Dimensional Printing Research Articles

Use of 3-dimensional printing at the point-of-care to manage a complex wound in hemifacial necrotizing fasciitis: a case report

BackgroundComplex facial wounds can be difficult to stabilize due to proximity of vital structures. We present a case in which a patient-specific wound splint was manufactured using computer assisted design and three-dimensional printing at the point-of-care to allow for wound stabilization in the setting of hemifacial necrotizing fasciitis. We also describe the process and implementation of the United States Food and Drug Administration Expanded Access for Medical Devices Emergency Use mechanism.Case presentationA 58-year-old female presented with necrotizing fasciitis of the neck and hemiface. After multiple debridements, she remained critically ill with poor vascularity of tissue in the wound bed and no evidence of healthy granulation tissue and concern for additional breakdown towards the right orbit, mediastinum, and pretracheal soft tissues, precluding tracheostomy placement despite prolonged intubation. A negative pressure wound vacuum was considered for improved healing, but proximity to the eye raised concern for vision loss due to traction injury. As a solution, under the Food and Drug Administration’s Expanded Access for Medical Devices Emergency Use mechanism, we designed a three-dimensional printed, patient-specific silicone wound splint from a CT scan, allowing the wound vacuum to be secured to the splint rather than the eyelid.After 5 days of splint-assisted vacuum therapy, the wound bed stabilized with no residual purulence and developed healthy granulation tissue, without injury to the eye or lower lid. With continued vacuum therapy, the wound contracted to allow for safe tracheostomy placement, ventilator liberation, oral intake, and hemifacial reconstruction with a myofascial pectoralis muscle flap and a paramedian forehead flap 1 month later. She was eventually decannulated and at six-month follow-up has excellent wound healing and periorbital function.ConclusionsPatient-specific, three-dimensional printing is an innovative solution that can facilitate safe placement of negative pressure wound therapy adjacent to delicate structures. This report also demonstrates feasibility of point-of-care manufacturing of customized devices for optimizing complex wound management in the head and neck, and describes successful use of the United States Food and Drug Administration’s Expanded Access for Medical Devices Emergency Use mechanism.

Monitoring the liberation of volatile organic compounds during fused deposition modeling three dimensional printing using solid-phase microextraction coupled to gas chromatography/mass spectrometry

Three-dimensional (3D) printers have gained tremendous popularity and are being widely used in offices, laboratories, and private homes. Fused deposition modeling (FDM) is among the most commonly used mechanisms by desktop 3D printers in indoor settings and relies on the extrusion and deposition of heated thermoplastic filaments, resulting in the liberation of volatile organic compounds (VOCs). With the growing use of 3D printers, concerns regarding human health have risen as the exposure to VOCs may cause adverse health effects. Therefore, it is important to monitor VOC liberation during printing and to correlate it to filament composition. In this study, VOCs liberated with a desktop printer were measured by solid-phase microextraction (SPME) combined with gas chromatography/mass spectrometry (GC/MS). SPME fibers featuring sorbent coatings of varied polarity were chosen for the extraction of VOCs liberated from acrylonitrile butadiene styrene (ABS), tough polylactic acid, and copolyester+ (CPE+) filaments. It was found that for all three filaments tested, longer print times resulted in a greater number of extracted VOCs. The ABS filament liberated the most VOCs while the CPE+ filaments liberated the fewest VOCs. Through the use of hierarchical cluster analysis and principal component analysis, filaments as well as fibers could be differentiated based on the liberated VOCs. This study demonstrates that SPME is a promising tool to sample and extract VOCs liberated during 3D printing under non-equilibrium conditions and can be used to aid in tentative identification of the VOCs when coupled to gas chromatography-mass spectrometry.

The theoretical adhesion of Staphylococcus aureus and Pseudomonas aeruginosa as nosocomial pathogens on 3D printing filament materials.

Microbial infections and nosocomial diseases associated with biomaterial have become a major problem of public health and largely lead to revision surgery, which is painful and quite expensive for patients. These infections are caused by formation of biofilm, which present a difficulty of treatment with conventional antibiotics. The aim of our study is to investigate the theoretical adhesion of Staphylococcus aureus and Pseudomonas aeruginosa on four 3-dimensional printing filament materials used in the manufacture of medical equipment. Thus, the physicochemical properties of these microorganisms and all filament materials were determined using the contact angle measurements. Our results indicated that bacterial surfaces were hydrophilic, strongly electron donating and weakly electron accepting. In contrast, nylon, acrylonitrile butadiene-styrene, polyethylene terephthalate, and polylactic acid surfaces were hydrophobic and more electron-donor than electron-acceptor. In addition, according to the values of total free interaction energy ΔGTotal, Staphylococcus aureus was found unable to adhere to the filament materials except polyethylene terephthalate surface. However, Pseudomonas aeruginosa showed adhesion capacity only for acrylonitrile butadiene-styrene and polyethylene terephthalate surfaces. These findings imply that the usage of these 3D printed materials in the medical area necessitates more research into enhancing their resistance to bacterial adherence.

Application of and Prospects for 3-Dimensional Printing in Transcatheter Mitral Valve Interventions.

ClinicalTrials.gov Protocol Registration System (NCT02917980).

Real Stiffness and Vividness Reproduction of Anatomic Structures Into the 3-Dimensional Printed Models Contributes to Improved Simulation and Training in Skull Base Surgery.

Despite the advancement of 3-dimensional (3D) printing technology with medical application, its neurosurgical utility value has been limited to understanding the anatomy of bones, lesions, and their surroundings in the neurosurgical field. To develop a 3D printed model simulating the surgical technique applied in skull base surgery (SBS), especially to reproduce visually the surgical field together with the mechanical properties of tissues as perceived by the surgeon through procedures performance on a model. The Young modulus representing the degree of stiffness was measured for the tissues of anesthetized animals and printing materials. The stiffness and vividness of models were adjusted appropriately for each structure. Empty spaces were produced inside the models of brains, venous sinuses, and tumors. The 3D printed models were created in 7 cases of SBS planned patients and were used for surgical simulation. The Young modulus of pig's brain ranged from 5.56 to 11.01 kPa and goat's brain from 4.51 to 13.69 kPa, and the dura of pig and goat values were 14.00 and 24.62 kPa, respectively. Although the softest printing material had about 20 times of Young modulus compared with animal brain, the hollow structure of brain model gave a soft sensation resembling the real organ and was helpful for bridging the gap between Young moduli values. A dura/tentorium-containing model was practical to simulate the real maneuverability at surgery. The stiffness/vividness modulated 3D printed model provides an advanced realistic environment for training and simulation of a wide range of SBS procedures.

Helping Surgeons’ Hands: A Biomechanical Evaluation of Ergonomic Instruments

"Ergonomic" is a common descriptor for a desk or computer workspace but is a term rarely used to describe a surgical instrument. Instead, surgeons spend many hours in inconvenient positions, often using instruments that are not ergonomic. Improving the ergonomics of surgical instruments may decrease the required force for simple tasks and allow for more efficient surgery. To evaluate the impact of ergonomic surgical instruments, the authors developed ergonomic screwdriver handles. The shape and size of these handles were engineered using previous dental studies and 3-dimensional modeling to create an ideal handle for specific glove sizes. Participants were recruited to test 3 different ergonomic handle sizes against a standard screwdriver while assessing digital peak force, digital contact area, and participant preference. Ten participants (3 women) with glove sizes ranging from 6 to 8 were evaluated. Ergonomic screwdriver handles sized for glove sizes 6 and 7 required significantly less thumb peak force than the standard screwdriver for all participants (702 N for glove size 6 and 567 N for glove size 7 ergonomic screwdrivers, vs 1780 N for "one size fits all" standard screwdriver). Participants consistently preferred screwdrivers that required lower thumb and index finger forces. All ergonomic handles required lower thumb and index finger force. Eighty percent of participants preferred a screwdriver modeled within 1 glove size of their own. Improved ergonomic handles require less force and are preferred by surgeons. The significant decrease in thumb peak force for glove sizes 6 and 7 suggests that there is room for ergonomic improvement in instruments, especially for surgeons with smaller hands. Manufacturing ergonomic screwdriver handles and using the evolving convenience of 3-dimensional printing may help to develop a more comfortable work environment for surgeons.

Three-dimensional printing and virtual reconstruction in surgical planning of double-outlet right ventricle repair.

For more than a decade, 3-dimensional (3D) printing has been identified as an innovative tool for the surgical planning of double-outlet right ventricle (DORV). Nevertheless, lack of evidence concerning its benefits encourages us to identify valuable criteria for future prospective trials. We conducted a retrospective study involving 10 patients with DORV operated between 2015 and 2019 in our center. During a preoperative multidisciplinary heart team meeting, we harvested surgical decisions following a 3-increment step process: (1) multimodal imaging; (2) 3D virtual valvular reconstruction (3DVVR); and (3) 3D-printed heart model (3DPHM). The primary outcome was the proportion of predicted surgical strategy following each of the 3 steps, compared with the institutional retrospective surgical strategy. The secondary outcome was the change of surgical strategy through 3D modalities compared with multimodal imaging. The incremental benefit of the 3DVVR and 3DPHM over multimodal imaging was then assessed. The operative strategy was predicted in 5 cases after multimodal imaging, in 9 cases after 3DVVR, and the 10 cases after 3DPHM. Compared with multimodal imaging, 3DVVR modified the strategy for 4 cases. One case was correctly predicted only after 3DPHM inspection. 3DVVR and 3DPHM improved multimodal imaging in the surgical planning of patients with DORV. 3DVVR allowed a better appreciation of the relationships between great vessels, valves, and ventricular septal defects. 3DPHM offers a realistic preoperative view at patient scale and enhances the evaluation of outflow tract obstruction. Our retrospective study demonstrates benefits of preoperative 3D modalities and supports future prospective trials to assess their impact on postoperative outcomes.

Thermal and acoustic performance evaluation of 3D-Printable PLA materials

In this study, additive manufacturing or three dimensional (3D) printing technology was utilized to develop thermal and acoustic insulation materials. A 3D model was carefully designed to obtain thermal and acoustic insulation properties using Autodesk software and print the materials using QIDI X-PLUS 3D printer with precise and controlled shape and structure. Biodegradable PLA filament was used as printing ink. A comprehensive evaluation was conducted to check whether this new branch of technology is suitable for producing insulation materials. Testing results revealed that insulation materials produced from 3D printing technology have excellent thermal and acoustic insulation properties. The lowest obtained thermal conductivity value was 0.037 W/mK, and the maximum obtained sound transmission loss was 48.27 dB at 1600 Hz frequency. In case of physical properties, density of insulation panels ranges from 366.46 to 721.26 kg/m3, and porosity ranges from 43 to 71%. Life cycle cost (LCC) analysis was carried out to obtain the optimum insulation thickness, energy savings, and payback period of developed insulation materials for different locations in the USA. It was found that the optimum insulation thickness varies between 4 and 10 mm, energy savings varies between 45.0% and 67.2%, and payback period varies between 8.5 and 14.8 years. The effect of structural parameters (thickness, density, air permeability, and porosity) on insulation properties was also checked in order to obtain a relationship between structural parameters and insulation properties. It was found that both density and porosity have significant influence on insulation properties. Testing results also revealed that thermal and acoustic insulation properties follow opposite trends with the increase of density and porosity. The increase in density and decrease in porosity causes increase in acoustic insulation property, but decrease in thermal insulation property. A comparison was also made with commercially available acoustic and thermal insulation panels, and it was observed that produced 3D printed samples have better insulation properties. This indicates that developed materials have very good potential to be commercially used as building insulation materials. As produced insulation material has colored and glossy surfaces, it can be used in the interior or exterior of building walls and may also replace plasterboard or tiles of building walls.

Strategic cost and sustainability analyses of injection molding and material extrusion additive manufacturing

AbstractEconomic and environmental costs are assessed for four different plastics manufacturing processes, including cold and hot runner molding as well as stock and upgraded material extrusion three dimensional (3D) printers. A larger stock 3D printer was found to provide a melting capacity of 14.4 ml/h, while a smaller printer with an upgraded extruder had a melting capacity of 36 ml/h. 3D printing at these maximum melting capacities resulted in specific energy consumption (SEC) of 16.5 and 5.28 kWh/kg, respectively, with the latter value being less than 50% of the lowest values reported in the literature. Even so, analysis of these respective processes found them to be only 2.9% and 3.8% efficient relative to their theoretical minimum energy requirements. By comparison, cold and hot runner molding with an all‐electric machine had SEC of 1.28 and 0.929 kWh/kg, respectively, with efficiencies of 9.9% and 13.6% relative to the theoretical minima. Breakeven analysis considering the cost and carbon footprint of mold tooling found injection molding was preferable at a production quantity of around 70,000 units. Parametric analysis of model inputs indicates that the breakeven quantities are robust with respect to carbon tax incentives but highly dependent on mold costs, labor costs, and part size. Dimensional and mechanical properties of the molded and 3D printed specimens are also characterized and discussed.

Initial assessment of the toxicologic effects of leachates from 3-dimensional (3-D) printed objects on sperm quality in two model fish species

The use of 3-dimensional (3-D) printing is gaining popularity in life sciences and driving innovation in fields including aquatic sperm cryopreservation. Yet, little is known about the effects leachates from these objects may have on biological systems. In this study, we investigated if exposure to leachates from 3-D printed objects fabricated from different photo-curable resins could affect sperm quality in two model fish species, zebrafish (Danio rerio) and goldfish (Carassius auratus). Leachates were collected following contact periods of 10 min and 22 h with objects manufactured using a mask LCD resin printer and three different commercially available resins (i.e., standard, eco-friendly, and impact-resistant). Sperm cells were exposed to the leachates for 18 min, and parameters related to sperm motility, cell count, and membrane integrity were evaluated. All experiments were blinded. Leachate originating from contact with impact-resistant resin for 10 min significantly reduced the cell count of zebrafish sperm, while leachate originating from contact with standard resin for 22 h significantly increased the beat cross frequency of goldfish sperm. The changes were not observed across species and no adverse effects were recorded in percent motility, velocity, amplitude of lateral head movement, or membrane integrity of sperm. Our findings demonstrate that exposure to leachates from certain 3-D printed resins can affect sperm quality, while other resins may support sperm quality evaluation. Further investigations are warranted to assess other parameters, effects, and their biological relevance for a variety of aquatic species.

Utilizing 4D Printing to Design Smart Gastroretentive, Esophageal, and Intravesical Drug Delivery Systems.

The breakthrough of 3D printing in biomedical research has paved the way for the next evolutionary step referred to as four dimensional (4D) printing. This new concept utilizes the time as the fourth dimension in addition to the x, y, and z axes with the idea to change the configuration of a printed construct with time usually in response to an external stimulus. This can be attained through the incorporation of smart materials or through a preset smart design. The 4D printed constructs may be designed to exhibit expandability, flexibility, self-folding, self-repair or deformability. This review focuses on 4D printed devices for gastroretentive, esophageal, and intravesical delivery. The currently unmet needs and challenges for these application sites are tried to be defined and reported on published solution concepts involving 4D printing. In addition, other promising application sites that may similarly benefit from 4D printing approaches such as tracheal and intrauterine drug delivery are proposed.

Applying and Testing a Crowdsourcing Platform to Support Home-Based Simulation.

The purpose of this report is to: (1) highlight challenges of transitioning the delivery of simulation from centralized, in-person laboratory to decentralized, home-based, online format; (2) suggest a solution that involves the use of crowdsourcing community-based 3-dimensional printers to produce affordable simulators; and (3) present exploratory research and a test case aiming to identify crowdsourcing frameworks to accomplish this. We present a test case that shows the potential of the proposed solution to scale up the decentralized simulation practices during and beyond the COVID-19 pandemic. As a largely uncharted territory, the test case highlighted successes and areas for improvement that need to be addressed through both theoretical and empirical research and testing before full implementation and scale-up.

Four-Dimensional Printing of Stimuli-Responsive Hydrogel-Based Soft Robots

Four Dimensional Printing Stimuli Responsive Hydrogel Based Soft - Video. JoVE publishes peer-reviewed scientific video protocols to accelerate biological, medical, chemical and physical research. Watch our scientific video articles. JoVE is the world-leading producer and provider of science videos with the mission to improve scientific research, scientific journals, and education. Millions of scientists, educators and students at thousands of universities, colleges, hospitals and biopharmaceutical companies worldwide use JoVE for their research, teaching and learning.

Three dimensional (3D) printing in Orthopaedics: Scope of application and future perspectives

Three dimensional (3D) printing also known as additive manufacturing has the potential to change the paradigm of Orthopaedic practice. Modern times have witnessed exponential growth in 3D-printing technology as well as its uses. A wide spectrum of printers are now available, ranging from the desktop printer to high end manufacturing units. The ability to use a plethora of materials and create almost limitless geometric shapes with varying surface topography makes this method of production highly appealing. Certain inherent advantages include easy customizability, small production runs, less wastage of material, smaller footprint. Challenges such as lack of data, absence of established government regulations and cost considerations remain, but one can expect these to be overcome as the economy of scale plays out and the medical fraternity becomes more accommodating of the new technology. Keywords: Three dimensional printing, Recent Advances, Arthroplasty, Spine, Tumor Implants

3D-Printed Flat-Bone-Mimetic Bioceramic Scaffolds for Cranial Restoration.

The limitations of autologous bone grafts necessitate the development of advanced biomimetic biomaterials for efficient cranial defect restoration. The cranial bones are typical flat bones with sandwich structures, consisting of a diploe in the middle region and 2 outer compact tables. In this study, we originally developed 2 types of flat-bone-mimetic β-tricalcium phosphate bioceramic scaffolds (Gyr-Comp and Gyr-Tub) by high-precision vat-photopolymerization-based 3-dimensional printing. Both scaffolds had 2 outer layers and an inner layer with gyroid pores mimicking the diploe structure. The outer layers of Gyr-Comp scaffolds simulated the low porosity of outer tables, while those of Gyr-Tub scaffolds mimicked the tubular pore structure in the tables of flat bones. The Gyr-Comp and Gyr-Tub scaffolds possessed higher compressive strength and noticeably promoted invitro cell proliferation, osteogenic differentiation, and angiogenic activities compared with conventional scaffolds with cross-hatch structures. After implantation into rabbit cranial defects for 12 weeks, Gyr-Tub achieved the best repairing effects by accelerating the generation of bone tissues and blood vessels. This work provides an advanced strategy to prepare biomimetic biomaterials that fit the structural and functional needs of efficacious bone regeneration.

3D-printed epidermal sweat microfluidic systems with integrated microcuvettes for precise spectroscopic and fluorometric biochemical assays.

Systems for capture, storage and analysis of eccrine sweat can provide insights into physiological health status, quantify losses of water, electrolytes, amino acids and/or other essential species, and identify exposures to adverse environmental species or illicit drugs. Recent advances in materials and device designs serve as the basis for skin-compatible classes of microfluidic platforms and in situ colorimetric assays for precise assessments of sweat rate, sweat loss and concentrations of wide-ranging types of biomarkers in sweat. This paper presents a set of findings that enhances the performance of these systems through the use of microfluidic networks, integrated valves and microscale optical cuvettes formed by three dimensional printing in hard/soft hybrid materials systems, for accurate spectroscopic and fluorometric assays. Field studies demonstrate the capability of these microcuvette systems to evaluate the concentrations of copper, chloride, and glucose in sweat, along with the pH of sweat, with laboratory-grade accuracy and sensitivity.

Error analysis of stages involved in CBCT-guided implant placement with surgical guides when different printing technologies are used

Statement of problemDigital light processing (DLP), continuous liquid interface printing (CLIP), and stereolithography (SLA) technologies enable 3-dimensional (3D) printing of surgical guides. However, how their accuracy compares and how accuracy may affect subsequent steps in guided surgery is unclear. PurposeThe purpose of this in vitro study was to investigate the fabrication and seating accuracy of surgical guides printed by using DLP, SLA, and CLIP technologies and evaluate the positional deviation of the osteotomy site and placed implant compared with the digital implant plan. Material and methodsTwenty-one polyurethane models were divided into 3 groups and used to plan implants and design surgical guides. The guides were fabricated by using DLP, SLA, or CLIP 3D printers (n=7) and scanned, and the scan file was compared with the digital design file to analyze the fabrication accuracy at the intaglio and overall external surfaces using root mean square (RMS) values. The triple scan protocol was used to evaluate the seating accuracy of the guides on their respective models. Osteotomies were prepared on models by using the guides followed by a microcomputed tomography image of each osteotomy. The implants were placed through the guides, the scan bodies were tightened to implants, and the models were scanned to obtain the images of placed implant position. Osteotomy and placed implant images were used to calculate the entry point, apex, and long axis deviations from the planned implant position with a software program. A 2-way repeated-measures ANOVA of the RMS data was used to analyze printing and seating trueness, and homogeneity of variance analyses were used at each surface for precision. A 3-way repeated-measures ANOVA was used to analyze distance deviations over the stages (osteotomy and final implant) and locations studied, and a 2-way repeated-measures ANOVA was used for angular deviations. Homogeneity of variance analyses were performed for precision (α=.05). ResultsThe 3D printer type significantly affected the trueness of the guide at the intaglio surface (P<.001). SLA guides had the lowest mean RMS (59.04 μm) for intaglio surface, while CLIP had the highest mean RMS (117.14 μm). Guides from all 3D printers had low variability among measured deviations and therefore were similarly precise. The seating accuracy of SLA and DLP guides was not significantly different, but both had lower mean RMS values than CLIP (P=.003 for SLA, P=.014 for DLP). There were no significant interactions between the stage of surgery, the printer type, or the location of implant deviation (P=.734). Only the location of deviation (cervical versus apical) had a significant effect on distance deviations (P<.001). The printer type, stage of surgery, and their interaction did not significantly affect angular deviations (P=.41). ConclusionsThe 3D printing technology affected printing trueness. The intaglio surface trueness was higher with SLA and overall trueness was higher with the CLIP printer. The precision of all guides was similarly high. Guides from SLA and DLP printers had more accurate seating than those from CLIP. Higher deviations were observed at the apex; however, osteotomy and final implant position did not significantly differ from the digitally planned position.

3D Printing Technology for Chest Wall Reconstruction With a Sternum-Ribs-Cartilage Titanium Implant: From Ideation to Creation.

We describe the use of 3-dimensional (3D) printing technology to plan and reconstruct the sternum, adjoining cartilages, and ribs with a custom-made, anatomically designed, 3D-printed titanium implant for an isolated sternal metastasis complicated with a pathological fracture. We imported submillimeter slice computed tomography scan data into Mimics Medical 20.0 software and by manual bone threshold segmentation created a 3D virtual model of the patient's chest wall and tumor. For all-around tumor-free margins, we grew the tumor by 2 cm. The replacement implant was designed in 3D using the anatomical features of the sternum, cartilages, and ribs and manufactured using TiMG 1 powder fusion technology. Physiotherapy was provided prior to and following surgery, and the impact of reconstruction on pulmonary functions was assessed. At surgery, the precise resection, clear margins, and a secure fit were achieved. At follow-up, there was no dislocation, paradoxical movement, change in performance status, or dyspnea. There was a decrease in forced expiratory volume in 1 s (FEV1) from 105% prior to surgery to 82% following surgery and in forced vital capacity (FVC) from 108% to 75%, with no difference in the FEV1/FVC ratio, suggesting a restrictive pattern of impairment. With 3D printing technology, reconstructing a large anterior chest wall defect with a custom-made, anatomical, 3D-printed titanium alloy implant is feasible and safe, and it preserves the shape, structure, and function of the chest wall, albeit with a restrictive pattern of pulmonary function, which can be addressed with physiotherapy.

Remodeling arteries: studying the mechanical properties of 3D-bioprinted hybrid photoresponsive materials.

3D-printed cell models are currently in the spotlight of medical research. Whilst significant advances have been made, there are still aspects that require attention to achieve more realistic models which faithfully represent the in vivo environment. In this work we describe the production of an artery model with cyclic expansive properties, capable of mimicking the different physical forces and stress factors that cells experience in physiological conditions. The artery wall components are reproduced using 3D printing of thermoresponsive polymers with inorganic nanoparticles (NPs) representing the outer tunica adventitia, smooth muscle cells embedded in extracellular matrix representing the tunica media, and finally a monolayer of endothelial cells as the tunica intima. Cyclic expansion can be induced thanks to the inclusion of photo-responsive plasmonic NPs embedded within the thermoresponsive ink composition, resulting in changes in the thermoresponsive polymer hydration state and hence volume, in a stimulated on-off manner. By changing the thermoresponsive polymer composition, the transition temperature and pulsatility can be efficiently tuned. We show the direct effect of cyclic expansion and contraction on the overlying cell layers by analyzing transcriptional changes in mechanoresponsive mesenchymal genes associated with such microenvironmental physical cues. The technique described herein involving stimuli-responsive 3D printed tissue constructs, also described as four- dimensional (4D) printing, offers a novel approach for the production of dynamic biomodels.

A chairside digital radiographic guide for registering digital casts to cone beam computed tomography scans with strong metallic artifacts

Accurate registration of digital casts and cone beam computed tomography (CBCT) scans with strong metallic artifacts is essential for the accuracy of guided implant surgery. This article describes a procedure for mapping digital casts onto CBCT scans containing significant scatter artifacts in the virtual implant planning stage. The technique uses a chairside segmented occlusal wing-like radiographic guide, which is constructed of digital splints fabricated using a desktop 3-dimensional printer and composite resin spheres as markers to accurately superimpose the bimaxillary digital scans onto the CBCT scans in a single procedure. This cost-effective technique is timesaving for clinicians and patients, and the digital information for implant planning can be collected in a single visit.