The technique for 3D printing patient-specific models for auricular reconstruction.

PURPOSE: Currently, surgeons approach autogenous microtia repair by creating a two-dimensional (2D) tracing of the unaffected ear to approximate a three-dimensional (3D) construct, a difficult process. To address these shortcomings, this study introduces the fabrication of patient-specific, sterilizable 3D printed auricular model for autogenous auricular reconstruction. METHODS: A high-resolution 3D digital photograph was captured of the patient's unaffected ear and surrounding anatomic structures. The photographs were exported and uploaded into Amira, for transformation into a digital (.stl) model, which was imported into Blender, an open source software platform for digital modification of data. The unaffected auricle as digitally isolated and inverted to render a model for the contralateral side. The depths of the scapha, triangular fossa, and cymba were deepened to accentuate their contours. Extra relief was added to the helical root to further distinguish this structure. The ear was then digitally deconstructed and separated into its individual auricular components for reconstruction. The completed ear and its individual components were 3D printed using polylactic acid filament and sterilized following manufacturer specifications. RESULTS: The sterilized models were brought to the operating room to be utilized by the surgeon. The models allowed for more accurate anatomic measurements compared to 2D tracings, which reduced the degree of estimation required by surgeons. Approximately 20 g of the PLA filament were utilized for the construction of these models, yielding a total material cost of approximately $1. CONCLUSION: Using the methodology detailed in this report, as well as departmentally available resources (3D digital photography and 3D printing), a sterilizable, patient-specific, and inexpensive 3D auricular model was fabricated to be used intraoperatively. This technique of printing customized-to-patient models for surgeons to use as 'guides' shows great promise.

Enhanced Osteoblast Response to Porosity and Resolution of Additively Manufactured Ti-6Al-4V Constructs with Trabeculae-Inspired Porosity.

The addition of porosity to the traditionally used solid titanium metal implants has been suggested to more closely mimic the natural mechanical properties of bone and increase osseointegration in dental and orthopedic implants. The objective of this study was to evaluate cellular response to three-dimensional (3D) porous Ti-6Al-4V constructs fabricated by additive manufacturing using laser sintering with low porosity (LP), medium porosity (MP), and high porosity (HP) with low resolution (LR) and high resolution (HR) based on a computed tomography scan of human trabecular bone. After surface processing, construct porosity ranged from 41.0% to 76.1%, but all possessed micro-/nanoscale surface roughness and similar surface chemistry containing mostly Ti, O, and C. Biological responses (osteoblast differentiation, maturation, and local factor production) by MG63 osteoblast-like cells and normal human osteoblasts favored 3D than two-dimensional (2D) solid constructs. First, MG63 cells were used to assess differences in cell response to 2D compared to LR and HR porous 3D constructs. MG63 cells were sensitive to porosity resolution and exhibited increased osteocalcin (OCN), vascular endothelial growth factor (VEGF), osteoprotegerin (OPG), and bone morphogenetic protein 2 (BMP2) on HR 3D constructs than on 2D and LR 3D constructs. MG63 cells also exhibited porosity-dependent responses on HR constructs, with up to a 6.9-fold increase in factor production on LP-HR and MP-HR constructs than on HP-HR constructs. NHOsts were then used to validate biological response on HR constructs. NHOsts exhibited decreased DNA content and alkaline phosphatase activity and up to a 2.9-fold increase in OCN, OPG, VEGF, BMP2, and BMP4 on 3D HR constructs than on 2D controls. These results indicate that osteoblasts prefer a 3D architecture than a 2D surface and that osteoblasts are sensitive to the resolution of trabecular detail and porosity parameters of laser-sintered 3D Ti-6Al-4V constructs.

Additively manufactured 3D porous Ti-6Al-4V constructs mimic trabecular bone structure and regulate osteoblast proliferation, differentiation and local factor production in a porosity and surface roughness dependent manner.

Additive manufacturing by laser sintering is able to produce high resolution metal constructs for orthopedic and dental implants. In this study, we used a human trabecular bone template to design and manufacture Ti-6Al-4V constructs with varying porosity via laser sintering. Characterization of constructs revealed interconnected porosities ranging from 15-70% with compressive moduli of 2579-3693 MPa. These constructs with macro porosity were further surface-treated to create a desirable multi-scale micro-/nano-roughness, which has been shown to enhance the osseointegration process. Osteoblasts (MG63 cells) exhibited high viability when grown on the constructs. Proliferation (DNA) and alkaline phosphatase specific activity, an early differentiation marker, decreased as porosity increased, while osteocalcin, a late differentiation marker, as well as osteoprotegerin, vascular endothelial growth factor and bone morphogenetic proteins 2 and 4 increased with increasing porosity. Three-dimensional (3D) constructs with the highest porosity and surface modification supported the greatest osteoblast differentiation and local factor production. These results indicate that additively manufactured 3D porous constructs mimicking human trabecular bone and produced with additional surface treatment can be customized for increased osteoblast response. Increased factors for osteoblast maturation and differentiation on high porosity constructs suggest the enhanced performance of these surfaces for increasing osseointegration in vivo.