Dental Asia Jul/Aug 2018

52 DENTAL ASIA JULY / AUGUST 2018 Behind the Scenes Case 1 Advanced implant reconstruction for a patient missing half of her upper jaw and all her teeth (Figs. 1-4). A 3D-printed replica of the jaw gives the surgeon a feel for the surgical demands of the situation. In this case, the patient is missing one side of her upper jaw and all the teeth and supporting bone. A resin model has been used to rehearse innovative surgery, and a white nylon model was sterilised and taken to surgery to help guide the surgeon in the course of an innovative implant procedure. This patient lost half her upper jaw because of cancer. Because of the loss of a great deal of bony structure, and the type and thickness of soft tissue that was grafted into place to Ƥll the resulting cavity, using ordinary dental implants to replace the missing teeth or support a prosthesis was possible. The patient was unable to open her mouth fully after surgery and radiation treatment complicated treatment still further. The approach was to imagine the remaining structure with a CT scan and to plan implant positions in implant planning software (Fig. 1). Although software simulation is useful, it does not offer the same tangible and intuitive feel as a 3D printed model. The3Dprintedmodel allowed the left half jaw, cheekbone, and both eye sockets to be ‘handled’, and for di ơ erent approaches for surgery to be trialled and other novel options to be considered (Fig. 2). On the left side of the jaw, two special ‘zygomatic’ implants were placed into the cheekbone. These are a type of dental implant used to anchor implant bridgework for people who have lost all their teeth and have little remaining jawbone (Fig. 3). Dr. Andrew Dawood, co-founder of Dawood & Tanner, Digits2widgets and Cavendish Imaging, presents four extraordinary projects demonstrating the life-changing uses of 3D printing in dental and facial treatments. By Dr. Andrew Dawood , BDS MRD RCS MSca Fig. 1: Planning in software Fig. 2: Physical planning with 3D printed model Fig. 3: 3D-milled titanium bar Ƥtted to implant Fig. 4a: Final smile post-op Fig. 4b: Prosthesis in place For the right side, a new, specially designed custom 3D milled implant was fabricated, which could be inserted b a c kwa r d s i n t o the rim of the eye socket, through a small existing scar. I believe this is the first ever use of a ‘reverse’ implant, o n l y c o n c e i v e d and implemented w i t h t h e h e l p of 3D printing - the procedure was tried out by actually ‘operating’ on a resinmodel before surgery. Figures 4a and 4b show the result. • I mp l a n t d e s i g n a n d s u r g e r y : Dr. Andrew Dawood • P r o s t h e t i c r e c o n s t r u c t i o n : Dr. Susan Tanner • Facial surgery: Mr. Jonathan Collier and Mr. Simon Eccles, Chelsea and Westminster Hospital • 3D modelling: Dr. Veronique Sauret, Cavendish Imaging. Case 2 Computer-guided replacement of upper teeth in 30 minutes with a 3D printed template (Figs. 5-7). I m p l a n t p l a n n i n g s o f t w a r e (Nobel Clinician) is used to plan the position of dental implants for a patient missing all his teeth. To transfer this virtual planning