Printed Titanium Implants in UK Cranio-Maxillofacial Surgery: Part II – Perceived performance (outcomes, logistics and costs)

Alexander M.c. Goodson, Sat Parmar, Siva Ganesh, Daanesh Zakai, Ahad Shafi, Catherine Wicks, Rory O’connor, Elizabeth Yeung, Farhan Khalid, Arpan Tahim, Siddharth Gowrishankar, Alexander Hills, E Mark Williams

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    Abstract

    This second part explores perceptions and understanding of clinical performance, turnaround, and costs for printed titanium implants or plates in common procedures, evaluating both ‘in-house’ and ‘outsourced’ CAD-CAM pathways. A cross-sectional study, supported by the British Association of Oral and Maxillofacial Surgeons (BAOMS) and a national trainee-led recruitment team, was conducted over 14 weeks. A total of 132 participants took part (demographic data is reported in Part I). For fibular-flap mandibular reconstruction, most participants (69% - 91%) perceived printed titanium as superior to intraoperatively or preoperatively hand-bent plates for surgical duration, accuracy, dental restorability, and aesthetics. There was less agreement about complications and plate-failure risks. Most perceived printed plates to be superior to traditional wafer-based maxillary osteotomy for surgical duration (61%) and maxillary positioning (60%). For orbital floor repair, most perceived improvements in surgical duration (83%, especially higher-volume operators p=0.009), precision (84%), and ease of placement (69%). Rarely (less than 5%) was any outcome rated inferior to traditional techniques for any procedure. Perceived turnaround times and costs were variable, but the greatest consensus was for two-segment fibular-flap reconstructions and orbital floor repair. Industry estimates were generally consistent between two company representatives, but manufacturing-only costs differed when using in-house (departmental) designers. Costs and turnaround times are questionable barriers since few understand ‘real-world’ figures. Designing in-house can dramatically alter costs. Improved accuracy and surgical duration are common themes but biomechanical benefits are less-well understood. This study paints a picture of the potentially routine applications and benefits of printed titanium, capacity for uptake, understanding amongst surgeons, and areas for improvement.

    Original languageEnglish
    Pages (from-to)320-328
    JournalBritish Journal of Oral and Maxillofacial Surgery
    Volume59
    Issue number3
    DOIs
    Publication statusPublished - 21 Aug 2020

    Keywords

    • 3D printing
    • additive manufacture
    • Laser sintering
    • Selective laser melting/SLM
    • Printed titanium
    • Indications
    • Applications
    • Osteosynthesis
    • Patient-specific implants/PSI
    • Fibular flap
    • Waferless osteotomy
    • Orbital floor repair

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