Massimiliano Fantini

CAD/CAM and rapid prototyped scaffold construction for bone regenerative medicine and surgical transfer of virtual planning: A pilot study

We developed a model to test new bone constructs to replace spare skeletal segments originating from new generation scaffolds for bone marrow-derived mesenchymal stem cells. Using computed tomography (CT) data, scaffolds were defined using computer-aided design/computer-aided manufacturing (CAD/CAM) for rapid prototyping by three-dimensional (3D) printing. A bone defect was created in pig mandible ramus by condyle resection for CT and CAD/CAM elaboration of bone volume for cutting and scaffold restoration. The protocol produced a perfect-fitting bone substitute model for rapid prototyped hydroxyapatite (HA) scaffolds. A surgical guide system was developed to accurately reproduce virtually planned bone sectioning procedures in animal models to obtain a perfect fit during surgery.

CAD/CAM guided secondary mandibular reconstruction of a discontinuity defect after ablative cancer surgery

A surgical guide is projected to aid the repositioning of the mandibular segments in their original locations, and a reconstruction bone plate is provided to support the fibula free flap. Computer-aided mandibular reconstruction involves three steps: virtual surgical planning, CAD/CAM and rapid-prototyping procedures for the design and manufacture of the customised surgical device and surgery. The duration of the reconstructive phase (<1.5 h intraoperative time) was reduced in comparison with traditional secondary mandibular reconstruction. The bone plate permitted the maximal restoration of the original facial and mandibular contours and the more precise positioning of the residual mandibular ramus in comparison with conventional procedures. No complication was noted during the mean follow-up period of 12 months. The protocol presented in this paper offers some benefits: 1) The virtual environment permitted ideal preoperative planning of mandibular segment repositioning in secondary reconstruction; 2) Intraoperative time was not consumed by approximate and repeated bone plate modelling; 3) Using CT data obtained before primary surgery, the reconstruction bone plate was designed using the original external cortical bone as a template to reproduce the ideal mandibular contour; 4) Prototyped resin models of the bone defect allowed the surgeon to train preoperatively by simulating the surgery.

A CAD/CAM-prototyped anatomical condylar prosthesis connected to a custom-made bone plate to support a fibula free flap

This paper describes a new protocol for mandibular reconstruction. Computer-aided design/computer-aided manufacturing (CAD/CAM) technology was used to manufacture custom-made cutting guides for tumor ablation and reconstructive plates to support fibula free flaps. CT scan data from a patient with an odontogenic keratocyst on the left mandibular ramus were elaborated to produce a virtual surgical plan of mandibular osteotomy in safe tissue for complete ramus resection. The CAD/CAM procedure was used to construct a customized surgical device composed of a cutting guide and a titanium reconstructive bone plate. The cutting guide allowed the surgeon to precisely transfer the virtual planned osteotomy into the surgical environment. The bone plate, including a custom-made anatomical condylar prosthesis, was designed using the outer surface of the healthy side of the mandible to obtain an ideal contour and avoid the bone deformities present on the side affected by the tumor. Operation time was reduced in the demolition and reconstruction phases. Functional and aesthetic outcomes allowed patients to immediately recover their usual appearance and functionality. This new protocol for mandibular reconstruction using CAD/CAM to construct custom-made guides and plates may represent a viable way to reproduce the patient’s anatomical contour, give the surgeon better procedural control, and reduce operation time.

3D restitution, restoration and prototyping of a medieval damaged skull

Purpose – The purpose of this paper is to describe the method of virtually and physically reconstructing the missing part of a badly damaged medieval skull by means of reverse engineering, computer‐aided design (CAD) and rapid prototyping (RP) techniques.Design/methodology/approach – Laser scanning data were used to create the 3D model of the damaged skull. Starting from this digital model, a virtual reconstruction of the missing part of the skull, based on the ideal symmetry with respect to the mid‐sagittal plane, was achieved in a CAD environment. Finally, the custom‐designed model was directly fabricated by means of the RP process.Findings – The result shows that the designed missing part of the skull fits very well with the existing skeletal remains. The final physical assembly of the prototyped element on the damaged skull was tested, restoring it to its whole original shape.Research limitations/implications – The entire process was time‐consuming and may be applied just to the most representative sk...

Immediate facial rehabilitation in cancer patients using CAD–CAM and rapid prototyping technology: a pilot study

PurposeThis study describes the workflow in a procedure to create a provisional facial prosthesis for cancer patients using digital and rapid prototyping technologies without the need for supporting craniofacial implants.Materials and methodsAn integrated workflow procedure aimed at the construction of provisional silicone prosthesis was used to rehabilitate a facial disfigurement in a patient who had undergone ablative surgery of the midface. A laser scan of the defect was obtained, and a digital model of the patient′s face was constructed using virtual mirroring of the healthy side and referencing the “Nose Digital Library.”ResultsThe missing volume of the face was reconstructed, and a rapid-prototyped mold was devised to process the silicone prosthesis. A provisional eyeglasses-supported prosthesis designed with a CAD/CAM-projected titanium substructure was connected using the micro-components of implant prosthetic devices.ConclusionsThe workflow described herein offers a viable procedure for quickly restoring facial defects by means of provisional prosthetic rehabilitation.

Improving the spatial orientation of human teeth using a virtual 3D approach

Since teeth are resistant to decomposition processes, they provide important and at times unique sources of information about fossil humans. Fortunately, dental remains reflect significant evolutionary changes. These changes make a very important and often exclusive contribution to the definition of new taxa or the attribution of fossil specimens to existing taxa. The traditional approach to dental morphometric analyses usually focuses on the recording of several measures of the tooth with calipers, especially the two basic crown diameters (buccolingual and mesiodistal). However, since these measures do not adequately represent the complex morphology of the tooth, 2D images and 3D digital models of dental morphology have been used. For both types of analysis, the possibility of correctly comparing homologous teeth depends on the adoption of a common orientation system. The lack of such a system makes it difficult to compare the results of different studies. Here we describe a new method for orienting teeth specifically devised for the upper and lower first molar (M1). Samples of unworn maxillary (n=15) and mandibular (n=15) first molars of modern humans were scanned with a Roland Picza 3D digitizer. The 3D virtual models were used to compare our new orientation method with those proposed in the literature. The new orientation system, which meets a geometric criterion, is based on three points identified on the cervical line and ensures acceptable repeatability of the spatial positioning and orientation independent of the shape and wear of the first molar under investigation. This orientation system is a first step toward the creation of a virtual set of hominid and fossil human first molars, which will allow us to make comparisons via a sophisticated and noninvasive approach. This pilot study also provides guidelines to extend the new methodology to the other types of teeth.

New protocol for construction of eyeglasses-supported provisional nasal prosthesis using CAD/CAM techniques.

A new protocol for making an immediate provisional eyeglasses-supported nasal prosthesis is presented that uses laser scanning, computer-aided design/computer-aided manufacturing procedures, and rapid prototyping techniques, reducing time and costs while increasing the quality of the final product. With this protocol, the eyeglasses were digitized, and the relative position of the nasal prosthesis was planned and evaluated in a virtual environment without any try-in appointment. This innovative method saves time, reduces costs, and restores the patients aesthetic appearance after a disfiguration caused by ablation of the nasal pyramid better than conventional restoration methods. Moreover, the digital model of the designed nasal epithesis can be used to develop a definitive prosthesis anchored to osseointegrated craniofacial implants.

CAD-CAM-generated hydroxyapatite scaffold to replace the mandibular condyle in sheep: preliminary results.

In this study, rapid CAD-CAM prototyping of pure hydroxyapatite to replace temporomandibular joint condyles was tested in sheep. Three adult animals were implanted with CAD-CAM-designed porous hydroxyapatite scaffolds as condyle substitutes. The desired scaffold shape was achieved by subtractive automated milling machining (block reduction). Custom-made surgical guides were created by direct metal laser sintering and were used to export the virtual planning of the bone cut lines into the surgical environment. Using the same technique, fixation plates were created and applied to the scaffold pre-operatively to firmly secure the condyles to the bone and to assure primary stability of the hydroxyapatite scaffolds during masticatory function. Four months post-surgery, the sheep were sacrificed. The hydroxyapatite scaffolds were explanted, and histological specimens were prepared. Different histological tissues penetrating the scaffold macropores, the sequence of bone remodeling, new apposition of bone and/or cartilage as a consequence of the different functional anatomic role, and osseointegration at the interface between the scaffold and bone were documented. This animal model was found to be appropriate for testing CAD-CAM customization and the biomechanical properties of porous, pure hydroxyapatite scaffolds used as joint prostheses.

The design and rapid prototyping of surgical guides and bone plates to support iliac free flaps for mandible reconstruction.

Sir:This report describes a novel protocol for the construction of surgical cutting guides and reconstructive titanium bone plates to guide osteotomies according to the preoperative plan and to position and fix an osseous free flap in mandibular reconstruction after cancer removal. Computed tomograp

Three-dimensional morphology of heel fat pad: an in vivo computed tomography study

Heel fat pad cushioning efficiency is the result of its structure, shape and thickness. However, while a number of studies have investigated heel fat pad (HFP) anatomy, structural behavior and material properties, no previous study has described its three‐dimensional morphology in situ. The assessment of the healthy, unloaded, three‐dimensional morphology of heel pad may contribute to deepen the understanding of its role and behavior during locomotion. It is the basis for the assessment of possible HFP morphological modifications due to changes in the amount or distribution of the loads normally sustained by the foot. It may also help in guiding the surgical reconstruction of the pad and in improving footwear design, as well as in developing a correct heel pad geometry for finite element models of the foot. Therefore the purpose of this study was to obtain a complete analysis of HFP three‐dimensional morphology in situ. The right foot of nine healthy volunteers was scanned with computed tomography. A methodological approach that maximizes reliability and repeatability of the data was developed by building a device to lock the foot in a neutral position with respect to the scan planes during image acquisition. Scan data were used to reconstruct virtual three‐dimensional models for both the calcaneus and HFP. A set of virtual coronal and axial sections were extracted from the three‐dimensional model of each HFP and processed to extract a set of one‐ and two‐dimensional morphometrical measurements for a detailed description of heel pad morphology. The tissue exhibited a consistent and sophisticated morphology that may reflect the biomechanics of the foot support. HFP was found to be have a crest on its anterior dorsal surface, flanges on the sides and posteriorly, and a thick portion that reached and covered the posterior surface of the calcaneus and the achilles tendon insertion. Its anterior internal portion was thinner and a lump of fat was consistently present in this region. Finally, HFP was found to be thicker in males than in females.