|
1
|
Mian SH, Moiduddin K, Elseufy SM, Alkhalefah H. Adaptive Mechanism for Designing a Personalized Cranial Implant and Its 3D Printing Using PEEK. Polymers (Basel) 2022; 14:1266. [PMID: 35335596 PMCID: PMC8955283 DOI: 10.3390/polym14061266] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/07/2022] [Accepted: 03/16/2022] [Indexed: 12/29/2022] Open
Abstract
The rehabilitation of the skull's bones is a difficult process that poses a challenge to the surgical team. Due to the range of design methods and the availability of materials, the main concerns are the implant design and material selection. Mirror-image reconstruction is one of the widely used implant reconstruction techniques, but it is not a feasible option in asymmetrical regions. The ideal design approach and material should result in an implant outcome that is compact, easy to fit, resilient, and provides the perfect aesthetic and functional outcomes irrespective of the location. The design technique for the making of the personalized implant must be easy to use and independent of the defect's position on the skull. As a result, this article proposes a hybrid system that incorporates computer tomography acquisition, an adaptive design (or modeling) scheme, computational analysis, and accuracy assessment. The newly developed hybrid approach aims to obtain ideal cranial implants that are unique to each patient and defect. Polyetheretherketone (PEEK) is chosen to fabricate the implant because it is a viable alternative to titanium implants for personalized implants, and because it is simpler to use, lighter, and sturdy enough to shield the brain. The aesthetic result or the fitting accuracy is adequate, with a maximum deviation of 0.59 mm in the outside direction. The results of the biomechanical analysis demonstrate that the maximum Von Mises stress (8.15 MPa), Von Mises strain (0.002), and deformation (0.18 mm) are all extremely low, and the factor of safety is reasonably high, highlighting the implant's load resistance potential and safety under high loading. Moreover, the time it takes to develop an implant model for any cranial defect using the proposed modeling scheme is very fast, at around one hour. This study illustrates that the utilized 3D reconstruction method and PEEK material would minimize time-consuming alterations while also improving the implant's fit, stability, and strength.
Collapse
Affiliation(s)
- Syed Hammad Mian
- Department of Industrial Engineering, College of Engineering, King Saud University, P.O. Box 800, Riyadh 11421, Saudi Arabia; (K.M.); (S.M.E.); (H.A.)
| | - Khaja Moiduddin
- Department of Industrial Engineering, College of Engineering, King Saud University, P.O. Box 800, Riyadh 11421, Saudi Arabia; (K.M.); (S.M.E.); (H.A.)
| | - Sherif Mohammed Elseufy
- Department of Industrial Engineering, College of Engineering, King Saud University, P.O. Box 800, Riyadh 11421, Saudi Arabia; (K.M.); (S.M.E.); (H.A.)
| | - Hisham Alkhalefah
- Department of Industrial Engineering, College of Engineering, King Saud University, P.O. Box 800, Riyadh 11421, Saudi Arabia; (K.M.); (S.M.E.); (H.A.)
| |
Collapse
|
|
2
|
Chauhan D, Chattopadhyay P, Thakur A. Reconstruction of cranial defect with patient-specific implants: Four different cost-effective techniques. Natl J Maxillofac Surg 2022; 13:136-142. [PMID: 35911808 PMCID: PMC9326212 DOI: 10.4103/njms.njms_200_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/24/2020] [Accepted: 04/04/2021] [Indexed: 11/04/2022] Open
|
|
3
|
Chaudhary A, Sinha VD, Chopra S, Shekhawat J, Jain G. Low-Cost Customized Cranioplasty with Polymethyl Methacrylate Using 3D Printer Generated Mold: An Institutional Experience and Review of Literature. INDIAN JOURNAL OF NEUROTRAUMA 2021. [DOI: 10.1055/s-0041-1729679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Abstract
Background Cranioplasty is performed to repair skull defects and to restore normal skull anatomy. Optimal reconstruction remains a topic of debate. Autologous bone flap is the standard option but it may not be available due to traumatic bone fractures, bone infection, and resorption. In this article, the authors presented their experience with prefabrication of precise and low-cost polymethyl methacrylate (PMMA) mold using three-dimensional (3D) digital printing.
Materials and Methods A total of 30 patients underwent cranioplasty between March 2017 and September 2019 at Sawai Man Singh Medical College Jaipur, India. Preoperative data included diagnosis for which decompressive craniectomy was done and Glasgow coma scale score. Intraoperative data included operating time. Postoperative data included cosmetic outcome in the form of cranial contour and margins, complications such as infection, seroma, implant failure, wound dehiscence, and hematoma.
Results Patient age at cranioplasty ranged from 12 to 63 years with a mean age of 36.7 years. The mean operating time was 151.6 minutes (range 130–190 minutes). The mean follow-up period was 8 months (range 6–13 months). Postoperative wound dehiscence developed in one case (3.3%). Cranial contour and approximation of the margins were excellent and aesthetic appearance improved in all patients.
Conclusion Low-cost PMMA implant made by digital 3D printer mold is associated with reconstruction of the deformed skull contour giving satisfactory results to the patient and his family members, at a low cost compared with other commercially available implants. This technique could be a breakthrough in cranioplasty.
Collapse
Affiliation(s)
- Ankit Chaudhary
- Department of Neurosurgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Virendra Deo Sinha
- Department of Neurosurgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Sanjeev Chopra
- Department of Neurosurgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Jitendra Shekhawat
- Department of Neurosurgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Gaurav Jain
- Department of Neurosurgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| |
Collapse
|
|
4
|
Chaudhary A, Sinha VD, Chopra S, Shekhawat J, Jain G. Low-Cost Customized Cranioplasty with Polymethyl Methacrylate Using 3D Printer Generated Mold: An Institutional Experience and Review of Literature. INDIAN JOURNAL OF NEUROTRAUMA 2020. [DOI: 10.1055/s-0040-1713459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Abstract
Background Cranioplasty is performed to repair skull defects and to restore normal skull anatomy. Optimal reconstruction remains a topic of debate. Autologous bone flap is the standard option but it may not be available due to traumatic bone fractures, bone infection, and resorption. The authors present their experience with prefabrication of precise and low-cost polymethyl methacrylate (PMMA) mold using three-dimensional (3D) digital printing.
Methods A total of 30 patients underwent cranioplasty between March 2017 and September 2019 at Sawai Man Singh Medical College Jaipur, India. Preoperative data included diagnosis for which decompressive craniectomy was done and Glasgow coma scale score was observed. Intraoperative data included operating time. Postoperative data included cosmetic outcome in the form of cranial contour and margins, complications such as infection, seroma, implant failure, wound dehiscence, and hematoma.
Results Patient age at cranioplasty ranged from 12 to 63 years with a mean age of 36.7 years. The mean operating time was 151.6 minutes (range 130–190 minutes). The mean follow-up period was 8 months (range 6–13 months). Postoperative wound dehiscence developed in one case (3.3%). Cranial contour and approximation of the margins were excellent and aesthetic appearance improved in all patients.
Conclusion Low-cost PMMA implant made by digital 3D printer mold is associated with reconstruction of the deformed skull contour giving satisfactory results to the patient and his family members, at a low cost compared with other commercially available implants. This technique could be a breakthrough in cranioplasty.
Collapse
Affiliation(s)
- Ankit Chaudhary
- Department of Neurosurgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Virendra Deo Sinha
- Department of Neurosurgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Sanjeev Chopra
- Department of Neurosurgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Jitendra Shekhawat
- Department of Neurosurgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Gaurav Jain
- Department of Neurosurgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| |
Collapse
|
|
5
|
De La Peña A, De La Peña-Brambila J, Pérez-De La Torre J, Ochoa M, Gallardo GJ. Low-cost customized cranioplasty using a 3D digital printing model: a case report. 3D Print Med 2018; 4:4. [PMID: 29782609 PMCID: PMC5954791 DOI: 10.1186/s41205-018-0026-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 03/22/2018] [Indexed: 11/21/2022] Open
Abstract
Background Cranial defects usually occur after trauma, neurosurgical procedures like decompressive craniotomy, tumour resections, infection and congenital defects. The purpose of cranial vault repair is to protect the underlying brain tissue, to reduce any localized pain and patient anxiety, and improve cranial aesthetics. Cranioplasty is a frequent neurosurgical procedure achieved with the aid of cranial prosthesis made from materials such as: titanium, autologous bone, ceramics and polymers. Prosthesis production is often costly and requires complex intraoperative processes. Implant customized manufacturing for craniopathies allows for a precise and anatomical reconstruction in a shorter operating time compared to other conventional techniques. We present a simple, low-cost method for prosthesis manufacturing that ensures surgical success. Case presentation Two patients with cranial defects are presented to describe the three-dimensional (3D) printing technique for cranial reconstruction. A digital prosthesis model is designed and manufactured with the aid of a 3D computed tomography. Both the data of large sized cranial defects and the prosthesis are transferred to a 3D printer to obtain a physical model in poly-lactic acid which is then used in a laboratory to cast the final customised prosthesis in polymethyl methacrylate (PMMA). Conclusions A precise compliance of the prosthesis to the osseous defect was achieved. At the 6 month postoperative follow-up no complications were observed i.e. rejection, toxicity, local or systemic infection, and the aesthetic change was very significant and satisfactory. Customized 3D PMMA prosthesis offers cost advantages, a great aesthetic result, reduced operating time and good biocompatibility.
Collapse
Affiliation(s)
- Abel De La Peña
- Plastic and Reconstructive Surgeon, Plastic Surgery Institute, Mexico City, Mexico
| | - Javier De La Peña-Brambila
- 2Maxillofacial Surgeon, PhD, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco Mexico
| | - Juan Pérez-De La Torre
- 3Plastic and Reconstructive Surgeon, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco Mexico
| | - Miguel Ochoa
- 4Neurosurgeon, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco Mexico
| | - Guillermo J Gallardo
- Plastic and Reconstructive Surgeon, Plastic Surgery Institute, Mexico City, Mexico
| |
Collapse
|
|
6
|
Kharade P, Dholam K, Gorakh A. A technique for fabrication of cranial prostheses using high-temperature vulcanizing silicone material. J Prosthet Dent 2016; 118:113-115. [PMID: 28024824 DOI: 10.1016/j.prosdent.2016.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/05/2016] [Accepted: 10/05/2016] [Indexed: 11/17/2022]
Abstract
Cranioplasty is performed with various alloplastic implant materials, each having advantages and drawbacks. High-temperature vulcanizing silicone is used to fabricate cranioplasty implants because of certain beneficial properties. Silicone cranial implants lead to better adaptation with the bone adjacent to the cranial defect than acrylic resin and metal cranial prostheses. This article describes a technique for fabricating cranial implant prostheses using high-temperature vulcanizing silicone material.
Collapse
Affiliation(s)
- Pankaj Kharade
- Assistant Professor, Department of Prosthodontics, Dr ZA Dental College and Hospital, Aligarh Muslim University, Aligarh, India.
| | - Kanchan Dholam
- Professor, Department of Dental and Prosthetic Surgery, Tata Memorial Hospital, Mumbai, India
| | - Ahire Gorakh
- Dental Technician, Department of Dental and Prosthetic Surgery, Tata Memorial Hospital, Mumbai, India
| |
Collapse
|
|
7
|
Gupta L, Aparna IN, Balakrishnan D, Deenadayalan L, Hegde P, Agarwal P. Cranioplasty with custom made alloplastic prosthetic implant: A case report. World J Clin Cases 2014; 2:482-487. [PMID: 25232556 PMCID: PMC4163775 DOI: 10.12998/wjcc.v2.i9.482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 05/30/2014] [Accepted: 06/27/2014] [Indexed: 02/05/2023] Open
Abstract
Cranial defects often occur due to trauma. The treatment of such defects is a challenge to the skill and knowledge of the practitioner. This article presents one such case, where a 15-year-old boy had suffered extensive loss of the right cranium following a road traffic accident. The patient required rehabilitation of the right fronto-temporal cranial anatomy and was managed using a custom made heat polymerized acrylic alloplastic implant.
Collapse
|
|
8
|
Sharma S, Nanda A, Koli D, Daksh S, Verma M. Role of a dentist in comprehensive management of a comatose patient with post traumatic head injury and neuropathological chewing. Indian J Palliat Care 2014; 20:146-52. [PMID: 25125873 PMCID: PMC4130004 DOI: 10.4103/0973-1075.132639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Injury of the head and neck region can result in substantial morbidity. Comprehensive management of such patients requires team work of several specialties, including dentists. A young female patient with extensive loss of cranium and associated pathological chewing was referred to the dental department. The lost cranium was replaced by a custom-made, hand-fabricated cranioplast. Trauma due to pathological mastication was reduced by usage of a custom-made mouthguard. Favorable results were seen in the appearance of the patient and after insertion of the mouthguard as evidenced in good healing response. The intricate role of a dental specialist in the team to manage a patient with post traumatic head injury has been highlighted. The take away message is to make the surgical fraternity aware of the scope of dentistry in the comprehensive management of patients requiring special care.
Collapse
Affiliation(s)
- Sunanda Sharma
- Department of Prosthodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Aditi Nanda
- Department of Prosthodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Dheeraj Koli
- Department of Prosthodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Sapna Daksh
- Department of Prosthodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Mahesh Verma
- Department of Prosthodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| |
Collapse
|
|
9
|
Caro-Osorio E, De la Garza-Ramos R, Martínez-Sánchez SR, Olazarán-Salinas F. Cranioplasty with polymethylmethacrylate prostheses fabricated by hand using original bone flaps: Technical note and surgical outcomes. Surg Neurol Int 2013; 4:136. [PMID: 24232827 PMCID: PMC3815033 DOI: 10.4103/2152-7806.119535] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 07/29/2013] [Indexed: 11/24/2022] Open
Abstract
Background: Decompressive craniectomies (DC) mandate future cranioplasties, accounting for the large array of biomaterials for this purpose. Polymethylmethacrylate (PMMA) is a very reliable thermoplastic that can be prefabricated or even molded intraoperatively to create an adequate prosthesis. Preformed PMMA implants made by hand have been superseded by newer 3-D printed implants, but this is accompanied by higher costs and timing issues, apart from having limited availability in developing and third-world countries. Methods: A total of 26 patients were operated over a span of 11 years. A total of 26 custom hand-made PMMA prostheses were fabricated using original bone flaps with the aid of a prosthodontist, in a process that took approximately 70 minutes for each implant. The result was an exact duplication of the patient's bone flap. Results: Of the 26 patients who underwent cranioplasty, the majority of patients were males, with a mean age of 39.2 years and traumatic brain injury as main indication for DC. After a mean interval of 2.4 months, all 26 patients underwent a cranioplasty and prosthesis placement. Only two patients (7.6%) suffered from direct cranioplasty-related complications after a median follow-up of 10.4 months. Median Glasgow Outcome Scale scores improved significantly from 3 to 4 after cranioplasty (P = 0.008). Conclusion: Prefabrication of custom PMMA prostheses by hand when original bone flaps are available is an excellent alternative to newer 3-D printing techniques, because it is relatively cheaper, less time consuming, and offers excellent results in terms of anatomical reconstruction and improvement of neurological function in long-term follow-ups.
Collapse
Affiliation(s)
- Enrique Caro-Osorio
- Institute of Neurology and Neurosurgery, Hospital Zambrano Hellion, Tec Salud, Monterrey, Nuevo León, México
| | | | | | | |
Collapse
|
|
10
|
Gronet PM, Waskewicz GA, Richardson C. Preformed acrylic cranial implants using fused deposition modeling: A clinical report. J Prosthet Dent 2003; 90:429-33. [PMID: 14586305 DOI: 10.1016/j.prosdent.2003.08.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Fabrication of acrylic cranial implants by conventional methods of moulage and mold formation may be difficult when the margin of the defect cannot be accurately detected. Three-dimensional anatomic models built by fused deposition modeling can serve as templates for the fabrication of custom acrylic implants for large or complicated cranial defects. Virtual mirror imaging of the contralateral nondefect side can facilitate the restoration of symmetry in appearance-sensitive areas. This clinical report presents a method for the fabrication of cranial implants for 2 patients using anatomic modeling technology.
Collapse
|
|
11
|
Miyake H, Ohta T, Tanaka H. A new technique for cranioplasty with L-shaped titanium plates and combination ceramic implants composed of hydroxyapatite and tricalcium phosphate (Ceratite). Neurosurgery 2000; 46:414-8. [PMID: 10690731 DOI: 10.1097/00006123-200002000-00028] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The use of hydroxyapatite-based ceramics for cranioplasties has recently increased in Japan, because of the good cosmetic outcomes, biocompatibility, strength, osteoconductive properties, and lack of risk of disease transmission associated with these materials. However, miniplate fixation has not been possible for ceramic implants. We describe a new technique for miniplate fixation of ceramic implants. METHODS Combination ceramic implants composed of hydroxyapatite and tricalcium phosphate (Ceratite; NGK Spark Plug Co., Aichi, Japan) were used for cranioplasties. A slot and a pair of holes were cut in each Ceratite implant, for use as a fixation unit. We have also developed a new L-shaped titanium plate (HOMS Engineering Inc., Nagano, Japan) that fits into the fixation unit. We first insert an L-shaped titanium plate through the slot from the back surface of the Ceratite implant. We then bend the plate outward at the front surface of the Ceratite implant and fix it to the cranium of the patient with titanium screws. The Ceratite implant is usually firmly fixed to the cranium of the patient with three L-shaped titanium plates. RESULTS Using L-shaped titanium plates and Ceratite implants, we successfully performed cranioplasties for seven patients with cranial defects resulting from external decompression craniotomies. The Ceratite implant exactly fit the bone window for each patient. Surgical maneuvers were simple and easy for all patients, permitting shorter operating times. All Ceratite implants were firmly fixed, and no postoperative infections have occurred. CONCLUSION Our new technique for cranioplasty is simple and allows rigid fixation of Ceratite implants.
Collapse
Affiliation(s)
- H Miyake
- Department of Neurosurgery, Osaka Medical College, Takatsuki City, Japan
| | | | | |
Collapse
|