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Abstract
Three-dimensional (3D) printing is based on additive technology in which layers of materials are gradually placed to create 3D objects. The world of 3D printing is a rapidly evolving field in the medical industry as well as in most sectors of our lives. In this report we present current technological possibilities for 3D printing in the surgical field. There are different 3D printing modalities and much confusion among clinicians regarding the differences between them. Three-dimensional printing technologies can be classified based on the basic material used: solid, liquid, and powder. We describe the main printing methods from each modality and present their advantages while focusing on their applications in different fields of surgery, starting from 3D printing of models for preoperative planning up to patient-specific implants (PSI). We present the workflow of 3D printing for the different applications and our experience in 3D printing surgical guides as well as PSI. We include examples of 3D planning as well as clinical and radiological imaging of cases. Three-dimensional printing of models for preoperative planning enhances the 3D perception of the planned operation and allows for preadaptation of surgical instruments, thus shortening operation duration and improving precision. Three-dimensional printed PSI allow for accurate reconstruction of anatomic relations as well as efficiently restoring function. The application of PSI is expanding rapidly, and we will see many more innovative treatment modalities in the near future based on this technology.
Highlights
Three-dimensional (3D) printing is based on additive technology in which layers of materials are gradually placed to create 3D objects
The application of patient-specific implants (PSI) is expanding rapidly, and we will see many more innovative treatment modalities in the near future based on this technology
Three-dimensional printing of models for preoperative planning enhances the 3D perception of the planned operation, either as a visual-tactile aid or for performing mock surgeries
Summary
Most of the surgical departments nowadays have tried using 3D printing in one way or another, starting from visual-tactile aids for preplanning surgery and up to complete virtual planning of the surgery and customized surgical guides as well as patientspecific implants (PSI) which stay in the living body. A 3D model was printed allowing for pre-bending of the reconstruction plate prior to the operation, reducing operation duration and allowing for easy and accurate adaptation of the plate following the resection In this process bone elongation is performed which results in new bone and soft tissue augmentation. D: A respective cutting guide for the fibula is designed allowing for a perfect flap harvest including supplemental positioning of the osteotomies performed on the fibula bone to create the final three-piece bone graft which will reconstruct the mandible. When performing orthognathic surgery to correct the position of the upper and lower jaws one can use a wafer intraoperatively to position the jaws and bend plates intraoperatively, or use 3D printed cutting guides (A) to perform accurate osteotomies in 3D preplanned waferless operations prior to placement of patient-specific fixating plates (B).
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