STEREOLITHIC MODELS IN ORAL AND

MAXILLOFACIAL SURGERY
Romanian Journal of Oral Rehabilitation
Vol.11 , No.4 , October – December 2019
Mihail Balan, Tiberiu – Alexandru Zaharia, Andrada Doscas , Mihai Liviu Ciofu

Presented By :
P.Pravallika .
IIIrd MDS .
 INTRODUCTION
• Stereolithography is a rapid prototyping method , which
allows the fabrication of anatomically accurate , 3-
dimensional epoxy and acrylic resin models from various
types of medical data.
• The device which performs stereolithography is called
Stereolithography Apparatus (SLA) .
• Stereolithography was developed by CHARLES W.HULL in
1986 .
• The process was developed to overcome limitations of
conventional CAM milling versus the inability to reproduce
intricate anatomy of body structures.
• Hull described a concentrated beam of ultraviolet light
focused onto the surface of vat filled with liquid
photopolymer which cures it , thereby producing 3D model .
• This machine has 4 parts ;
• A tank filled with several gallons of liquid
photopolymer.
• A perforated platform immersed in the tank.
• An ultraviolet laser.
• A computer that drives the laser and the
platform.
 AUTHOR WANTS TO PROVE THAT
• As for the models usage, they are useful in diagnostics, preoperative
planification and proper implant modelling , offering an optimal integration in
the recipient site .
• A. Post-operative oncological defect reconstruction and surgical planning; Due
to the anatomical complexity of cervical regions, postoperative defect
reconstruction has always been a challenge for surgeons, especially defects
that need repositioning and immobilization of transferred tissue. The purpose
of post-operative reconstruction is reestablishing, as close to normal as
possible, functionality, esthetics, shape, symmetry, offering a structural sound
for future prostheses. Also, using color stereolithography allows the surgeon
to evaluate the extent of a tumor, resection margins and relationship with
important anatomical structures (alveolar nerve, infratemporal fossa and)
commending it as a valuable technique used in oral and maxillofacial defect
reconstruction .
• B. Maxillofacial Trauma The overall number of trauma articles accepted was
12, most of them illustrate 3D modelling of the orbit with titan mesh
anatomical contouring, reducing the overall procedure time and risk of
failure, producing promising results; except orbital trauma stereolithography
has been used for panfacial trauma, zygomatic complex and overall complex
trauma, the following articles presented the most precise and relevant data.
• Novelli et al.⁸ studied the link between orbital floor implant on the model
and in the patient, resulting in a 1.3mm deviation, without residual diplopy
and with a volumetric variation of the orbit lesser than 1cm³. Mehra et al.⁵
used the stereolithic model in trauma in order to inform the patient
regarding loss of substance, treatment possibilities , with pre-operative
modeling of the plates according to the patients anatomy, the defects being
reconstructed using bone allografts and titan mesh, they also used calvarian
bone graft for orbital wall and sinus cavity reconstruction.
• C. Orthognathic surgery; Esthetic is the most important branch of maxillofacial
surgery involving 3 important anatomical landmarks: soft tissue, bone and
dentition. Initially orthognathic surgery implied clinical and radiological
evaluation of bone structures and teeth, by integrating 3D technology in the
process the clinicians work load has diminished , and it has exact descriptive
capability with the possibility of foretelling/predicting the final result, thus
permitting the patient to see a preview; stereolithography is used in order to
create occlusal splints, osteotomy guides and prefabricate fixation plates,
offering excellent and replicaeable results.
• D. Maxillofacial prosthetics Defect reconstruction represents the most
important and complex part of surgery, but some surgical procedures make
reconstruction impossible, be it immediate or later on. Due to this
maxillofacial prosthetics are a viable treatment option , stereolithical
modeling being mirrored through the large number of articles(9), by
eliminating the human error factor and some technological steps, be it by
scanning the whole face and making the prosthetic through mirroring the
healthy side, or by virtual planning and ulterior machining, reducing the
overall time and offering satisfactory results; it can also be used for creating
implant guides as a form of additional retention that allows a fast and exact
fitting
• DISCUSSIONS ;
• Stereolithography, as a supporting technique in maxillofacial surgery, has been
shown to be useful for preoperative planning, but also as part of the surgical
procedure, facilitating the procedure itself by allowing a proper adaptation and
fitting of the free flap, allowing the surgeon to properly remove the tumor
without a second thought related to closure; the leading problem, so far has been
related to accuracy, the models and the final reconstruction. 3D reconstruction
accuracy is still a controversy.
• These models were categorized into 4 treatment groups: distraction osteogenesis,
reconstruction, pathology, and trauma management. The scores of each category
were computed and compared among the treatment groups. Stereomodels are
commonly applied for distraction osteogenesis and reconstructive surgery of the
craniomaxillofacial region. The surgeons found them to be particularly useful in
surgical simulation, in prosthesis fabrication, and as an intraoperative guide for
reconstructive surgery. They also considered them extremely valuable as a
teaching tool and for enhancing communication with patients.
• CONCLUSION; Stereolithic models have an important role in contemporary
oral and maxillofacial surgery. This review highlights the applications of 3D
printing in various areas of surgical simulation, including preoperative
planning, intraoperative guidance, and surgeon training.
• They are a useful tool to assess traumatic and pathologic defects requiring
complicated surgery and reconstruction.
• They can be used for the fabrication of custom TMJ prostheses, and are
effective tools to facilitate patient education and doctor to doctor
communication.
• The specific types of 3-D model can be selected depending on the specific
clinical indications. In our experience, the use of SLA models has significantly
contributed to improved reconstruction of form and function, decreased
operating room time due to advanced treatment planning, and ability to
perform more precise and accurate surgical procedures.
• MERITS ;
• Diagnosis and treatment planning
• Direct visualization of anatomic structures
• Surgical guides/templates
• Surgical practice/rehearsal
• Designing incisions
• Surgical resections
• Assessment of bony defects for grafting
• Adaptation/pre-bending of reconstruction plates
• Fabrication of custom prostheses
• TMJ prostheses, distraction devices, fixation devices
• Decreased Surgical time Anesthesia time
• Wound exposure duration
• More predictable results
• Improved colleague communication
• Educational tool for patients
• DEMERITS;
• Time consuming depending on the size of the object.
• Require support structures.
• Expensive process.
• REFERENCES
• 1. Apparatus for production of three-dimensional objects by stereolithography. (1984). Retrieved from
https://patents.google.com/patent/US4575330A/en
• 2. The Ultimate Guide to Stereolithography (SLA) 3D Printing | Formlabs. (n.d.). Retrieved December 27,
2018, from https://formlabs.com/blog/ultimate-guide-to-stereolithography-sla-3d-printing/
• 3. Chang, E. I., Jenkins, M. P., Patel, S. A., & Topham, N. S. (2016). Long-Term Operative Outcomes of
Preoperative Computed Tomography-Guided Virtual Surgical Planning for Osteocutaneous Free Flap
Mandible Reconstruction. Plastic and Reconstructive Surgery, 137(2), 619–623.
https://doi.org/10.1097/01.prs.0000475796.61855.a7
• 4. Shu, D., Liu, X., Guo, B., Ran, W., Liao, X., & Zhang, Y. (2014). Accuracy of using computer-aided rapid
prototyping templates for mandible reconstruction with an iliac crest graft. World Journal of Surgical
Oncology, 12(1), 190. https://doi.org/10.1186/1477-7819-12-190
• 5. Mehra, P., Miner, J., D‟Innocenzo, R., & Nadershah, M. (2011). Use of 3-D Stereolithographic Models
in Oral and Maxillofacial Surgery. Journal of Maxillofacial and Oral Surgery, 10(1), 6–13.
https://doi.org/10.1007/s12663-011-0183-3
• 6. Cornelius, C.-P. P., Giessler, G. A., Wilde, F., Metzger, M. C., Mast, G., & Probst, F. A. (2016). Iterations
of computer- and template assisted mandibular or maxillary reconstruction with free flaps containing
the lateral scapular border - Evolution of a biplanar plug-on cutting guide. Journal of CranioMaxillofacial
Surgery, 44(3), 229–241. https://doi.org/10.1016/j.jcms.2015.11.0