A new method for designing and fabricating customised mandibular reconstruction plates using three-dimensional printing technology

Abstract

Background: Mandibular reconstruction following malignancy ablation is the mainstream therapy in restoring patients’ aesthetic and functional outcomes. Currently the titanium reconstruction plates used are commercialised products with unified specifications. The plate should be bended to match the individual anatomical contour of mandible, while the process is time- and energy-consuming. Over-bending would induce stress fatigue and potential plate fracture. Objective: To design and fabricate the customised titanium mandibular reconstruction plate based on three-dimensional (3D) printing technology. Methods: The computed tomography imaging of patients with mandible tumour were acquired. The Proplan CMF 2.0 software (Materialise, Leuven, Belgium) was used to facilitate virtual 3D model reconstruction and surgical simulation. We used the combination of different computer-aided design tools based on our established algorithm. The digital file of the customised plate was then subjected to 3D printing by fusing fine pure titanium powders together. Findings: Virtual mandibular surgery was operated and double-barrel fibular reconstruction was simulated to restore the mandibular continuity and body height. The customised titanium plate was successfully designed and fabricated. The plate included three parts: the lower 2.0 mm-thick reconstruction plate which curved like the outer shape of the restored mandible, the upper 1.0 mm-thick miniplate and the two bars connecting the upper and lower plates. Conclusion: This work presents a new and versatile method for designing and fabricating customised mandibular reconstruction plates using 3D printing technology. The superiority of applying the 3D-printed customised titanium plate in surgery will be further explored.