Protective and positioning devices in maxillofacial prosthodontics and radiotherapy: Overview

Introduction: Three-dimensional (3D) printing plays a rapidly expanding role in the field of craniomaxillofacial (CMF) surgery; however, the time and costs required to efficiently utilize this technology are highly variable. To better delineate the temporal and financial resources needed to establish an efficient workflow, we conducted a systematic review and meta-analysis of studies utilizing patient-directed 3D-printed constructs in the setting of CMF surgery. Methods: A systematic review was performed using PubMed, Web of Science, and Embase. In total, 1679 articles were screened and 45 met inclusion criteria. Primary outcomes included the costs of 3D-printed constructs and the time required for virtual surgical planning (VSP), 3D printing, surgery, and hospitalization. Results: The aggregated data assessed 751 patients, 738 surgeries, and 1136 3D-printed constructs. The most common surgical indication was post-neoplastic reconstruction (n = 304), and the most common surgical procedure was mandibular reconstruction (n = 287). Printed constructs were as follows: contour models (44.1%), guides (30.9%), implants (12.5%), splints (12.1%), and prostheses (0.5%). Printing was the longest contributor to the preoperative workflow, averaging 401.6 minutes, while VSP required, on average, only 98.6 minutes. There was no significant difference in VSP time between constructs printed in-house and those contracted from commercial vendors. However, constructs printed in-house were significantly cheaper than those procured from vendors, averaging $252.20 and $2735.50, respectively (P < .001). Of articles reporting intraoperative time (n = 19), 78.9% reported significant reductions when using 3D-printed constructs. Conclusion: 3D printing, especially in-house workflows, may reduce costs and improve efficiency for CMF surgery.

Three-Dimensional Printing for Craniomaxillofacial Surgery: A Systematic Review and Meta-analysis of Applications and Logistical Outcomes

This study aimed to assess the performance of a tongue-positioning device in interfractional tongue position reproducibility by cone-beam computed tomography (CBCT). Fifty-two patients treated with radiation therapy (RT) while using a tongue positioning device were included in the study. All patients were treated with 28 or 30 fractions using the volumetric modulated arc therapy technique. CBCT images were acquired at the 1st, 7th, 11th, 15th, 19th, 23th, and 27th fractions. Tongues on planning computed tomography (pCT) and CBCT images were contoured in the treatment planning system. Geometric differences in the tongue between pCT and CBCT were assessed by the Dice similarity coefficient (DSC) and averaged Hausdorff distance (AHD). Two-dimensional in vivo measurements using radiochromic films were performed in 13 patients once a week during sessions. The planned dose distributions were compared with the measured dose distributions using gamma analysis with criteria of 3%/3 mm. In all patients, the mean DSC at the 1st fraction (pCT versus 1st CBCT) was 0.80 while the mean DSC at the 27th fraction (pCT versus 27th CBCT) was 0.77 with statistical significance (p-value = 0.015). There was no statistically significant difference in DSC between the 1st fraction and any other fraction, except for the 27th fraction. There was statistically significant difference in AHD between the 1st fraction and the 19th, 23th, and 27th fractions (p-value < 0.05). In vivo measurements showed an average gamma passing rate of 90.54%. There was no significant difference between measurements at the 1st week and those at other weeks. The tongue geometry during RT was compared between pCT and CBCT. In conclusion, the novel tongue-positioning device was found to minimize interfractional variations in position and shape of the tongue.

Novel tongue-positioning device to reduce tongue motions during radiation therapy for head and neck cancer: Geometric and dosimetric evaluation

Contemporary Applications of 3D Printing in Prosthodontics

We describe the development of 3D-printed stents using our digital workflow and their effects on patients enrolled in the lead-in phase of a multi-center, randomized Phase-II trial. 

Development and clinical implementation of a digital workflow utilizing 3D-printed oral stents for patients with head and neck cancer receiving radiotherapy

A prospective parallel design study testing non-inferiority of customized oral stents made using 3D printing or manually fabricated methods.

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A prospective parallel design study testing non-inferiority of customized oral stents made using 3D printing or manually fabricated methods.