Patient-specific, printed titanium implants for reconstruction of mandibular continuity defects: A systematic review of the evidence

Three dimensional (3D) planning/computer-aided-design (CAD) and virtual surgery has evolved to the point that it improves efficiency, accuracy, creativity and reproducibility in cranio-maxillofacial (CMF) surgery (Steinbacher, 2015). The process of CAD (following analysis of 3D imaging data) provides the means to rapid-prototype a stereolithigraphic resin model/mould upon which a titanium implant can be flexed, pressed or moulded preoperatively (and most importantly, checked against the stereolithigraphic model) for subsequent intraoperative use. This technique has become standard practise in maxillofacial centres worldwide. We know that when compared to traditional intraoperative shaping techniques, it improves accuracy and efficiency in mandibular reconstruction; notably eliminating the time taken during surgery to bend the plate by eye that would otherwise be required using the traditional approach, yet allowing as much time as needed by the technician preoperatively to achieve the best ‘handmade’ result possible (Gil et al., 2015). With the advent of additively-manufactured, ‘3D-printed’ titanium (more specifically selective laser melting; SLM), it has been proposed by one author group that SLM (‘printed’) mandibular reconstruction plates further reduce the duration of surgery and frequency of complications, as well as producing a more accurate reconstruction due to the elimination of human error in the final stages of fabrication (in contrast to a plate bent to a stereolithigraphic model preoperatively) (Tarsitano et al., 2016a). Printing titanium plates/implants enables a seamless, automated transition from CAD to computer aided manufacture (CAM), further reducing the introduction of human error in the fabrication stage.