Design of patient-specific maxillofacial implants and guides

Abstract

With the development of three-dimensional (3D) design and manufacturing technologies, it is possible to easily manufacture various computer-aided patient-specific instruments. In the maxillofacial region, treatment of facial defects, asymmetries, and dental disorders can be done efficiently by using custom-made implants. In addition, reconstruction of the jaws even including temporomandibular joints can be performed by today’s 3D technologies. One of the most popular subjects is the use of computer-aided design and manufacturing techniques in orthognathic surgery. Postoperative outcomes of maxillofacial surgeries can be improved by integrating the patient-specific implants (PSIs) into the treatment protocol. With this novel approach, the contouring that is required to ensure the geometrical compatibility between the patient's anatomical form and the implant is eliminated. Screw positions can be planned during the preoperative simulation so as not to damage any anatomical structure. These preoperative preparations shorten the operating room time. Also, customized osteotomy and drill guides can be used to fixate the implants in the planned position, which minimizes damage possibility over the maxillofacial region and makes surgeries more accurate. The fabrication stages of such implants include (1) obtaining a three-dimensional solid body model of anatomical structures from the patient’s two-dimensional scanning images, (2) simulation of the operation on the anatomical computer model, (3) design of the PSI according to the patient’s model, (4) manufacturing of implants by using proper additive production methods. In this chapter, we described state-of-the-art studies about the development of patient-specific maxillofacial implants and guides, highlighted current insights, and focused on reported clinical outcomes. Besides, we presented the design stages of a PSI and guide for a bimaxillary orthognathic surgery.