Craniomaxillofacial Surgical Planning
3D Systems' VSP® surgical planning solutions for craniomaxillofacial (CMF) applications received FDA clearance as a service-based approach to personalized surgery over 10 years ago.
3D Systems and Stryker Corporation have partnered to provide surgeons with best-in-class products and services for craniomaxillofacial surgeries. As a leader in personalized healthcare solutions, 3D Systems has planned and delivered devices for more than 140,000 patient-specific cases. The Stryker Craniomaxillofacial business specializes in providing patient-specific options and innovative solutions that help drive efficiencies in surgical suites. The combination of Stryker’s specialized team and advanced implants with 3D Systems' cutting-edge 3D printing technologies and expert consulting services positions both companies to provide a superior level of service to healthcare professionals who use these revolutionary solutions.
Craniomaxillofacial Applications
VSP Orthognathics
This complete planning service eliminates the need for traditional model surgery. The first step is an interactive web meeting between the surgeon and an engineer where they simulate the procedure, including surgically accurate placement of osteotomies and bony movements. The result is an intermediate and final splint providing the clinical transfer of the digital plan into surgery. Splints are designed with several customizable features, such as minimizing/maximizing occlusal overlap, palatal strutting, sandwich splints, and more. Final surgical splints are produced in a clear material approved for up to 30 days of intraoral use. Additional patient-specific surgical guides can also be produced as required.
Benefits
At the heart of the VSP Orthognathics product is the transition away from traditional model surgery to a more accurate, anatomically based surgical simulation method. By combining medical imaging (CT/CBCT), accurate planning of osteotomies and movements, and precise surgical splints, the system removes hassle by streamlining cases and providing excellent clinical results. Surgery may be made more predictable and efficient through visualization of the anatomy through the planning process and by identifying where bony overlaps and gaps exist, all before surgery.
Technology
More than 10 years of research and development have culminated in a streamlined product offering for orthognathic surgical planning. Keys of 3D Systems' technology include the ability to accurately integrate occlusal data from high-resolution scans of the stone models and their ability to fabricate guides, splints and other tools as needed for your case using 3D printing technologies.
Case Flow
Splint and Guide Design
As the direct link to a case, the splints are highly important outputs of the system. Splints are designed with a number of customizable features, such as minimizing/maximizing occlusal overlap, palatal strutting, sandwich splints (for segmental LeFort I cases) and more. Final surgical splints are produced in a clear material approved for up to 30 days of intraoral use.
VSP Orthognathics solution provides a variety of guide options
VSP Reconstruction
This surgical planning solution is intended for head and neck reconstruction. The most widely used application is for mandibular or maxillary reconstruction using the fibula free flap and other vascularized grafts. It can also be used for reconstruction techniques for trauma, congenital defects or tumors of the facial skeleton. Surgeons report that use of the VSP Reconstruction solution enables them to perform these surgeries with more confidence and a three-dimensional perspective as compared to cases without pre-surgical planning. Dozens of peer reviewed journal articles substantiate the use of the VSP Reconstruction models, guides, and templates to reduce surgical time and create more accurate reconstructions.
Benefits
Surgeons report that use of the VSP Reconstruction product enables them to perform these surgeries with more confidence and a 3D understanding as compared to cases without pre-surgical planning. Dozens of peer reviewed journal articles substantiate the use of the VSP Reconstruction templates, models and guides in helping to reduce surgical time and create more accurate reconstructions.
Deliverables
- Reconstructed model of the anatomy showing the proposed post-operative outcome with graft in place.
- Patient specific resection guide(s) for the maxilla and/or mandible, to allow accurate transfer of the digital plan.
- Graft osteotomy guide for the donor site that contains precise osteotomies to create closing wedges, if needed.
- Metal instrument(s) that fit into the resection or osteotomy guides to provide for more accurate osteotomies and eliminate debris.
VSP Reconstruction mandible model with pre-planned cut lines
VSP Cranial
This solution applies proven and FDA-cleared virtual surgical planning techniques to craniofacial cases, especially procedures related to craniosynostosis and cases that require cranial vault distraction. Building on the success of the renowned VSP surgical planning solutions, VSP Cranial delivers improved surgical outcomes to surgeons by providing accurate pre-surgical visualization of cuts and movements, real-time comparison to age-matched normative anatomical contour, and personalized marking and positioning guides for realization of a digital plan.
Features
- Online web meetings between 3D Systems Healthcare experts and the surgeon for planning of complex osteotomies
- Accurate pre-surgical visualization of cuts and movements
- Real-time comparison to age-matched normative anatomical contour
- Personalized marking and positioning guides for realization of digital plan
- Provision of images, measurements, precision 3D printed models, marking and positioning guides
VSP Cranial provides advanced visualization for pre-surgical planning
VSP Distraction
These surgical planning solutions for distraction osteogenesis include designing placement of osteotomies, planning of distractor vectors and creation of templates for guidance of device placement, device bending and osteotomy placement. The patient’s 3D anatomy is reviewed during the planning session, and underlying teeth roots and nerves are visualized for proper distractor placement. Each case is customized to the actual distractor file to be used during surgery. Some uses of VSP Distraction include osteotomy placement, identifying a distraction vector plan, creation of templates to guide device placement, and facilitation of pre-operative hardware set up.
Uses
- Determine the placement of osteotomies
- Identify a distraction vector plan
- Create templates to guide device placement
- Facilitate pre-operative hardware set up
VSP Distraction enables osteotomy planning
VSP Trauma
This solution allows the surgeon to digitally reduce the fractured bony segments prior to surgery. The digitally reduced plan is transferred to the operating room through a series of models, guides, templates, or digital images. Since these are typically time-sensitive cases, 3D Systems makes quick service a priority. Deliverables for VSP Trauma cases include patient-specific osteotomy and positioning guides, occlusal-based positioning splints, and digitally reduced, perfected or mirrored anatomic models. Modified DICOM can be produced based on the surgical plan for use in intraoperative stereotactic navigation systems.
Deliverables
- Custom osteotomy and positioning guides can be designed specifically for a specific patient and plan. Occlusal-based positioning splints are a straightforward way to achieve maximum intercuspation and establish proper jaw relationship.
- Digitally reduced, perfected or mirrored anatomical models can be designed for a more simplified approach to reduction.
- Modified DICOM can be produced based on the surgical plan for use in intraoperative stereotactic navigation systems.
Facilitating trauma reduction surgery with repositioning guides
Jaw in a Day
Jaw in a Day® enables immediate placement of a provisional dental prosthesis during a single-stage free tissue transfer jaw reconstruction surgery. The surgical planning, along with guide and prosthesis designs, is completed using state-of-the-art CAD/CAM technology, allowing the patient to emerge after a single surgery with a full jaw reconstruction, including dental rehabilitation.
* Jaw in a Day is a registered trademark of David L Hirsch.
Technical Requirements
- Fine-cut CMF and fibula donor site CT scans (protocols available).
- Occlusal stone models and/or intraoral occlusal scans.
- Completed order form.
- Lead-time is 3-4 weeks from receipt of data to surgery.
Clinical Considerations
- Patient selection considerations:
- Benign lesions
- Minimal soft tissue loss
- Bone loss of greater than 6cm
- Fibula guide must be reproduced perfectly on the fibula (using special features/shape of guide).
- Consider using tooth-borne resection guides.
- Implants with guided system must be tapped and at bone level.
- Occlusal splint is a must.
- Provide enough room for bone, soft tissue, and prosthesis to fit comfortably (about 12mm mini-mum clearance from FFF to opposing dental arch).
- Custom reconstruction plate recommended, though may be slightly more difficult to inset with dental prosthesis.
Jaw in a Day allows for immediate placement of a provisional dental prosthesis
VSP End-to-End Workflow in Action
Integrating precision healthcare with 3D technologies for better surgical outcomes
Products used for CMF
ProJet 7000 HD
Mid-range integrated solution for SLA quality and accuracy
DMP Flex 350 and DMP Flex 350 Dual
Robust, flexible metal 3D printer for rapid part production
DICOM 3D Model Software
Advanced Visualization Software
3D Sprint
Plastic Additive Manufacturing Software
Geomagic Freeform
Organic 3D Design Software
3DXpert
All-in-One Integrated Software for Industrial Additive Manufacturing
Accura ClearVue (SLA)
High clarity plastic, multitude of applications
Accura ABS White (SL 7810) (SLA)
Simulate and replace CNC-machined white ABS parts
LaserForm 17-4PH (A)
Excellent corrosion resistance, high strength with good toughness
LaserForm Ti Gr23 (A)
High strength, low weight, excellent biocompatibility - lower Oxygen than Gr5
LaserForm Ti Gr1 (A)
Light weight, biocompatible, extreme temperature and corrosion resistance
DuraForm PA (SLS)
Durable polyamide (nylon) material for production parts