula M, Marcián P, Sándor GK, Hyttinen J, Wolff J (2014) Finite element analysis of customized reconstruction plates for mandibular continuity defect therapy. J Biomech 47(1):264–268

  40. 40.

    Yu Y, Zhu R, Zeng Z-L, Jia Y-W, Wu Z-R, Ren Y-L, Chen B, Ding Z-Q, Cheng L-M (2014) The strain at bone-implant interface determines the effect of spinopelvic reconstruction following total sacrectomy: a strain gauge analysis in various spinopelvic constructs. PLoS ONE 9(1)

  41. 41.

    Ning X, Wen Y, Xiao-Jian Y, Bin N, De-Yu C, Jian-Ru X, Lian-Shun J (2008) Anterior cervical locking plate-related complications; prevention and treatment recommendations. Int Orthop 32(5):649–655

  42. 42.

    Basciftci FA, Korkmaz HH, Üşümez S, Eraslan O (2008) Biomechanical evaluation of chincup treatment with various force vectors. Am J Orthod Dentofac Orthop 134(6):773–781

  43. 43.

    Arcam A2 setting the standard for additive manufacturing, http://www.arcam.com/wp-content/uploads/Arcam-A2.pdf. Accessed: 12-Jul-2019

  44. 44.

    Salerno A, Maio ED, Iannace S, Netti PA (2011) Tailoring the pore structure of PCL scaffolds for tissue engineering prepared via gas foaming of multi-phase blends. J Porous Mater 19(2):181–188

  45. 45.

    Liu P, Chen G-F (2014) Porous materials, processing and applications. Elsevier

  46. 46.

    Geraedts J, Doubrovski E, Verlinden J (2012) Three views on additive manufacturing: business, research, and education. ResearchGate. TMCE, Karlsruhe

  47. 47.

    Facchini L, Magalini E, Robotti P, Molinari A (2009) Microstructure and mechanical properties of Ti-6Al-4V produced by electron beam melting of pre-alloyed powders. Rapid Prototyp J 15:171–178

  48. 48.

    Wysocki B, Idaszek J, Szlązak K, Strzelczyk K, Brynk T, Kurzydłowski KJ, Święszkowski W (2016) Post processing and biological evaluation of the titanium scaffolds for bone tissue engineering. Materials 9(3)

  49. 49.

    Van Bael S, Kerckhofs G, Moesen M, Pyka G, Schrooten J, Kruth J-P (2011) Micro-CT-based improvement of geometrical and mechanical controllability of selective laser melted Ti6Al4V porous structures. Mater Sci Eng A 528:7423–7431

  50. 50.

    van Grunsven W, Hernandez-Nava E, Reilly GC, Goodall R (2014) Fabrication and mechanical characterisation of titanium lattices with graded porosity. Metals 4(3):401–409

  51. 51.

    Parthasarathy J, Starly B, Raman S (2011) A design for the additive manufacture of functionally graded porous structures with tailored mechanical properties for biomedical applications. J Manuf Process 13:160–170

  52. 52.

    Alvarez K, Nakajima H (2009) Metallic scaffolds for bone regeneration. Materials. 2(3):790–832

  53. 53.

    Li JP, Li SH, Van Blitterswijk CA, de Groot K (2005) A novel porous Ti6Al4V: characterization and cell attachment. J Biomed Mater Res A 73(2):223–233

  54. 54.

    Harada K, Watanabe M, Ohkura K, Enomoto S (2000) Measure of bite force and occlusal contact area before and after bilateral sagittal split ramus osteotomy of the mandible using a new pressure-sensitive device: a preliminary report. J Oral Maxillofac Surg 58(4):370–373; discussion 373–374

  55. 55.

    Madsen MJ, Haug RH (2006) A biomechanical comparison of 2 techniques for reconstructing atrophic edentulous mandible fractures. J Oral Maxillofac Surg 64(3):457–465

  56. 56.

    Hernández-Nava E, Smith CJ, Derguti F, Tammas-Williams S, Léonard F, Withers PJ, Todd I, Goodall R (2015) The effect of density and feature size on mechanical properties of isostructural metallic foams produced by additive manufacturing. Acta Mater 85:387–395

  57. 57.

    Parthasarathy J, Starly B, Raman S, Christensen A (2010) Mechanical evaluation of porous titanium (Ti6Al4V) structures with electron beam melting (EBM). J Mech Behav Biomed Mater 3(3):249–259

  58. 58.

    Gerlach KL, Schwarz A (2002) Bite forces in patients after treatment of mandibular angle fractures with miniplate osteosynthesis according to Champy. Int J Oral Maxillofac Surg 31(4):345–348

  59. 59.

    Kumar ST, Saraf S, Devi SP (2013) Evaluation of bite force after open reduction and internal fixation using microplates. J Dent Tehran Iran 10(5):466–477

  60. 60.

    Rustemeyer J, Melenberg A, Sari-Rieger A (2014) Costs incurred by applying computer-aided design/computer-aided manufacturing techniques for the reconstruction of maxillofacial defects. J Craniomaxillofac Surg 42(8):2049–2055

  61. 61.

    Gutwald R, Jaeger R, Lambers FM (2017) Customized mandibular reconstruction plates improve mechanical performance in a mandibular reconstruction model. Comput Methods Biomech Biomed Eng 20(4):426–435

  62. 62.

    M. Ashish: Process planning for the rapid machining of custom bone implants, (2011)

  63. 63.

    Hermawan H, Ramdan D, Djuansjah JRP (2011) Metals for biomedical applications. In: Fazel R (ed) Biomedical engineering - from theory to applications. InTech

  64. 64.

    Cronskär M, Bäckström M, Rännar L (2013) Production of customized hip stem prostheses – a comparison between conventional machining and electron beam melting (EBM). Rapid Prototyp J 19(5):365–372

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The authors extend their appreciation to the Deanship of Scientific Research at King Saud University for funding this work through Research group no, RG-1440-034.

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Correspondence to Khaja Moiduddin.

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Moiduddin, K., Mian, S.H., Ahmed, N. et al. Integrative and multi-disciplinary framework for the 3D rehabilitation of large mandibular defects. Int J Adv Manuf Technol 106, 3831–3847 (2020). https://doi.org/10.1007/s00170-019-04762-3

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  • Customized implant
  • Additive manufacturing
  • Electron beam melting
  • Stress distribution
  • Lattice reconstruction plate
  • Mandibular restoration