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      Three-dimensional Printing in Maxillofacial Surgery: Hype versus Reality

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          Abstract

          Three-dimensional printing technology is getting more attention recently, especially in the craniofacial region. This is a review of literature enlightening the materials that have been used to date and the application of such technology within the scope of maxillofacial surgery.

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          Most cited references23

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          3D-printing techniques in a medical setting: a systematic literature review

          Background Three-dimensional (3D) printing has numerous applications and has gained much interest in the medical world. The constantly improving quality of 3D-printing applications has contributed to their increased use on patients. This paper summarizes the literature on surgical 3D-printing applications used on patients, with a focus on reported clinical and economic outcomes. Methods Three major literature databases were screened for case series (more than three cases described in the same study) and trials of surgical applications of 3D printing in humans. Results 227 surgical papers were analyzed and summarized using an evidence table. The papers described the use of 3D printing for surgical guides, anatomical models, and custom implants. 3D printing is used in multiple surgical domains, such as orthopedics, maxillofacial surgery, cranial surgery, and spinal surgery. In general, the advantages of 3D-printed parts are said to include reduced surgical time, improved medical outcome, and decreased radiation exposure. The costs of printing and additional scans generally increase the overall cost of the procedure. Conclusion 3D printing is well integrated in surgical practice and research. Applications vary from anatomical models mainly intended for surgical planning to surgical guides and implants. Our research suggests that there are several advantages to 3D-printed applications, but that further research is needed to determine whether the increased intervention costs can be balanced with the observable advantages of this new technology. There is a need for a formal cost–effectiveness analysis. Electronic supplementary material The online version of this article (doi:10.1186/s12938-016-0236-4) contains supplementary material, which is available to authorized users.
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            Biocompatibility and osteogenesis of biomimetic nano-hydroxyapatite/polyamide composite scaffolds for bone tissue engineering.

            In this study, we prepared nano-hydroxyapatite/polyamide (n-HA/PA) composite scaffolds utilizing thermally induced phase inversion processing technique. The macrostructure and morphology as well as mechanical strength of the scaffolds were characterized. Mesenchymal stem cells (MSCs) derived from bone marrow of neonatal rabbits were cultured, expanded and seeded on n-HA/PA scaffolds. The MSC/scaffold constructs were cultured for up to 7 days and the adhesion, proliferation and differentiation of MSCs into osteoblastic phenotype were determined using MTT assay, alkaline phosphatase (ALP) activity and collagen type I (COL I) immunohistochemical staining and scanning electronic microscopy (SEM). The results confirm that n-HA/PA scaffolds are biocompatible and have no negative effects on the MSCs in vitro. To investigate the in vivo biocompatibility and osteogenesis of the composite scaffolds, both pure n-HA/PA scaffolds and MSC/scaffold constructs were implanted in rabbit mandibles and studied histologically and microradiographically. The results show that n-HA/PA composite scaffolds exhibit good biocompatibility and extensive osteoconductivity with host bone. Moreover, the introduction of MSCs to the scaffolds dramatically enhanced the efficiency of new bone formation, especially at the initial stage after implantation. In long term (more than 12 weeks implantation), however, the pure scaffolds show as good biocompatibility and osteogenesis as the hybrid ones. All these results indicate that the scaffolds fulfill the basic requirements of bone tissue engineering scaffold, and have the potential to be applied in orthopedic, reconstructive and maxillofacial surgery.
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              Three-Dimensional Printing and Medical Imaging: A Review of the Methods and Applications.

              The purpose of this article is to review recent innovations on the process and application of 3-dimensional (3D) printed objects from medical imaging data. Data for 3D printed medical models can be obtained from computed tomography, magnetic resonance imaging, and ultrasound using the Data Imaging and Communications in Medicine (DICOM) software. The data images are processed using segmentation and mesh generation tools and converted to a standard tessellation language (STL) file for printing. 3D printing technologies include stereolithography, selective laser sintering, inkjet, and fused-deposition modeling . 3D printed models have been used for preoperative planning of complex surgeries, the creation of custom prosthesis, and in the education and training of physicians. The application of medical imaging and 3D printers has been successful in providing solutions to many complex medical problems. As technology advances, its applications continue to grow in the future.
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                Author and article information

                Journal
                J Tissue Eng
                J Tissue Eng
                TEJ
                sptej
                Journal of Tissue Engineering
                SAGE Publications (Sage UK: London, England )
                2041-7314
                20 April 2018
                Jan-Dec 2018
                : 9
                : 2041731418770909
                Affiliations
                [1-2041731418770909]UCL Eastman Dental Institute, London, UK
                Author notes
                [*]Jonathan Knowles, UCL Eastman Dental Institute, 256 Gray’s Inn Road, London WC1X 8LD, UK. Email: j.knowles@ 123456ucl.ac.uk
                Author information
                https://orcid.org/0000-0002-9841-3406
                Article
                10.1177_2041731418770909
                10.1177/2041731418770909
                5949934
                29774140
                8fed0e57-a5ff-48b0-a6d4-a7a0b0d49dd7
                © The Author(s) 2018

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 5 March 2018
                : 25 March 2018
                Categories
                Short Communications
                Custom metadata
                January-December 2018

                Biomedical engineering
                3d printing,facial reconstruction,maxillofacial surgery,surgical education

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