Author Topic: Biotechnology Plastic Surgery Forum - LayerWise Titanium Lower Jaw Implant  (Read 8625 times)

Offline DrBermant

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LayerWise applied Additive Manufacturing (AM) to produce an award-winning Titanium total lower jaw implant reconstruction. To treat a senior patient's progressive osteomyelitis of almost the entire bone, surgeons opted for such a complete implant the first time ever.

Doctors use 3D printing to rebuild a woman's jaw



This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

LayerWise builds world's first complete lower jaw implant sounds interesting. However, there are many details missing. There have been other total jaw reconstructions done in the past metal based.

I do like the access to denture screws, but would love to know the stress bearing metallic features of the printed process vs the forged titanum and other metallic implant frames that have been on the market. I do like the bioengineering element, but that also has been done from CAT scan templates in non biomaterials.

As a surgeon who used to perform jaw reconstructions, having a reasonably priced custom engineered implant is a miracle that may yet not be available. What was the product cost of such technology for the current market?

Making structurally viable implants that can take the stress of the human jaw is bad enough, making it an exact match to the patient's anatomy even better. Not there yet, renewable bone like framework bio-identical to the patient coming. Check out this forum post about such tissue engineering for the human ear, cartilage, not bone, but concepts along the same line. Reconstructive Ear Otoplasty Forum - Building Ears With 3D Printing Progress

I have spent hours rebuilding vascularized living tissue jaws from patients hips and am so aware of the issues involved in this matter.

I have used titanium in my jaw reconstructions in the past, but these have been in the plates and screws using bone and my framework. Are you working on bone matrix or vascularized composite jaw implants?

Come join in this Biotechnology discussion.

Hope this helps,

Michael Bermant, MD
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« Last Edit: February 13, 2012, 11:51:29 PM by DrBermant »
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Offline DrBermant

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Re: Biotechnology Plastic Surgery Forum - LayerWise Titanium Lower Jaw Implant
« Reply #1 on: February 14, 2012, 12:09:17 AM »
This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

The next question would be what documentation do they have about the success of this implant? Boy would I like to set up the Standard Pictures to demonstrate jaw reconstruction and better yet the videos. Such material would be best before the surgery to demonstrate the before, after, and sequential views for the recovery time frame. The best surgery has no bruising or swelling. Document this aspect and force the operating doctors to work on minimizing it for faster less painful recovery. Working on minimizing pain and back to activity is what I did for my jaw fractures and jaw reconstructions. It is a noble effort, one I just do not see online or in the literature much if ever.

This methodology would need to be accompanied by numeric documentation system like how wide jaw opening, side to side movement, jaw projection, bite force front and back, pain medication use after surgery. I am sure someone could improve this concept and make for a better reality based documentation vs. hand waving hype.

Hope this helps,

Michael Bermant, MD
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Michael Bermant, MD
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Offline Peter Mercelis

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Re: Biotechnology Plastic Surgery Forum - LayerWise Titanium Lower Jaw Implant
« Reply #2 on: February 14, 2012, 01:24:26 PM »
Dear Dr. Bermant,
thanks for initating this interesting discussion. Just would like to comment a few things on this jawbone implant we manufactured. First of all, let me tell you that scientific publications will follow soon. Up to know, only a general press release was sent out, and as you indicate, a lot of scientifically relevant information were not published yet.

Regarding the mechanical properties that you refer to, the 'printed' titanium material fulfills and even outperforms the mechanical specifications of forged Ti6Al4V (grade 5/23) alloys. The laser based printing process results in a fully dense material with a very fine microstructure, thus resulting in very good mechanical properties.

We agree that printing of living tissue will offer huge benefits in the future, but unfortunately this technology is still in its infancy. We do expect a great synergy between the use of 'printed' biocompatible metals like titanium, providing structural strength where necessary, and the use of printed tissue or biodegradable scaffolds, allowing regeneration of the human (bone) tissue. Both the Universities of Leuven and Hasselt in Belgium, that were involved in this reconstruction case, are performing research on the use of biodegradable bone scaffolds and on printing living tissues.

Best regards,
Peter Mercelis, PhD – LayerWise

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Re: Biotechnology Plastic Surgery Forum - LayerWise Titanium Lower Jaw Implant
« Reply #3 on: February 14, 2012, 02:48:40 PM »
Dear Dr. Bermant,
thanks for initating this interesting discussion. Just would like to comment a few things on this jawbone implant we manufactured. First of all, let me tell you that scientific publications will follow soon. Up to know, only a general press release was sent out, and as you indicate, a lot of scientifically relevant information were not published yet.

Regarding the mechanical properties that you refer to, the 'printed' titanium material fulfills and even outperforms the mechanical specifications of forged Ti6Al4V (grade 5/23) alloys. The laser based printing process results in a fully dense material with a very fine microstructure, thus resulting in very good mechanical properties.

We agree that printing of living tissue will offer huge benefits in the future, but unfortunately this technology is still in its infancy. We do expect a great synergy between the use of 'printed' biocompatible metals like titanium, providing structural strength where necessary, and the use of printed tissue or biodegradable scaffolds, allowing regeneration of the human (bone) tissue. Both the Universities of Leuven and Hasselt in Belgium, that were involved in this reconstruction case, are performing research on the use of biodegradable bone scaffolds and on printing living tissues.

Best regards,
Peter Mercelis, PhD – LayerWise

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

Welcome to our forum and discussion. Thank you for the additional information. If any of your surgeons, engineers,  and or patients would like to join in this dialogue, please let them know about us. The goal is to stimulate development and use others' experience to enhance the documentation to see just how good a method really is.

I encourage the use of Standard Photographic Documentation as I have been evolving over the years and would be glad to start a discussion about what has worked and what has not.

From the engineering perspective, it is not just the initial product characteristics, but how the part wears in the body. In someone in their 80's that may not be as much of a factor, but what about for the 16 year old trauma victim. We are looking for wear characteristics not just of the metal at the high stress areas, but the interface with the remaining body. Will the TMJ wear into the base of the skull over time? Over how long? What follow up will be needed? What living condition modifications will patients need to adapt to such as MRI and CAT scans. I know the answers to some of these, but the public does not.

This is the advantage of trying to stimulate a public meets the surgeon and engineers forum.

Hope this helps,

Michael Bermant, MD
Learn More About Plastic Surgery
Michael Bermant, MD
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