Mandibular Reconstruction Using 3D-Printing Modeling Technology

Introduction: Mandibular reconstruction can be challenging for the surgeon wishing to restore its unique geometry. Reconstruction can be achieved with titanium bone plates and autogenous bone grafting. Incorporation of the bone graft into the mandible provides continuity and strength required for proper aesthetics, function and permitting dental implant rehabilitation at a later stage. Precious time in the operating room is invested in plate contouring to reconstruct the mandible. The use of 3D-Printing modeling enables accurate contouring of plates prior to surgery. Furthermore, this technology can be utilized during the second stage of reconstruction, in which a template is created for harvesting of bone implant.

Materials and Methods: A 27-year-old man suffering from left mandibular plexiform ameloblastoma, approximately 5.3 X 4.3 cm in size, extending from the distal root of tooth no. 36 up to the sigmoid notch. An 8 cm resection was planned with bone plate reconstruction in the first stage, and reconstruction with iliac crest bone graft in the second stage. CT imaging was performed on a 64-slice MDCT scanner (Brilliance 64, Philips Medical). Volumetric data was acquired (1 mm slice thickness, 0.5 mm increment, 0.75 s rotation time, 120 kVp, 50 mAs). DICOM data was converted to STL format. A photopolymer jetting device (PolyJet Technology, Eden500V, Objet Geometries Ltd, Rehovot, Israel) “printed” super-thin layers (down to 16 microns) of hard plastic and a gel-like support material at 600 x 600 dpi to create the model.

Results: Excellent aesthetic and functional results with the prefabricated plate were achieved in a shorter operating time. Bone graft configuration was made according to template, and positioned properly for planned dental implants.

Conclusion: 3-D printing Objet's PolyJet Technology is a promising method for precise mandibular reconstruction using bone plates and grafts, whereby operation time is shortened and the surgical procedure is made easier.