Renishaw Works With University Hospital of Wales to 3D Print Guides & Mandibular Implant for Cancer Patient

Founded in 1973, Renishaw is headquartered in the UK with offices around the world. Although the engineering and scientific technology firm specializes in metrology, they have been the power behind some remarkable 3D printing projects—from creating an orbital implant for a surgery in Nepal to 3D printing parts for the Land Rover BAR yacht competing in the America’s Cup, and far more.

Now, Renishaw has released a new case study about a recent project in metal 3D printing where they were able to help medical professionals at the University Hospital of Wales (UHW) with reconstructive work for a cancer patient who had part of his lower jaw removed.

Both a maxillofacial surgeon, Dr. Cellan Thomas, and restorative dentistry consultant, Dr. Liam Addy, were in charge of the case, handling care for the 60-year-old male with oral cancer. Their plan was to reconstruct the left side of his lower jaw with two sections harvested from his fibula bone. To do so, they would need a mandibular plate implant to hold together the sections from the fibula with the healthy sections of the jaw while the bone began to heal.

Drs. Thomas and Addy took strict measures to control the environment for the process and the surgery, choosing to create a 3D printed implant and cutting and drilling guides. In doing so, they were also pioneering a new way of preparing for and doing surgery at UHW—and in this case, for a procedure that is rare, and requires a team of up to ten medical professionals.

Dr. Thomas was aware of the benefits of 3D printing, to include precision, strength, flexibility, and more. Their plan was to have three cutting and drilling guides made, along with the mandibular plate implant.

“Most hospitals still rely on in-house prosthetic teams manufacturing their own implants using traditional methods. Hand forming and welding complex components can run the risk of parts breaking off in mid-surgery,” states Renishaw in their case study. “UHW was unwilling to face that risk. Additive manufacturing allowed the specific and complex geometries of each component to be produced and built as single pieces.”

Thomas and Addy worked with the International Centre for Design and Research (PDR), world leaders in design and applied research headquartered at Cardiff Metropolitan University, as well as Renishaw for precise additive manufacturing and assistance in completing the digital workflow sequence. 3D planning was part of what made the treatment a success, with the medical team using a CAD/CAM suite. The CT information was converted using Materialise Mimics software, and then the data was transferred into FreeForm Plus software, a favorite of Dr. Dominic Eggbeer, a Research Fellow at PDR. Dr. Eggbeer enjoys using FreeForm so much that he describes it as ‘digital clay.’

The .stl files were sent to the Renishaw facility just outside of Cardiff, and the five components were printed on their AM250 additive manufacturing systems in titanium, tested to ISO 10993 part 1.

PDR also helped Dr. Thomas by creating the 3D design for a cutting guide for him to remove sections of bone and vascular tissue.

“The precision-printed cutting guide fitted the fibula in only one location to remove any error and the mating face of the guide was perfectly contoured to fit the fibula bone with temporary screws holding the guide in place,” states Renishaw.

“The guides included an innovative design-for-assembly feature by including pilot holes to be drilled at the correct position on the bone sections and remaining jaw sections to allow for the final fixation screws. These would align perfectly with the final fixing positions on the mandible implant.”

Along with the guides, PDR was able to give the surgical team 3D models of the fibula, maxilla, and mandible to practice on before surgery, and to use for reference in the operating room too.

In the operating room, the fibula bone and tissue were attached to the existing part of the jaw, and the implant was screwed into place.

“The bone pieces fitted perfectly,” states Renishaw in their case study. “The plate was screwed into place using screw-holes that aligned with the pre-drilled pilot holes in each of the four sections of the new jaw.”

The surgery went off without a hitch—and not only that, the patient was actually getting hitched in a wedding ceremony just weeks afterward! He also recovered so well that he was able to have restorative dental surgery too with implants and bridges, once the bone had fused together.

“This is a great example of taking the best practices of precision engineering into hospital applications to deliver better, more predictable outcomes which benefit the patient, the hospital team, and have overall cost savings,” said Ed Littlewood, Marketing Manager at Renishaw’s Medical Dental Products Division.

Most importantly, there was a very successful outcome for the patient. Along with that, however, was the bonus of savings in cost, along with time in the operating room (by one or two hours).

“This case shows an intelligent use of additive manufacturing in the operating theatre. It shows how pre-planning saves surgery time,” said Dr. Eggbeer.

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