As he stood on a Syrian street in his civil war-ravaged country, a 23-year-old man was suddenly dropped to the ground as a rifle round shattered his lower jaw and blew his teeth to bits.

The patient was rushed across the the Syria-Israel border crossing to the Rambam Health Care Campus – Hospital, where he arrived in critical condition. The bullet had completely destroyed his lower jaw and rendered him unable to speak or eat – and it left him with little prospect of leading a normal life in the future.

syrian civil war

One million people have been wounded during Syria’s civil war and more than 200,000 people have been killed in the conflict which began in 2011.

 “Until now, the possibility of recovery in such cases was limited,” said Ofra Bar-Shalom, the Director of Israel AB Dental.

ramban hospital 3d printed jaw replacementBut this case was different due to advances in 3D printing technology and design.

After emergency treatment stabilized the patient’s condition, he was sent to the Department of Oral and Maxillofacial Surgery where doctors immediately began the process of designing the reconstruction of the underlying structure of his jaw.

The Israeli doctors, lacking any medical records for the patient – or for that matter any knowledge of how his jaw looked before he was wounded – took CT scans of what remained of his face as their starting point. Part of the modeling data came from a match to another man’s jaw which came from a large database of scans the team could access.

1831814-18Using this information and constructing a mathematical model based on the jaw structure of other patients who possessed a similar upper jaw structure, they built a custom-fit replacement which was 3D printed in medical-grade titanium by AB Dental.

Haifa’s Rambam Medical Center, the Israeli Health and Defense Ministries and AB Dental provided the patient with his new metal jaw at no charge.  A day after surgery, the patient was once again eating and speaking.

The work was done by Professor Adi Rachmiel, the Director of Rambam’s Department of Oral and Maxillofacial Surgery along with Dr. Yoav Leiser. Leiser, a specialist in restoring eye sockets, jaws and cheek bones, said the procedure gave the patient back more than simply the ability to eat and speak.

“We succeeded in returning his ‘human quality,’” Leiser said.

And it was a complex process as well.

“Treatment we’ve done in similar cases required a combination of many plates and several rounds of analysis. The new treatment is a single plate, and it’s personalized and tailored to the patient.” Rachmiel says.

Image 17Bar-Shalom says the method used is called a PSI (Patient Specific Implant), and it involves such implants being custom made for a specific patient. All the planning is done before surgery, and design changes can even take place during the surgical procedure itself.

“It saves time and analysis and gives an excellent outcome and quality,” said Bar-Shalom.

Once the team had arrived at a desired location for the implant along the jaw, a plastic model was created and once medical staff approved the model, a titanium laser printer was used to make the final fitting.

The team says the saddle-shaped structure is attached to remaining bone remnants in the jaw, and some bone samples taken from the patient’s pelvis will later be implanted to replace the teeth he had lost.

The doctors say three Israeli patients – oral cancer survivors who need new jaws – are now scheduled to undergo similar treatments as a result of what they learned during the innovative procedure.

With the latest advances in 3D printing and modeling, doctors are now using the technology to address conditions from heart defects to maxillofacial injuries. Do you know of any other instances where 3D printing has been used in medicine? Please let us know in the 3D  Printed Jaw Implant forum thread at 3DPB.com.

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