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The application of additive manufacturing (AM) technology has been widely used in various medical fields, including craniomaxillofacial surgery. The aim of the present study was to examine the surgical efficiency and post-operative outcomes of patient-specific titanium mandibular reconstruction using AM. Major steps in directly designing and manufacturing 3D customized titanium implants are discussed. Furthermore, pre-operative preparations, surgical procedures and post-operative treatment outcomes were compared among patients who received mandibular reconstruction using a customized 3D titanium implant, titanium reconstruction plates or vascularized autologous fibular grafting. Use of a customized titanium implant significantly improved surgical efficiency and precision. When compared with mandibular reconstruction using the two conventional approaches, patients who received the customized implant were significantly more satisfied with their facial appearance, and exhibited minimal post-operative complications in the 12-month follow-up period. Patients who underwent mandibular reconstruction using a customized titanium implant displayed improved mandibular contour symmetry, restored occlusal function, normal range of mouth opening and no temporomandibular joint related pain; all complications frequently experienced by patients who undergo conventional approaches of mandibular reconstruction.

Background Orthopaedic implant infections are difficult to eradicate because bacteria adhering to implant surfaces inhibit the ability of the immune system and antibiotics to combat these infections. Thermal cycling is a temperature modulation process that improves performance and longevity of materials through molecular structural reorientation, thereby increasing surface uniformity. Thermal cycling may change material surface properties that reduce the ability for bacteria to adhere to the surface of orthopaedic implants. This study aims to determine whether thermal cycling of orthopaedic implants can reduce bacterial growth. Methods In a randomized, blinded in-vitro study, titanium and stainless steel plates treated with thermal cycling were compared to controls. Twenty-seven treated and twenty-seven untreated plates were covered with 10 ml tryptic soy broth containing ~ 105 colony forming units (CFU)/ml of bioluminescent Staphylococcus aureus (S. aureus)Xen29 and incubated at 37 °C for 14d. Quantity and viability of bacteria were characterized using bioluminescence imaging, live/dead staining and determination of CFUs. Results Significantly fewer CFUs grow on treated stainless steel plates compared to controls (p = 0.0088). Similar findings were seen in titanium plates (p = 0.0048) following removal of an outlier. No differences were evident in live/dead staining using confocal microscopy, or in metabolic activity determined using bioluminescence imaging (stainless steel plates: p = 0.70; titanium plates: p = 0.26). Conclusion This study shows a reduction in CFUs formation on thermal cycled plates in-vitro. Further in-vivo studies are necessary to investigate the influence of thermal cycling on bacterial adhesion during bone healing. Thermal cycling has demonstrated improved wear and strength, with reductions in fatigue and load to failure. The added ability to reduce bacterial adhesions demonstrates another potential benefit of thermal cycling in orthopaedics, representing an opportunity to reduce complications following fracture fixation or arthroplasty.

Ameloblastoma is a benign but locally invasive odontogenic tumor that causes significant morbidity. The aim is to study an ameloblastoma treatment with reconstruction using titanium plates adapted using stereolithographic models. A 48-year-old female patient referred due to asymptomatic osteolytic lesion between teeth 47 and 48 discovered during routine radiographic study. The pathoanatomical study described a desmoplastic ameloblastoma. Due to the possibility of it being a malignant lesion, a computerized axial tomography scan was performed, which showed that the tumor was not malignant. A stereolithographic model was prepared to make the cutting guides and facilitate fitting of reconstruction plates. Three-dimensional printing technology enables fast, accurate mandibular reconstruction, helping to shorten operation time.

Treatment for mandibular fractures is commonly performed via open reduction fixation with mini titanium or resorbable plates and screws. The investigators hypothesized differences in maximum mechanical stress forces and deflection with each plating material; however, it was proposed that the experimental forces withstood by the resorbable system would be enough to withstand normal forces produced during mastication. The sample was composed of fresh cadaver mandibles that were harvested, fractured, and fixated with plates and screws. The predictor variable was fracture fixation and included a titanium plating or resorbable poly-L-lactide plating system. The primary outcome measure was maximum load withstood before plating failure measured in Newtons (N). Descriptive and bivariate statistics were computed, P value was set at .05. The sample was composed of six mandibles with and grouped by type of fixation modality, Titanium (T) (n = 3) and Resorbable (n = 3). There was a statistically significant correlation between the T group and increased maximum load (N) before failure as compared to the R group, (P = 0.023). The results suggest that fracture fixation with titanium plates and screws can withstand greater maximum forces before failure; however, the resorbable plating system withstood forces similar to/or greater than the maximum forces produced during normal mastication., Biomedical engineering; Dentistry; Materials science; Surgey; Resorbable plates; Titanium plates; Fracture; Fixation; Poly-l-lactic acid; Mandible.

Background and Objectives: There are limited evidences available about the performance of biodegradable system in the treatment of linear mandibular fractures without the aid of postoperative maxillomandibular fixation (MMF). Hence, the present study was planned to evaluate the treatment outcomes in mandibular fractures, using 2.5 mm bioresorbable plates and screws without postoperative MMF. Methodology: This cohort study compares both prospective and retrospective data. The prospective study treated 20 adult patients with linear mandibular fracture using bioresorbable plates and screws, without using postoperative MMF (Group 1). Retrospective data were collected from a previous published study in which patients were treated with bioresorbable plates and screws with 2 weeks postoperative MMF (Group 2) and those treated with metal plates and screws without postoperative MMF (Group 3). Group 1 patients were followed up at 2 and 4 months to evaluate the functional outcomes in terms of fracture mobility, malocclusion, pain, and soft-tissue deformity and compared with its preoperative findings. Further, the treatment outcomes of Group 1, Group 2, and Group 3 were compared among themselves at 2-month follow-up. Results: Group 1 patients showed a significant improvement in the treatment outcomes at 2 and 4-month follow-up. In addition, when 2 months postoperative outcomes were compared among the three groups, no statistically significant difference was observed in the treatment outcomes. Conclusion: Endpoint osteosynthesis can be achieved with the bioresorbable fixation system when used in the treatment of un-displaced linear mandibular fractures, without postoperative MMF. A minor modification of using a lower size osteotomy drill can prevent screw loosening.

Introduction. Facial trauma remains an important pathology in present days because of its effects. Facial deformities and functional alteration affect patient’s life quality and his society reinsertion. First evaluation has to be thorough to avoid any secondary complications .This type of pathology involves a pluridisciplinary approach: ENT, OMF, neurosurgeon,plastic surgeon,intensive care doctor. Healing implies complex biological process .A healed bone is capable to perform normal duties without titanium plates help. Osteosynthesis allows a faster and correct recovery. Doctors need to possess profound knowledge with regard to anatomy and physiology and to be acquainted with the reconstructive methods used in craniofacial surgery. Material and methods. This study evaluates craniofacial trauma patients who suffered different types of surgical interventions at the ENT Clinic and OMF Department of Constanta County Hospital since January the 1st 2013 until June the 1st 2017. Results. The group involves 133 cases, both genders and all ages. These 2 elements play an important role in this pathology because of the fact that the vast majority of patients are young active males. The sex ratio in the study is 7:1. In most of cases, craniofacial traumas appear after aggressions and car accidents. The nose and mandibular are fractured in a higher percentage in comparison to other parts of facial structures. Discussions. Important and sensitive structures located at this level increase the risk of possible important and definitive damages.

Mandibular continuity defects are usually reconstructed with bone grafts. However, factors associated with the tumour and the patient can still be reasons to choose reconstruction plates. The aim of this study was to find out the results of mandibular reconstructions with stainless steel AO reconstruction plates after a long follow-up period. The records of 36 patients were reviewed for personal data and the history of disease, treatment and complications. Patients with failed reconstructions were compared with those in whom the procedure had been successful. Patients and surgeons gave their opinion on the functional and cosmetic results. The mean follow-up was 39 months (range 4-99); 4 patients were withdrawn because they developed early recurrent disease and in 17 patients the reconstruction failed. We found no significant differences between the successful and the failed group. Fourteen patients could be evaluated for functional outcome, 10 of whom were totally or satisfactorily rehabilitated. Therefore, stainless steel reconstruction plates can be used in patients when other options are inappropriate. (C) 2002 The British Association of Oral and Maxillofacial Surgeons.

Removal of jammed titanium screws can be difficult due to the problem of stripping of the hexagonal heads of the screws. We present a technique of extraction of stripped screws with the use of a standard 4.5 mm stainless steel hollow mill in a patient of peri-implant fracture of the radius fixed with a titanium locking plate 2 years back. The technique is quick, safe, and cost effective.

Background: The malar bone represents a strong bone on fragile support and its processes - frontal, orbital, maxillary and zygomatic are frequently the site of fracture. Current study was done to compare the stability of zygomatic complex fracture using Biodegradable plates and titanium miniplates with one point fixation. Materials and Methods: Twenty patients of zygomatic complex fracture were randomly selected and divided in two groups which were further divided into two subgroups (A, B). Group I patients were treated with titanium miniplate at zygomatic buttress and Group II was treated by bio-resorbable plates. One point fixation was done either at zygomatic buttress or at frontozygomatic suture and it was observed that both the site have been the most favored site of rigid internal fixation in terms of stability, aesthetics and prevention of rotation of the fracture segment in either vertical or horizontal axis. Conclusion: There is no significant difference in post operative outcomes between two groups, but still bioresorbable system has some advantage over titanium system as these plates resorbs over a period of time and does not cause any interference with growth and post operative radiotherapy. However application of biodegradable system demands highly précised technique.

Traumatic isolated frontonasal injuries are seldom reported in literature as they are generally seen along with panfacial, high velocity accidents. A peculiar case, in which the patient reported with an isolated frontonasal injury due to a freak accident involving a hoe is presented here. After surgical intervention, titanium plates were used to fix the frontal bone. The sinus lining was preserved and the nasal bone was reduced and immobilized. The patient was discharged and kept on a weekly follow up.