TY - JOUR
T1 - Printed Titanium Implants in UK Cranio-Maxillofacial Surgery: Part I – Access to digital planning and perceived scope for use in common procedures
AU - Goodson, Alexander M.C.
AU - Parmar, Sat
AU - Ganesh, Siva
AU - Zakai, Daanesh
AU - Shafi, Ahad
AU - Wicks, Catherine
AU - O’connor, Rory
AU - Yeung, Elizabeth
AU - Khalid, Farhan
AU - Tahim, Arpan
AU - Gowrishankar, Siddharth
AU - Hills, Alexander
AU - Mark Williams, E
N1 - Funding Information:
This study was funded externally through KESS (Knowledge Economy Skills Scholarships) , in partnership with Renishaw plc and the University of South Wales, UK . KESS is a pan-Wales higher level skills initiative led by Bangor University on behalf of the HE sector in Wales.
Funding Information:
It was part funded by the Welsh Government's European Social Fund (ESF) convergence programme for West Wales and the Valleys. Renishaw plc provided no input into the design of the survey or publication of the findings.
Publisher Copyright:
© 2020 The British Association of Oral and Maxillofacial Surgeons
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/8/21
Y1 - 2020/8/21
N2 - This first part of a two-part study examines perceived applications for and barriers to using printed titanium in light of current caseloads, funding pathways, and use of digital planning. It aims to demonstrate the scope for printed titanium in modern practice and to guide industry about the needs of UK surgeons. A cross-sectional study over 14 weeks was performed electronically with support from the British Association of Oral and Maxillofacial Surgeons (BAOMS) and a national trainee-led recruitment team. Ethics approval was obtained at the lead centre. A total of 132 participants joined the study (70% consultants, 25% specialty registrars, and 5% other), approximating a 29% response rate from consultant/registrar BAOMS members throughout mainland UK. Eighty-eight per cent used CAD-CAM design, with highly variable funding/access, design/manufacturing workflows (in-house/outsourced). Eighty-eight per cent were involved with trauma, 61% with orthognathic, and 52% with oncology-reconstruction surgery. Favourite applications for printed titanium were orbital floor repair (89%) and free-flap jaw reconstruction (87%). Most participants also cited maxillary/zygomatic osteotomies and cranioplasty (range 61%-73%). Although a popular application (78%), the evidence base in temporomandibular joint surgery is limited. Those performing orthognathic surgery perceived more indications than those who did not (p=0.013). Key barriers included cost, turnaround time and logistics, and the need to be trained in traditional techniques. Printed titanium was useful for both common and niche procedures, but was specifically limited in emergency trauma. Most surgeons had experience in CAD-CAM surgery but technical understanding appeared unclear. Limiting factors included variable funding and production pathways, perceived costs, and logistics, but in-house design can minimise them. In part II, we quantify perceived benefits and limitations and whether surgeons’ understanding and knowledge are sufficient to rationalise them.
AB - This first part of a two-part study examines perceived applications for and barriers to using printed titanium in light of current caseloads, funding pathways, and use of digital planning. It aims to demonstrate the scope for printed titanium in modern practice and to guide industry about the needs of UK surgeons. A cross-sectional study over 14 weeks was performed electronically with support from the British Association of Oral and Maxillofacial Surgeons (BAOMS) and a national trainee-led recruitment team. Ethics approval was obtained at the lead centre. A total of 132 participants joined the study (70% consultants, 25% specialty registrars, and 5% other), approximating a 29% response rate from consultant/registrar BAOMS members throughout mainland UK. Eighty-eight per cent used CAD-CAM design, with highly variable funding/access, design/manufacturing workflows (in-house/outsourced). Eighty-eight per cent were involved with trauma, 61% with orthognathic, and 52% with oncology-reconstruction surgery. Favourite applications for printed titanium were orbital floor repair (89%) and free-flap jaw reconstruction (87%). Most participants also cited maxillary/zygomatic osteotomies and cranioplasty (range 61%-73%). Although a popular application (78%), the evidence base in temporomandibular joint surgery is limited. Those performing orthognathic surgery perceived more indications than those who did not (p=0.013). Key barriers included cost, turnaround time and logistics, and the need to be trained in traditional techniques. Printed titanium was useful for both common and niche procedures, but was specifically limited in emergency trauma. Most surgeons had experience in CAD-CAM surgery but technical understanding appeared unclear. Limiting factors included variable funding and production pathways, perceived costs, and logistics, but in-house design can minimise them. In part II, we quantify perceived benefits and limitations and whether surgeons’ understanding and knowledge are sufficient to rationalise them.
KW - 3D printing
KW - additive manufacture
KW - Laser sintering
KW - Selective laser melting/SLM
KW - Printed titanium
KW - Indications
KW - Applications
KW - Osteosynthesis
KW - Patient-specific implants/PSI
KW - Fibular flap
KW - Waferless osteotomy
KW - Orbital floor repair
U2 - 10.1016/j.bjoms.2020.08.087
DO - 10.1016/j.bjoms.2020.08.087
M3 - Article
C2 - 33280946
SN - 0266-4356
VL - 59
SP - 312
EP - 319
JO - British Journal of Oral and Maxillofacial Surgery
JF - British Journal of Oral and Maxillofacial Surgery
IS - 3
ER -