Aumento do Rebordo Alveolar com Enxerto em Bloco Impresso Personalizado: Relato de Caso / Alveolar ridge augmentation with custom 3D-printed block graft: Case report

A utilização da tecnologia CAD/CAM (computer aided design/computer aided manufacturing) e 3D (tridimensional) para reconstruções alveolares na implantodontia permite o planejamento pré-operatório detalhado, o design do resultado desejado do enxerto e a avaliação virtual do resultado em relação à reconstrução protética. Este trabalho objetiva detalhar a técnica cirúrgica de enxerto ósseo sintético confeccionado por meio dessa tecnologia, seguido da instalação de implantes osseointegráveis e reabilitação protética em um defeito ósseo na mandíbula. Paciente masculino, 22 anos, compareceu à clínica por avulsão dos elementos 32, 31, 41 e 42 com significativa perda óssea vertical de rebordo alveolar. Devido à extensa perda óssea, realizou-se enxerto em bloco prototipado impresso. O escaneamento intraoral e os arquivos de imagem gerados foram enviados ao centro de planejamento virtual. Primeiramente, foi realizada a cirurgia para instalação do enxerto em bloco. Após o período de cicatrização, foi realizada cirurgia para instalação de dois implantes osseointegráveis. Esperado o período de três meses a partir da instalação dos implantes, foi realizada a confecção de próteses provisórias fixas sobre implantes a fim de realizar o condicionamento dos tecidos moles peri-implantares e o carregamento progressivo dos implantes. O aumento do rebordo alveolar através do uso de enxerto em bloco impresso personalizado apresentou-se como uma técnica com inúmeras vantagens, por não necessitar de sítio doador, reduzir tempo cirúrgico e apresentar perfeita adaptação do bloco ao defeito ósseo, resultando em menor morbidade pós-operatória. Essa técnica é uma indicação para casos de defeitos ósseos severos, visando a otimizar o resultado e a propiciar menor desconforto ao paciente.

The use of the technology CAD/CAM (computer aided design/computer aided manufacturing) and 3D (three dimensional) to alveolar reconstructions in implant dentistry allows detailed preoperative planning, the design of the desired grafting result, and the virtual evaluation of the result in relation to the prosthetic reconstruction. This paper aims to details the synthetic bone graft made through this technology, followed by the installation of osseointegrated implants and prosthetic rehabilitation in a bone imperfection in the jaw. A 22-year-old man attended the clinic due to a tooth avulsion of the four lower incisors with significant vertical bone loss of alveolar ridge. Because of the extensive bone loss, it was made a prototyped printed block graft. The intraoral scan and the generated image files were sent to the virtual planning center. First, it was necessary a surgery to install the block graft. After the healing process, it was made a surgery to put two osseointegrated implants. Three months later, temporary fixed prostheses on implants were made to conditioning the peri-implant soft tissues and the progressive loading of the implants. The increase of the alveolar ridge using personalized printed block graft was presented as a technique with numerous advantages, since it does not require a donor site, reduces the surgical time and presents perfect adaptation of the block to the bone imperfection, resulting in a less postoperative morbidity. This technique is indicated to cases of severe bone imperfections, aims to optimize results, and provide less discomfort to the patient.

Application of digital technology in the restoration of partial edentulous dentition with microstomia / 口腔疾病防治

Objective@# To explore the application of digital technology in the restoration of partial edentulous patients with microstomia. @*Methods@# A patient with microstomia was presented and seeking for the restoration of her full edentulous in the upper jaw and partial edentulous in the lower jaw (Kennedy Ⅲ). A digital intraoral scanning was used to obtain digital impressions of soft and hard tissues in the oral cavity. Computer aided design and 3D printing technology were used to design and fabricate the metal framework. @* Results @#The patient had no difficulty to wear or take off the dentures. The maxillary and mandibular dentures showed good retention, stability, mastication function and articulation. There was no tenderness in the one week and one month′s follow-up. And the chewing efficiency was satisfactory@*Conclusion@#This case report successfully designed and fabricated mandibular removable partial dentures for patients with microstomia through intraoral scanning and 3D printing technology. Thus, this work provides a new method and idea for treating partial edentulous dentition with microstomia

Research progress in mechanical strength enhancement methods of jaw tissue engineering scaffolds / 口腔疾病防治

@#Bone tissue engineering, as an emerging method for the treatment of jaw defects caused by oral and maxillofacial trauma, inflammation, tumors and other diseases, has been a research hotspot due to its advantages of wide sources of materials, low risk of immune rejection and personalized treatment. However, due to functional activities such as chewing and expression in the oral and maxillofacial regions, the mechanical strength of scaffolds is highly required. A single component of scaffolds can not fully meet the requirements of oral and maxillofacial bone defect repair. In this paper, the methods of strengthening the mechanical strength of jaw bone tissue engineering scaffolds are summarized by summarizing the research on strengthening the mechanical strength of scaffolds in recent years. A review of the literature showed that, composite modification, crosslinking, coating, bionic scaffolding and other new processing methods have been used to enhance the mechanical strength of scaffolds. Among these studies, research on compound modification occurred the earliest. Although this process is simple, other substances have been introduced to increase the number of degradation products, and the compounding ratio needs to be adjusted. The crosslinking method has the risk of cytotoxicity due to the use of crosslinking agents; the coating method does not change the original structure and only changes the surface modification; however, it can be better utilized if the problem of stress concentration between interfaces is solved. Biomimetic scaffolds and microregulatory scaffolds are emerging technologies in recent years that can improve the internal molecular arrangement of materials, thus enhancing mechanical strength. Therefore, on the basis of perfecting the traditional method, future research will focus on new nanoscale materials, bionic scaffolds and new methods for the precise control of scaffold microstructure.

Nursing care of lower cervical spine fracture treated with 3D print microporous titanium artificial vertebral body / 中国实用护理杂志

Objective@#To summarize the perioperative nursing measures and effects of 3D printed artificial cervical vertebrae for lower cervical spine fractures.@*Methods@#Treatment of 15 cases of lower cervical spine fracture with 3D printed artificial cervical vertebrae. Preoperative cervical spine fixation to prevent spinal cord injury, strict observation of clinical symptoms, assist the doctor to perform CT three-dimensional reconstruction of the cervical spine, and calculate the physiological height of the injured vertebrae; maintain the surgical position fixed during surgery, carefully prepare the supporting equipment, familiar with the surgical related steps, accurate delivery of all types of surgical instruments to assist with intraoperative fluoroscopy. Postoperative focus on the neck to see if there is swelling, effectively maintain the airway patency, observe changes in spinal nerve function, develop a personalized functional exercise program to promote rehabilitation, and actively prevent complications.@*Results@#The JOA score increased from (9.23±1.62) points before surgery to (14.09±1.35) points after surgery, and the improvement rate was 62.55%. There were no complications such as difficulty swallowing, hoarseness, and difficulty breathing.@*Conclusions@#Through targeted perioperative care, surgical complications can be reduced and the quality of life of patients improved.

Nursing care of lower cervical spine fracture treated with 3D print microporous titanium artificial vertebral body / 中国实用护理杂志

Objective To summarize the perioperative nursing measures and effects of 3D printed artificial cervical vertebrae for lower cervical spine fractures. Methods Treatment of 15 cases of lower cervical spine fracture with 3D printed artificial cervical vertebrae. Preoperative cervical spine fixation to prevent spinal cord injury, strict observation of clinical symptoms, assist the doctor to perform CT three-dimensional reconstruction of the cervical spine, and calculate the physiological height of the injured vertebrae; maintain the surgical position fixed during surgery, carefully prepare the supporting equipment, familiar with the surgical related steps, accurate delivery of all types of surgical instruments to assist with intraoperative fluoroscopy. Postoperative focus on the neck to see if there is swelling, effectively maintain the airway patency, observe changes in spinal nerve function, develop a personalized functional exercise program to promote rehabilitation, and actively prevent complications. Results The JOA score increased from (9.23 ± 1.62) points before surgery to (14.09 ± 1.35) points after surgery, and the improvement rate was 62.55%. There were no complications such as difficulty swallowing, hoarseness, and difficulty breathing. Conclusions Through targeted perioperative care, surgical complications can be reduced and the quality of life of patients improved.

Uso de nuevos recursos tecnológicos en la docencia de un curso de anatomía con orientación clínica para estudiantes de medicina / Use of new technological resources in the teaching of a clinical anatomy course for medicine students

El uso de recursos tecnológicos como material de apoyo en la docencia de anatomía humana tiene antecedentes históricos en Chile desde el siglo 19, con la llegada del primer modelo anatómico artificial. En conjunto con las tradicionales clases magistrales y lectura de los textos clásicos sobre la materia, durante los trabajos prácticos se presentaba al estudiante una serie de contenidos estrictamente anatómicos que posteriormente serían evaluados. Esta metodología de enseñanza se mantuvo hasta muy avanzado el siglo 20. Posteriormente con los avances en tecnología médica de las últimas décadas incorporados a la práctica clínica habitual, también debieron integrarse conocimientos sobre las estructuras anatómicas, en cuanto a su representación en los exámenes obtenidos mediante técnicas de imágenes médicas. Por esta razón para la formación de las nuevas generaciones de médicos, se han debido actualizar paulatinamente; la literatura básica integrando a ella contenidos clínicos, la metodología docente haciéndola participativa hacia el estudiante y en el último tiempo los materiales para trabajos prácticos, de manera que se logre un aprendizaje duradero, cuyos contenidos sean utilizados posteriormente en otras asignaturas básicas y clínicas. Previo a iniciar las actividades docentes en el laboratorio de anatomía de la nueva Escuela de Medicina de la Universidad de Tarapacá, Chile, la institución adquirió material de apoyo docente de última generación para complementar la enseñanza en los trabajos prácticos de anatomía. En este artículo se describirá la implementación de los nuevos recursos tecnológicos de apoyo docente en anatomía para nuestra escuela de medicina, entre los cuales se encuentran: modelos anatómicos impresos en tres dimensiones (3D) Erler-Zimmer®, cadáver humano sintético Syndaver®, mesa de disección digital 3D SECTRA® y su estación de trabajo complementaria. Todos estos materiales se unieron al uso de otros recursos tradicionales en la enseñanza de esta disciplina, para entregar los contenidos de la anatomía con un enfoque combinado.

The use of technological resources as assisting material in the teaching of human anatomy has been referenced in Chile since the 19th century with the first artificial anatomical model. In conjunction with traditional lectures and classical texts on the subject during practical work, the student was presented with a series of strictly anatomical contents that would later be evaluated. This teaching methodology was maintained until well into the 20th century. Subsequently, medical technology progress and innovation was integrated in clinical practice over the last decades. Further, knowledge of anatomical structures, in terms of their representation in exams obtained through medical imaging techniques was also consolidated. For this reason for the education of the new generations of medical doctors, a gradual update was required. These included basic clinical content literature, a teaching methodology with student participation, and use of materials for practical work to achieve learning techniques that would be useful in later courses. Prior to the beginning of the school year, the School of Medicine of the Universidad de Tarapacá acquired state of the art material to complement teaching in practical anatomy work for its anatomy laboratory. This article describes implementation of the new technological resources for educational support in anatomy for our school of medicine, among these are: anatomical models printed in three dimensions (3D) Erler-Zimmer®, synthetic human cadaver Syndaver®, SECTRA® 3D digital dissection table and complementary workstation. All of this material will be used in conjunction with other traditional resources when teaching anatomy, so as to provide an overall view of the contents in this subject area.

Clinical application of atlantoaxial pedicle screw placement assisted by a modified 3D-printed navigation template

OBJECTIVES: To investigate the primary clinical value of atlantoaxial pedicle screw placement assisted by a modified 3D-printed navigation template. METHODS: We retrospectively analyzed the cases of 17 patients treated from June 2015 to September 2016 with atlantoaxial pedicle screw placement assisted by a modified 3D-printed navigation template. All procedures were performed prior to surgery, including thin-slice CT scanning, medical image sampling and computerized 3D modeling of the atlantoaxial joint, optimal pedicle screw trajectory determination, and anatomical trait acquisition for the atlantoaxial pedicle, spinous process of the axis, vertebral lamina and posterior lateral mass, and design of a reverse template. During surgery, a navigation template was tightly attached to the atlantoaxial joint to assist in pedicle screw placement. Surgeons subsequently used an electric drill to remove the template through a guide channel and then placed the atlantoaxial pedicle screw. Observed indexes included the VAS score, JOA improvement rate, surgery duration, and blood loss. RESULTS: Surgery was successful in all 17 patients, with an average operation duration of 106±25 min and an average blood loss of 220±125 ml. Three days postoperatively, the VAS score decreased from 6.42±2.21 to 3.15±1.26. Six months postoperatively, the score decreased to 2.05±1.56. The postoperative JOA score increased significantly from 7.68±2.51 to 11.65±2.72 3 d after surgery and to 13.65±2.57 after 6 months. Sixty-eight pedicle screws were inserted successfully, with 34 in the atlas and 34 in the axis. According to the Kawaguchi standard, 66 screws were in grade 0 (97.06%), and 2 were in grade 1 (2.94%). The pre- and postoperative transverse and sagittal screw angles showed no significant differences. CONCLUSIONS: Atlantoaxial pedicle screw placement assisted by a modified 3D-printed navigation template is worth recommending due to the improved accuracy in screw placement, improved patient safety and beneficial clinical effects.

Patient-special screw template 3D printed based on external fixation for treatment of pelvic fractures / 中华创伤骨科杂志

Objective To investigate the feasibility and accuracy of a patient-special template for antegrade pubic branch screwing and sacroiliac screwing which is 3D printed and based on the external fixation for treatment of pelvic fractures.Methods From January to April 2017,5 patients with Tile B fracture of the pelvis were treated by external fixation for damage control and closed reduction of the fracture at the first stage.They were 4 males and one female,aged from 42 to 65 years(average,54.8 years).By the Tile classification,there were one case of type B1 and 4 cases of type B2.After the CT scan data following external fixation were reconstructed and the screw trajectories were designed in 3D format,an individual template for the pelvic model was 3D printed.After the feasibility was confirmed by the preoperative operation,the patient-special template was used to insert antegrade pubic branch screws and sacroiliac screws in the surgery.The accuracy and safety of the actual screwing aided by the template were evaluated by comparing postoperative CT scans and preplanned trajectories of the screws.Results The individualized 3D printing templates based on external fixation led to precise screw placements into the superior ramus of the pubis and the sacroiliac joint.All the patient-special templates matched the external fixation well.Screw placement time ranged frown 5.1 to 17.5 min,averaging 10.3 min.The fluoroscopy frequency ranged from 6 to 16 times,averaging 9 times.The wound healed primarily.There was no damnage to the vessels or nerves.Verification of preoperative and postoperative CT scans showed an axial displacement deviation of 1.60 + 0.21 mm and an angle deviation of 2.0° ± 0.3°.The screws were basically in the bone channel without penetrating the cortex of important parts.Conclusion In the treatment of pelvic fractures,a patient-special screw template 3D printed based on external fixation can help accurate and safe insertion of the screws in a minimally invasive manner,significantly reducing the operation time and radiation exposure.

Analysis of Technical Evaluation for Current Regulation of 3D Printed Customized Medical Device / 中国医疗器械杂志

This paper summarizes the current research status of 3D printed customized medical devices regulations in US and EU. Based on the discussion of 3D printed customized medical devices in the US and the European Union, some thoughts are put forward from design, manufacturing, testing and other aspects.

Accuracy verification of anterior cruciate ligament anchor point locating under the guidance of 3D model and AR navigation / 局解手术学杂志

Objective To investigate the precision and clinical practicability of anchor point locating under the guidance of augmented reality (AR) navigation for anterior cruciate ligament (ACL) reconstruction.Methods A cube model was made by 3D print which contained some concentric circles of different diameters to be the target.Fifty orthopedists were chosen and numbered from 1 to 50 to locate with AR guidance.Finally,the results of precision and score of satisfaction were analyzed.Results The location precision guided by AR in different diameter concentric circle were 74％ (0.25 cm),78％ (0.5 cm),83％ (0.75 cm),86％ (1.0 cm),89％ (1.25 cm),96％ (1.5 cm) respectively.The average satisfaction score of the orthopedists' was (8.7 ± 1.3).Conclusion Anchor point locating under the guidance of AR navigation is a feasible and effect method for clinical ACL reconstruction,which can observe the relations of the anchor point and the adjacent structure in real time.

Flexural strength of various kinds of the resin bridges fabricated with 3D printing

PURPOSE: Manufacturing with AM (Additive manufacturing) technique has many advantages; but, due to insufficient study in the area, it is not being widely used in the general clinic. In this study, differences of flexural strength among various materials of 3 unit fixed dental prosthesis were analyzed. MATERIALS AND METHODS: A metal jig for specimens that had a 3-unit-fixed dental prosthesis figure were fabricated. The jigs were made appropriately to the specifications of the specimens. Three different kinds of materials of specimens which were NC (mathacrylic esther based), DP-1 (Bisphenol A epoxy acrylate type oligomer based), and DT-1 (urethane acrylate based) were printed with DLP machine. Five specimens for each kind of material were printed with an angle of 30° from the horizontal surface. The specimens were placed on the jig and the flexural strength was measured and recorded using Universal testing machine. The recorded data was analyzed in SPSS using One-way ANOVA and Tukey HSD to determine the significance of the differences of flexural strength among the groups. RESULTS: The flexural strengths of each group were the followings: NC, 1119 ± 305 N; DP-1, 619 ± 150 N; DT-1, 413 ± 65 N. Using One-way ANOVA and Tukey Honestly Significant Difference test, significant difference was found between NC and the other groups (P 0.05). CONCLUSION: Higher flexural strength was shown in 3-unit-fixed dental prosthesis that were 3D printed using a DLP machine with NC material.

Aspirin bilayer tablets prepared with 3D printer for drug controlled release / 中国药学杂志

OBJECTIVE: Taking aspirin as a model drug, the feasibility of the controlled release of aspirin tablets was discussed, which was based on the individual demand of 3D printing technology. METHODS: The experiment selected 10 000 mPa·s hydroxypropyl methyl cellulose (HPMC10000) and polyacrylic acid (PAA) as a hydrophilic matrix sustained-release layer; hydroxypropyl methyl cellulose 100 mPa·s (HPMC100) as a quick release layer binder, sodium carboxymethyl starch (CMS-Na) and sodium carboxymethyl starch (SSG) as a quick release layer disintegrating agent, the use of 3D printer to print the slow release of aspirin tablets. Select 100 mg·mL-1 and polyvinylpyrrolidone (PVPK30) as a quick release layer binder, crosslinking sodium carboxymethyl cellulose (CC-Na) as a quick release layer disintegrating agent, hydroxypropyl methyl cellulose (HPMC100) as the matrix material release layer, with the traditional press pressing speed of aspirin sustained-release tablet, as contrast agents. The physical and chemical properties of tablets produced in two different modes of production (film weight difference, hardness and thickness) and release profile were investigated. RESULTS: The physical and chemical properties of the two tablets are all in the Pharmacopoeia. Comparison of two kinds of drug release curve showed that the ASA-HPMC (14%, ω) and the press release curve of double layer tablets printing film is similar, and the release rate is higher than the tablet (6% ω. ASA-HPMC double layer tablets), ASA-HPMC (8%, ω) and ASA-HPMC (10%, ω) printing film final release amount increased with hydrophilic matrix HPMC. CONCLUSION: 3D printers print different shapes of tablets with different release profiles, in which the release of the package is higher than the other tablets.

Nursing care of patients with malignant tumor treated by 3D printing individualized template and 125I seed implantation / 中华护理杂志

This paper summarized nursing experience of 23 patients with malignant tumor treated by 3D printing individualized template and 125I seed implantation.Nursing points included:preoperative assessment and preparation,reviewing the process of template conduction,assisting the physician to simulate the position of patients,making treatment plans,preparing templates before operation;resetting and maintaining position of patients,performing template alignment,seed implantation,monitoring vital signs and complications during operation;observation of complications,providing radiation protection and discharge guidance after operation.All 23 patients completed 125I seed implantation and no serious complication was observed.All patients recovered well and were discharged after treatment.

The value of 3D print technique in the precious reconstruction of the defects and malformations of maxillofacial bone / 实用口腔医学杂志

Objective:To study the value of 3D print technique in the reconstruction of the defects and malformations of oral and maxillofacial bone.Methods:6 cases with defects and malformations of oral and maxillofacial bone were examined by CT scanning,treated by the implantation of 3D printed implants.Results:Before operation,3D printed model clearly showed the status of the defects and malformations for the precious preoperative implant shaping.The implants for the reconstruction were prepared by 3D print techinique.Perfect reconstruction of the defects was achieved.Conclusion:3 D printing technology exerts promising values in the precious and effective reconstruction of the defects and malformations of maxillofacial bones.

3D printing of the individual female pelvic structure / 实用医学杂志

Objective To explore the application of 3D printing technology in individual pelvic structure of female and its value in obstetrics and gynecology based on the CT datasets of the pelvic structure and digital three-dimensional reconstruction. Methods CTA image dataset of a patient from gynecology department was obtained for constructing three-dimensional models of each organ using the digital three-dimensional reconstruction technology , then the digital 3D model with the same size as the model displayed was printed with Z510 3D printer. Results 3D models of patient′s lumbosacral vertebrae, aorta artery, common iliac artery, internal and external iliac artery , postcava , common iliac vein , internal and external iliac vein , pelvis ureter , uterus and uterine artery were printed out in the same size replica of the virtual reality model. Conclusion 3D printed model has all the features of 3D vision and can be touched and felt by people , which can provide new insights for medical education, clinical and medical research.