RAPID MANUFACTURING IN MEDICINEProf. dr. Jules PoukensProf. dr. Ivo Lambrichts

University Hasselt, Dep. Basic Medical Science, BelgiumMaastricht UniversityMedical Center Sittard / Heerlen, the Netherlands

OVERVIEW OF PRESENTATION

1 DESCRIPTION CLINICAL DEFECTS

2 RECONSTRUCTION PAST AND PRESENT

3 CASE STUDY SKULL DEFECT

4 CASE STUDY TEMPERO-MANDIBULAR JOINT

5 CASE STUDY MANDIBULAR DEFECT

6 CONCLUSION

WHAT ARE CRANIO-MAXILLOFACIAL DEFECTS ?

GOOD OLD FASHIONED WAYPRE-OPERATIVE MANUFACTURED IMPLANT

CT SCAN RAPID PROTOTYPING MODEL

MANUAL MANUFACTURED WAX MODELIMPLANT PMMA INJECTION MOULDED

– Standard design to customized design– Computer assistance in design and

manufacturing of implants (CAD-CAM)

5

SHIFT IN MEDICAL TREATMENT

SIMPLANT CMF SOFTWARE

SEGMENTATION VISUALISATION

3D VISUALISATION OF BONE AND SOFT TISSUE

Case study

SKULL DEFECT

RAPID PROTOTYPING MODEL

ONLY FOR VALIDATION OF IMPLANT

PATIENT

Young girl

- Car accident with large skull defect

- Reconstruction with titanium

implant

(electron beam melting)

DESIGN

Final design

ImplantTi6Al4V

ELECTRON BEAM MELTING (ARCAM)

Now follows operation video and pics

Not suited for sensitive viewers !

VIDEO SKULL

EXAMPLE CLINICAL RESULT

Case Study

CUSTOM TEMPERO-MANDIBULAR JOINT IMPLANT

Anatomy TMJFOSSA

CONDYLE

Diseases involving condylar bone lossOsteoarthrosis Cancer

Congenital Removal former implants

FOSSA part

• Titaniumsheet with 4 layers titanium mesh (custom fit) – Purpose: allow bone and soft

tissue ingrowth → maximize long-term stability of the fossa

• UHMW polyethylene with posterior stop– Flat functional surface– Provide a centric relation posititon

for the condyle

CONDYLE part

• Shaft: titanium(custom fit)

• Head: cobalt-chrome molybdene

Manufacturing(TMJ Concepts, USA)

• Construction of TMJ prosthesis

Manufacturing

Manufacturing

Surgical technique

• Approach: preauricular incision

Surgical technique

• Applying fossa– Fixation to zygomatic arch– 3-4 titanium screws 2.0mm

Surgical technique

• Applying mandible part– Fixation with 4-12 titanium

screws 2.0mm

Poukens- Lambrichts

Surgical technique

• Fitting condyle in fossa• Manipulating mandibula to

check movement possibilities

Case StudyMANDIBULAR IMPLANT

• Female , 83years old• Patient visited the out-patient clinic with

a large purulent wound on the chin • Diagnosis : massive osteomyelitis of the

mandible caused by tooth infection

Patient

Pre-operative

Anatomy (muscles)Movement of temporomandibular joint

Current treatment I• Free Bone transplants • Vascularized bone transplants

• Rib• Iliac crest• Radius• Fibula

Current treatment IICustom bended reconstruction plate with condylar

head part

Custom-made implant

Custom-made implantDesign I

Custom-made implant

Custom-made implant

Hydroxy-apatite coating

• ALERT!!!Not suited for sensitive viewers

Video

VIDEO

POSTOP

“

CONCLUSION

Computer aided engineering applied tomedicine: That's one small step for anengineer, one giant leap in medicalhistory"

Thanks for your attention