Three-dimensional rapid prototyping models in cranio-maxillofacial surgery: systematic review and new clinical applications

Olszewski, Raphaël [UCL]

Medical models represent portions of human anatomy obtained from three-dimensional (3D) medical imaging. The aim was to provide a current review of clinical applications, technical accuracy and artefacts explanation with rapid prototyping (RP) technologies in cranio-maxillofacial (CMF) surgery. We also presented new RP clinical applications in reconstructive, orthognathic, and malformative CMF surgery. A systematic review of the literature was conducted on PubMed, and based on title-abstract sifting by one observer. Inclusion criteria consisted of medical rapid prototyping, 3D models, stereolithography, selective laser sintering, fused deposition modelling, 3D printing, polyjet, maxillofacial, craniofacial, cranioplasty, and implantology. In total we found 573 articles and 96 were retained for this review. Four principal sources of 3D models for clinical applications in CMF surgery are stereolithography, selective laser sintering, 3D printing, and fused deposition modeling. 3D models were used in most of domains of CMF surgery such as: reconstructive, orthognathic, temporo-mandibular surgery, craniofacial malformations, cranioplasty, and implantology. Majority of selected articles presented with a low level of evidence (level 4, case series and case reports). Problems with costs of models and machines, toxicity of material used to build up the model, need of multidisciplinary expertise still limit the use of 3D RP models to complex cases and to university hospitals teams. Further research should be directed toward ecological low-cost 3D RP techniques providing an accuracy acceptable with its clinical use. Randomized control trials should be developed to prove the usefulness of 3D RP models in CMF surgery.