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M. Ghazizadeh Ahsaie and H. Farajpour
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b
dc
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Fig. 10 Patient presented with ameloblastoma lesion in the right side of the mandible. (a) The
Materialise MIMICS 21.0 software (Materialise NV, Leuven, Belgium) translated the CBCT
DIOCM data into axial, coronal, and sagittal planes and 3D view. (b) The tumor region was
detected, segmented in red, and virtual surgical resection guiding plans were placed anterior and
posterior to the lesion borders in the body of mandible. (c) The mandibular bone defect was reconstructed by mirroring the normal mandibular body on the left side, and (d) the prosthesis was
designed based on the remaining mandibular bone. (e) The nal prosthesis design was divided into
two porous sections
Data Storing andConversion inComputer-Assisted Oral andMaxillofacial Treatments
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b
c
d
Fig. 11 Creating 3D model of mandible with exact location of inferior alveolar nerve (IAN)
traced within the bone. (a) DICOM CBCT images of mandible is imported in the Materialise
MIMICS 21.0 software (Materialise NV, Leuven, Belgium). (b) A curved arch is traced on the
axial section, and (c) the corresponding panoramic view of mandible in thin section is provided.
The location of IAN is traced by connection of adjacent following dots. (d) The STL model is
generated with IAN depicted in red from the mandibular foramen in the posterior lingual to the
mental foramen in the anterior buccal of mandible
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M. Ghazizadeh Ahsaie and H. Farajpour
6.4 Orthognathic Surgery andSplint Design (Fig.12)
Conventional orthognathic surgery planning uses cephalometric analysis and mock
surgery on stone dental models. Today, computer-assisted surgical planning virtually performs osteotomies in the maxilla and mandible, and the segments can be
repositioned in any plane [25]. This method is especially useful in patients with
complex craniofacial deformities and asymmetric malocclusion resulting in facial
asymmetry. CMF ProPlan (Materialise, Leuven, 3001, Belgium) is used for splint
design and orthognathic surgery assessments. The software can accept both DICOM
data from CT imaging and STL les commonly obtained from dental optical scans
intraorally or from patients’ dental cast and further integrate this information by
fusion of DICOM to STL by superimposition of ducial markers or landmarks.
Automatic cephalometric analysis can be performed on the fused data, and Lefort,
Bilateral Sagittal Split Osteotomy (BSSO), and genioplasty osteotomies and surgical cuts with virtual placement of xation devices can be done on 3D models. This
computer-assisted surgical planning is highly accurate, providing a virtual plan that
facilitates communication between treatment team and decrease operation time.
Translating this virtual plan to real surgery is mainly done by CAD/CAM fabricated
interocclusal intermediate and nal splints, which further guide fragment repositioning [26, 27].
6.5 Dental Implant Surgical Guide (Fig.13)
Patients’ CBCT data can be imported to treatment planning software applications to
further design and fabricate surgical guides using CAD/CAM technology. The clinician can virtually assess ridge height, width, undercut, and angulation and evaluate
if there is a need for bone augmentation and whether this can be done intraoperatively. Virtual dental implant, from implant library provided by these software, can
be placed, angulated, or repositioned in the desired location, considering the ridge
anatomy and location of anatomic landmarks like distance to the sinus or nasal oor
cortex in the maxilla and IAN canal in the mandible. 3D printed surgical guides can
be mucosa, teeth, or bone supported and allow for more predictable implant insertion during the actual surgery. Although surgical guides can aid in predicting the
optimum site for implant insertion, the surgeon should be prepared for any complications that may occur intraoperatively [28].
Data Storing andConversion inComputer-Assisted Oral andMaxillofacial Treatments
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b
c
d
Fig. 12 Virtual planning for orthognathic surgery in a class III patient (angle classication) with
an anterior open bite using the CMF ProPlan (Materialise, Leuven, 3001, Belgium). (a) DICOM
data from CBCT is imported, and 3D image with segmented maxilla and mandible is provided. (b)
The STL le obtained from dental optical scan and (c, d) integration of digital data from CBCT
and optical scans of the dental arch are presented. (e) Automatic cephalometric analysis provides
information on how the osteotomy segments should be cut. (f) Computer-assisted surgical planning and the osteotomy segments of the maxilla and mandible which can be repositioned in any
plane. Intermediate and nal orthodontic splints are further designed
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M. Ghazizadeh Ahsaie and H. Farajpour
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Fig. 12 (continued)
Data Storing andConversion inComputer-Assisted Oral andMaxillofacial Treatments
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a
c
e f
b
d
Fig. 13 Designing implant surgical guide for posterior mandible (Blue Sky Plan, USA). (a)
DICOM CBCT images of mandible is imported, and cross-sectional, reformatted panoramic, and
3D surface rendering views are reconstructed. (b) 3D optical dental scan in STL format is further
fused to the 3d surface rendering view of mandible obtained from CBCT. (c, d) The software contains implant library with customized overlays corresponding to the shape and size of individual
implant types. (e) The clinician can choose the selected implant setting and virtually place the
suitable choice considering patients’ anatomic and functional factors. Note that the safe distance
to inferior alveolar nerve canal (IAN) and adjacent tooth roots is marked around the implant xture. (f) The tooth-supported surgical guide is now designed and ready to be exported to a 3D printer
7 Conclusion
DICOM data from various imaging can be used in third-party diagnostic software
and improve clinicians’ understanding of maxillofacial anatomy. Errors can be generated during any step of the process, including image acquisition, post-processing,
as well as 3D printing. Accurate choice of the source images, DICOM section thickness, and appropriate choice of printing modality are critical to achieve optimum
accuracy.
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M. Ghazizadeh Ahsaie and H. Farajpour
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Classification ofCutting-Edge Additive
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Manufacturing Techniques
HeliaSadatHaeriBoroojeni, SadraMohaghegh,
andArashKhojasteh
1 Introduction
Additive manufacturing techniques, one of the advanced technologies subsets, can
be dissected into extrusion- and fusion-based methods. The former is descriptive of
methods wherein layers of an extruded material is fused to attain the nal object,
including fused deposition modeling (FDM) and inkjet techniques. The latter refers
to methods wherein particle fusion is conducted using a stimulating agent, such as
laser, light, or heat, in order to fabricate the nal product. Fusion-based methods
include selective laser sintering (SLS), selective laser melting (SLM), direct metal
laser sintering (DMLS), electron beam melting (EBM), stereolithography (SLA),
and digital light process (DLP). Extrusion-based techniques are assumed to be relatively more cost-effective and straightforward methods [1, 2]; thus, most commonly
employed techniques are from their category [3] (Fig.1).
Hinging upon the selection of manufacturing methods, certain physicochemical
and biologic behavior of produced scaffolds can be anticipated. This is rooted in the
technical manufacturing specics that dictate the scaffolds’ geometrical characteristics (i.e., pore size, pore interconnectivity, porosity, and mechanical resistance)
and materials of choices [4]. For instance, when aiming for multi-material constructs, extrusion-based methods such as FDM are employed, and SLA or SLS are
initially ruled out [5]. Hence, materials of choice for each additive manufacturing
methods must be inevitably accounted for.
H. S. H. Boroojeni · S. Mohaghegh
Department of Oral and Maxillofacial Surgery, School of Dentistry,
Shahid Beheshti University of Medical Sciences, Tehran, Iran
A. Khojasteh (*)
Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of
Medical Sciences, Tehran, Iran
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023
A. Khojasteh et al. (eds.), Emerging Technologies in Oral and Maxillofacial
Surgery, https://doi.org/10.1007/978-981-19-8602-4_4
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Cutting-Edge Additive
Manufacturing Techniques
Extrusion-Based Methods
Fused Deposition Molding
(FDM)
Computer-Aided Wet Spinning
(CAWS)
Inkjet Printing
Stereolithography (SLA)
H. S. H. Boroojeni et al.
Low-temperature Deposition9
Manufacturing (LDM)
Powder Melt Extrusion
Digital Light Processing
(DLP)
Fusion-Based Methods
Selective Laser Sintering
(SLS)
Selective Laser Melting
(SLM)
Direct Metal Laser Sintering
(DMLS)
Electron Beam Melting (EBM)
Fig. 1 Cutting-Edge Additive Manufacturing Techniques
Regeneration, reconstruction, and rehabilitation areas of maxillofacial treatment
modalities can use different manufacturing techniques [6, 7]. Inkjet and FDM are
commonly employed for preparation of molds and rehabilitation prostheses [6],
while fabrication of surgical guides and reconstructive maxillofacial implants is
aimed for thorough application of FDM, SLA, SLS, and direct ink writing methods.
In terms of regenerative procedures, SLS, FDM, and bio-printing methods can be
employed for scaffold fabrication [6].
2 Fused Deposition Molding (FDM)
With FDM, extrusion of a melted material from a nozzle compartment occurs in the
liquid form. This method was initially developed in 1989 by Crump. The design of
FDM setups is based in spatial coordination of displacing nozzles and platforms, in
regard to CAD inputs. The dened trajectory of nozzle motion in X and Y planes,
coupled with platform displacement in Z plane, leads to fabrication of predesigned
scaffolds. On the other hand, some FDM systems are comprised of xated nozzles
while the platform travels spatially in three plans [8].
In order to prepare the printing blend, the nozzle temperature is increased until
the melting point of the working thermoplastic polymer is reached. Upon polymer
melting, piston compression, gas compression, or rotating screws are used to extrude
the material through the nozzle. Variables, including nozzle diameter, nozzle speed,
extrusion speed, printing temperature, printing pressure and platform temperature,
must be tuned.
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