The patient could speak and swallow the day after surgery

3D-printed jaw replacement is world first

A Belgian woman has received what is claimed to be the first patient-specific 3D-printed lower jaw replacement.

Scientists from the Functional Morphology group of the University of Hasselt Biomed research institute directed the procedure on an 83-year-old patient with progressive osteomyelitis of almost her entire lower jawbone.

Biomed collaborated on the pioneering project with a number of academic and engineering partners, including the Xios College, the Catholic University of Leuven, Orbis Medical Centre, Xilloc Medical, and Additive Manufacturing (AM) specialist LayerWise. Although the operation took place in June 2011, the details of the pioneering procedure have only just been reported into the public domain.

LayerWise built the complex metal implant structure layer by layer using its dedicated AM technology. In this process a laser selectively heats metal powder particles to attach them to the previous layer without an adhesive. This additive approach makes it possible to print functional implant shapes that would otherwise require multiple metal-working steps.

Some parts of the structure, such as joint surfaces, were then polished, and fixture sites for future prosthetic dental superstructures were incorporated.

The surface was then coated with plasma-sprayed artificial bone – a hydroxyapatite bone substitute compound – by Cam Bioceramics.

Weighing 107g, the implant is only slightly heavier than a natural lower jaw.

“The patient suffered from an infection of almost the entire mandible with a large wound in her face,” says cranio-maxillofacial surgeon Prof Dr Jules Poukens of the University of Hasselt, who led the surgical team that performed the implant. “In order to retain an open airway, and swallowing and chewing functions, surgical removal of the entire mandible was necessary. The classical treatment – removing the damaged bone – would result in a small mandible without any support and function.”

Prof Poukens said the surgery took less than four hours. “Shortly after waking up from the anaesthetics the patient spoke a few words, and the day after she was able to speak and swallow normally again.”

The 3D-printed replacement approach spares elderly patients prolonged surgery cycles, he added.

LayerWise managing director Dr Peter Mercelis said: “Besides a successful track record in industrial sectors, metal AM is gaining importance in medical implantology. AM’s freedom of shape allows the most complex freeform geometries to be produced as a single part prior to surgery.” Patient‐specific implants could be used on a much wider scale than human bone transplants, he continued, with less risk of medical complications.

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