Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2016-04-19, 10:56:04 | version 1.38.0
Dental Tribune United Kingdom Edition | 5/201520 TRENDS&APPLICATIONS Nowadays, no aspect of human life seems to have been left untouched by the ever-expanding digital tech- nology. Particularly in scientific fields, digitalisation has working wonders during the past few years, to the degree that it is even difficult to imagine going back to the ordeal of analogue methods and putting up with their vagaries. A remark- able blessing of digital technology, among others, is the exceptional precision and high control over the measurements, never possible to obtainthroughanyofthepreceding methods. There is no surprise then that it has the strongest appeal to thefieldsofknowledgeandpractice wherein precision is amongst the most critical element of success. Hot spot for digital technology Withalotoftechnicalsensitivity at its heart, the dentistry can easily be viewed as a hot spot for imple- menting digital technology to achieve the most-wished preci- sion. Indeed, the digital technol- ogy has already gained a stable foothold in dentistry and there is an ongoing shift towards embrac- ing digital systems into the dental practice. Predictably, the majority of the advertised technologies and servicesaregearedtowardsroutine dental procedures. On the other hand, the most significant ad- vancements have been witnessed in an area which falls only within the experience of specialists; it is the domain of maxillofacial sur- gery where tailoring the treatment plan to the unique conditions of the patient is the key to success. Herethestate-of-the-artdigitaltech- nologycomesinhandytofullycus- tomisethetreatmentbytakingthe slightest details into consideration andreflectingthatintothesurgical and restorative solutions. Though the successful recon- structionofanyhumanstructureis justifiably a challenge, the stakes are even higher when the oral and maxillofacialareaisaffected.Inthis lattercase,caremustbetakentore- trievefunctioninconjunctionwith restoring aesthetics. Oftentimes, even the second objective might takeprecedence.Assuch,thesignif- icanceofprecisionandadaptability to the existing structures for the maxillofacial implants cannot be overemphasised. Fortunately, with the advent of 3-D digital designing and additive manufacturing a fully satisfactory treatment is no more a remote possibility. The virtual environment of 3-D software accommodates full in- spection of the surgical area from multiple angles. It also facilitates designing and adjustment of the form of the future implant with much ease and with respect to topography of the surrounding structures. Thanks to the available technology and material, now it is possible to 3-D print such intricate designs with above-standard ac- curacy and minimum technical glitch. The result is the highest fit of precision always craved for by maxillofacial surgeons to comple- ment their skilful incisions. Case presentation Since its inception, DRSK Com- pany has been committed to ex- plore potentials for incorporation of the digital and computer science into the dental field by devising innovative solutions. With 3-D serv- ices being a major activity of DRSK, the company has been approached for 3-D designing the maxillofacial implants of different kinds and successfully accomplished them. All these 3-D designed implants are highlycustomisedandfeaturegreat accuracy and therefore satisfy both surgicalandmechanicalstandards. Patient case Onesuchrecentlycarriedoutpro- ject that merits further elaboration is the design and manufacture of one-of-a-kind mandibular implant (Fig.1)forreconstructingthemissing mandible body (Fig. 2). The patient, a young man, had lost the entire mandible except for the rami after beingseverelyinjuredinablast.Over theyears,thepatienthadundergone severalsurgerieswithlittleimprove- ments achieved. In point of fact, one con- sequence of those sur- geries was the formation of fibrous scar tissues which, as will be explained in the following,exacerbatedthesituation and restricted the chance for an effectivetreatment. At the time the surgical team contacted DRSK, the patient had already received a graft taken from his fibula. Owing to the extent of structure loss, the graft alone failed to yield the anticipated results. Needless to say, the ultimate goal ofthetreatmentwastoimprovethe aesthetics and retrieve the function of the reconstructed jaw by a pros- thetic treatment and giving the patient a chance to experience an almost normal mastication once more.However,theformandsizeof the grafted bone could not provide the required support for prosthetic structuressuchasdentalfixtures. Eventually, the surgical team de- cided to seek assistance from DRSK and use its 3-D services expertise to design and manufacture an ad hoc mandibular implant that fully complies with the patient’s un- favourable conditions and enables thecomplementaryprosthodontics Mandibularbodyreconstruction with a 3-D printed implant By Dr Saeid Kazemi,Reza Kazemi,Sita Rami Reddy Jonnala & Dr Ramin S.Khanjani,Sweden Fig.3: Left and right segments of the implant were designed to be placed and screwed over the corresponding ramus.—Fig.4: At the front,left and right segments of the implant met and dovetailed into each other.— Fig.5:A temporaryorsurgicalmiddlepiecewasdesigned tobeplacedover theleft andright sectionsat thesurgicalsession.—Fig.6:Themiddlepieceshouldhold twopiecesinplaceat thefront.—Fig.7:Theprosthetic, permanent middle section.—Fig. 8: After the healing period: Insertion of the prosthetic component with unscrewing und removing of the surgical middle part.—Fig. 9: Insertion of the prosthetic middle section, carrying the teeth.—Fig.10: Fixation of the prosthetic middle section. Fig. 1: One-of-a-kind mandibular implant as reconstruction for the missing mandible body.—Fig. 2: Replica of the patient’s skeleton.Missing mandible body replaced with a fibula graft. 1 2 7 8 9 3 4 5 6 10 DTUK0515_20-21_Kazemi 15.10.15 12:06 Seite 1 12 789 3456 DTUK0515_20-21_Kazemi 15.10.1512:06 Seite 1