Metal 3D printing of prosthetics and implants for head and neck oncologic reconstruction

Abstract

Indications for resection of maxillofacial and mandibular skeletal structures include extirpation of benign and malignant tumors, trauma, and congenital defects. Reconstruction of these structures often demands free tissue transfer incorporating bone and/or soft tissue with placement of rigid titanium implants to span the bony defect and anchor the autologous bone. Historically, such implants were mass-produced in standard formats, requiring manual bending during surgery to the patient’s specific bony anatomy. Recent technological and manufacturing advancements have permitted the use of three-dimensional (3D) printed, patient-specific maxillofacial and mandibular reconstructive prosthetics and implants. Preoperative 3D printing of patient-specific prosthetics and implants composed of titanium has revolutionized maxillofacial and mandibular reconstructive surgery and has been associated with improvements in operative efficiency, enhanced functional outcomes, and reduced complication rates in early studies. Herein, we review the history and current state of metal 3D printing of prosthetics and implants for head and neck oncologic reconstruction and posit future directions for innovation and surgical refinement in this area.

Keywords

3D printing / titanium / stereolithography / head and neck / reconstruction / virtual surgical planning / Jaw-in-a-Day

References

[1] Haring CT, Marchiano EJ, Stevens JR, Malloy KM, Casper KA, Prince ME, et al. Osteotomized folded scapular tip free flap for complex midfacial reconstruction. Plast Aesthet Res. 2021; 8: 33. [DOI] [PubMed] [PMC]

[2] Chepeha DB, Moyer JS, Bradford CR, Prince ME, Marentette L, Teknos TN. Osseocutaneous radial forearm free tissue transfer for repair of complex midfacial defects. Arch Otolaryngol Head Neck Surg. 2005; 131: 513-7. [DOI] [PubMed]

[3] Futran ND. Primary reconstruction of the maxilla following maxillectomy with or without sacrifice of the orbit. J Oral Maxillofac Surg. 2005; 63: 1765-9. [DOI] [PubMed]

[4] Kim RY, Sokoya M, Ducic Y, Williams F. Free-Flap Reconstruction of the Mandible. Semin Plast Surg. 2019; 33: 46-53. [DOI] [PubMed] [PMC]

[5] Knott PD, Suh JD, Nabili V, Sercarz JA, Head C, Abemayor E, et al. Evaluation of hardware-related complications in vascularized bone grafts with locking mandibular reconstruction plate fixation. Arch Otolaryngol Head Neck Surg. 2007; 133: 1302-6. [DOI] [PubMed]

[6] Kim HAJ, De Biasio MJ, Forte V, Gilbert RW, Irish JC, Goldstein DP, et al. Optimizing Osteotomy Geometries in Posterolateral Mandibulectomies. JAMA Otolaryngol Head Neck Surg. 2024; 150: 1113-20. [DOI] [PubMed]

[7] Klotch DW, Gal TJ, Gal RL. Assessment of plate use for mandibular reconstruction: has changing technology made a difference? Otolaryngol Head Neck Surg. 1999; 121: 388-92. [DOI] [PubMed]

[8] McBee DB, DiLeo MJ, Keehn CC, Huang AT, Haskins AD, Hernandez DJ. Early and Late Complications of Mandibulectomy Free Flap Reconstruction: Does the Selective Use of Soft Tissue Only Flaps Reduce Complications? Ann Otol Rhinol Laryngol. 2024; 133: 672-8. [DOI] [PubMed] [PMC]

[9] Singh TS Jr, Bhola N, Reche A. The Utility of 3D Printing for Surgical Planning and Patient-Specific Implant Design in Maxillofacial Surgery: A Narrative Review. Cureus. 2023; 15: e48242. [DOI] [PubMed] [PMC]

[10] Su YX, Thieringer FM, Fernandes R, Parmar S. Editorial: Virtual surgical planning and 3d printing in head and neck tumor resection and reconstruction. Front Oncol. 2022; 12: 960545. [DOI] [PubMed] [PMC]

[11] Yang WF, Choi WS, Leung YY, Curtin JP, Du R, Zhang CY, et al. Three-dimensional printing of patient-specific surgical plates in head and neck reconstruction: A prospective pilot study. Oral Oncol. 2018; 78: 31-6. [DOI] [PubMed]

[12] Antúnez-Conde R, Salmerón JI, Díez-Montiel A, Agea M, Gascón D, Sada Á, et al. Mandibular Reconstruction With Fibula Flap and Dental Implants Through Virtual Surgical Planning and Three Different Techniques: Double-Barrel Flap, Implant Dynamic Navigation and CAD/CAM Mesh With Iliac Crest Graft. Front Oncol. 2021; 11: 719712. [DOI] [PubMed] [PMC]

[13] Hidalgo DA. Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg. 1989; 84: 71-9. [PubMed]

[14] Van Thienen CE, Deraemaecker R. The serratus anterior scapular flap -A new osteomuscular unit. Eur J Plast Surg. 1988; 11: 156-61. [DOI]

[15] Marchetti C, Bianchi A, Mazzoni S, Cipriani R, Campobassi A. Oromandibular reconstruction using a fibula osteocutaneous free flap: four different “preplating” techniques. Plast Reconstr Surg. 2006; 118: 643-51. [DOI] [PubMed]

[16] Brix F, Hebbinghaus D, Meyer W. Procedures and equipment for model building in relation to orthopedic and traumatologic surgery planning. Rontgenpraxis. 1985; 38: 290-2. German. [PubMed]

[17] Mankovich NJ, Cheeseman AM, Stoker NG. The display of three-dimensional anatomy with stereolithographic models. J Digit Imaging. 1990; 3: 200- 3. [DOI] [PubMed]

[18] Dadhich A, Nilesh K, Shah S, Saluja H. Three-dimensional printing in maxillofacial surgery: A quantum leap in future. Natl J Maxillofac Surg. 2022; 13: S203-11. [DOI] [PubMed] [PMC]

[19] Cunningham LL Jr, Madsen MJ, Peterson G. Stereolithographic modeling technology applied to tumor resection. J Oral Maxillofac Surg. 2005; 63: 873-8. [DOI] [PubMed]

[20] Zoabi A, Redenski I, Oren D, Kasem A, Zigron A, Daoud S, et al. 3D Printing and Virtual Surgical Planning in Oral and Maxillofacial Surgery. J Clin Med. 2022; 11: 2385. [DOI] [PubMed] [PMC]

[21] Steenhuis HJ, Pretorius L. The additive manufacturing innovation: A range of implications. J Manuf Technol Manag. 2017; 28: 122-43. [DOI]

[22] Zoccali F, Colizza A, Cialente F, Di Stadio A, La Mantia I, Hanna C, et al. 3D Printing in Otolaryngology Surgery: Descriptive Review of Literature to Define the State of the Art. Healthcare (Basel). 2022; 11: 108. [DOI] [PubMed] [PMC]

[23] Naros A, Weise H, Tilsen F, Hoefert S, Naros G, Krimmel M, et al. Three-dimensional accuracy of mandibular reconstruction by patient-specific pre-bent reconstruction plates using an “in-house” 3D-printer. J Craniomaxillofac Surg. 2018; 46: 1645-51. [DOI] [PubMed]

[24] Gareb B, Van Bakelen NB, Vissink A, Bos RRM, Van Minnen B. Titanium or Biodegradable Osteosynthesis in Maxillofacial Surgery? In Vitro and In Vivo Performances. Polymers (Basel). 2022; 14: 2782. [DOI] [PubMed] [PMC]

[25] Spałek J, Ociepa P, Deptuła P, Piktel E, Daniluk T, Król G, et al. Biocompatible Materials in Otorhinolaryngology and Their Antibacterial Properties. Int J Mol Sci. 2022; 23: 2575. [DOI] [PubMed] [PMC]

[26] Domack AM, Silverman DA, Tang AL, Zender CA, Patil YJ. Managing Oromandibular Hardware Failure after Free Flap Surgery. Semin Plast Surg. 2022; 37: 53-6. [DOI] [PubMed] [PMC]

[27] Neumann A, Kevenhoerster K. Biomaterials for craniofacial reconstruction. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2009; 8: Doc08. [DOI] [PubMed] [PMC]

[28] Gareb B, Roossien CC, van Bakelen NB, Verkerke GJ, Vissink A, Bos RRM, et al. Comparison of the mechanical properties of biodegradable and titanium osteosynthesis systems used in oral and maxillofacial surgery. Sci Rep. 2020; 10: 18143. [DOI] [PubMed] [PMC]

[29] Della Bona A, Cantelli V, Britto VT, Collares KF, Stansbury JW. 3D printing restorative materials using a stereolithographic technique: a systematic review. Dent Mater. 2021; 37: 336-50. [DOI] [PubMed] [PMC]

[30] Nyirjesy SC, Heller M, von Windheim N, Gingras A, Kang SY, Ozer E, et al. The role of computer aided design/computer assisted manufacturing (CAD/CAM) and 3-dimensional printing in head and neck oncologic surgery: A review and future directions. Oral Oncol. 2022; 132: 105976. [DOI] [PubMed]

[31] Sethi RKV, Spector ME, Chinn SB. New technologies in bony reconstruction of complex head and neck defects. Curr Surg Reports. 2021; 9: 13. [DOI]

[32] Toto JM, Chang EI, Agag R, Devarajan K, Patel SA, Topham NS. Improved operative efficiency of free fibula flap mandible reconstruction with patient-specific, computer-guided preoperative planning. Head Neck. 2015; 37: 1660-4. [DOI] [PubMed]

[33] Prisman E, Haerle SK, Irish JC, Daly M, Miles B, Chan H. Value of preoperative mandibular plating in reconstruction of the mandible. Head Neck. 2014; 36: 828-33. [DOI] [PubMed]

[34] Hanasono MM, Skoracki RJ. Computer-assisted design and rapid prototype modeling in microvascular mandible reconstruction. Laryngoscope. 2013; 123: 597-604. [DOI] [PubMed]

[35] Lakkala P, Munnangi SR, Bandari S, Repka M. Additive manufacturing technologies with emphasis on stereolithography 3D printing in pharmaceutical and medical applications: A review. Int J Pharm X. 2023; 5: 100159. [DOI] [PubMed] [PMC]

[36] Tarsitano A, Mazzoni S, Cipriani R, Scotti R, Marchetti C, Ciocca L. The CAD-CAM technique for mandibular reconstruction: an 18 patients oncological case-series. J Craniomaxillofac Surg. 2014; 42: 1460-4. [DOI] [PubMed]

[37] Padilla PL, Mericli AF, Largo RD, Garvey PB. Computer-Aided Design and Manufacturing versus Conventional Surgical Planning for Head and Neck Reconstruction: A Systematic Review and Meta-Analysis. Plast Reconstr Surg. 2021; 148: 183-92. [DOI] [PubMed]

[38] May MM, Howe BM, O’Byrne TJ, Alexander AE, Morris JM, Moore EJ, et al. Short and long-term outcomes of three-dimensional printed surgical guides and virtual surgical planning versus conventional methods for fibula free flap reconstruction of the mandible: Decreased nonunion and complication rates. Head Neck. 2021; 43: 2342-52. [DOI] [PubMed]

[39] Goetze E, Kämmerer PW, Al-Nawas B, Moergel M. Integration of Perforator Vessels in CAD/CAM Free Fibula Graft Planning: A Clinical Feasibility Study. J Maxillofac Oral Surg. 2020; 19: 61-6. [DOI] [PubMed] [PMC]

[40] Avraham T, Franco P, Brecht LE, Ceradini DJ, Saadeh PB, Hirsch DL, et al. Functional outcomes of virtually planned free fibula flap reconstruction of the mandible. Plast Reconstr Surg. 2014; 134: 628e-34e. [DOI] [PubMed]

[41] Jiang FF, Hou Y, Lu L, Ding XX, Li W, Yan AH. Functional evaluation of a CAD/CAM prosthesis for immediate defect repair after total maxillectomy: a case series of 18 patients with maxillary sinus cancer. J Esthet Restor Dent. 2015; 27 Suppl 1: S80-9. [DOI] [PubMed]

[42] Bittermann G, Scheifele C, Prokic V, Bhatt V, Henke M, Grosu A, et al. Description of a method: computer generated virtual model for accurate localisation of tumour margins, standardised resection, and planning of radiation treatment in head & neck cancer surgery. J Craniomaxillofac Surg. 2013; 41: 279-81. [DOI] [PubMed]

[43] Zweifel DF, Simon C, Hoarau R, Pasche P, Broome M. Are virtual planning and guided surgery for head and neck reconstruction economically viable? J Oral Maxillofac Surg. 2015; 73: 170-5. [DOI] [PubMed]

[44] Liu BY, Cao G, Dong Z, Chen W, Xu JK, Guo T. The application of 3D-printed titanium mesh in maxillary tumor patients undergoing total maxillectomy. J Mater Sci Mater Med. 2019; 30: 125. [DOI] [PubMed]

[45] Takano M, Sugahara K, Koyachi M, Odaka K, Matsunaga S, Homma S, et al. Maxillary reconstruction using tunneling flap technique with 3D custom-made titanium mesh plate and particulate cancellous bone and marrow graft: a case report. Maxillofac Plast Reconstr Surg. 2019; 41: 43. [DOI] [PubMed] [PMC]

[46] Mayo W, Mohamad AH, Zazo H, Zazo A, Alhashemi M, Meslmany A, et al. Facial defects reconstruction by titanium mesh bending using 3D printing technology: A report of two cases. Ann Med Surg (Lond). 2022; 78: 103837. [DOI] [PubMed] [PMC]

[47] Pu JJ, Hakim SG, Melville JC, Su YX. Current Trends in the Reconstruction and Rehabilitation of Jaw following Ablative Surgery. Cancers (Basel). 2022; 14: 3308. [DOI] [PubMed] [PMC]

[48] Kim H, Roh T, Banegas DW, Cha IH, Kim HJ, Nam W, et al. Is immediate dental implant in fibula free flap beneficial for implant survival and osteoradionecrosis in jaw reconstruction? Oral Oncol. 2024; 156: 106945. [DOI] [PubMed]

[49] Nunez A, Pak KY, Kupferman S, Lee JK, Mallen-St Clair J. Unique Application of the Jaw-in-a-Day Technique in a Case of Trauma. Laryngoscope. 2025; 135: 2331-4. [DOI] [PubMed]

[50] Khatib B, Cheng A, Sim F, Bray B, Patel A. Challenges With the Jaw in a Day Technique. J Oral Maxillofac Surg. 2020; 78: 1869.e1-1869.e10. [DOI] [PubMed]

[51] Levine JP, Bae JS, Soares M, Brecht LE, Saadeh PB, Ceradini DJ, et al. Jaw in a day: total maxillofacial reconstruction using digital technology. Plast Reconstr Surg. 2013; 131: 1386-91. [DOI] [PubMed]

[52] Zweifel D, Bredell MG, Essig H, Gander T, Lanzer M, Rostetter C, et al. Total virtual workflow in CAD-CAM bony reconstruction with a single step free fibular graft and immediate dental implants. Br J Oral Maxillofac Surg. 2018; 56: 859-63. [DOI] [PubMed]

[53] Brown JS, Shaw RJ. Reconstruction of the maxilla and midface: introducing a new classification. Lancet Oncol. 2010; 11: 1001-8. [DOI] [PubMed]

[54] Terheyden H, Raghoebar GM, Sjöström M, Starch-Jensen T, Cawood J. Preprosthetic Surgery-Narrative Review and Current Debate. J Clin Med. 2023; 12: 7262. [DOI] [PubMed] [PMC]

[55] Noh K, Pae A, Lee JW, Kwon YD. Fabricating a tooth- and implant-supported maxillary obturator for a patient after maxillectomy with computer-guided surgery and CAD/CAM technology: A clinical report. J Prosthet Dent. 2016; 115: 637-42. [DOI] [PubMed]

[56] Jahadakbar A, Nematollahi M, Safaei K, Bayati P, Giri G, Dabbaghi H, et al. Design, modeling, additive manufacturing, and polishing of stiffness-modulated porous nitinol bone fixation plates followed by thermomechanical and composition analysis. Metals. 2020; 10: 151. [DOI]

[57] McCann AC, Shnayder Y, Przylecki WH, Kakarala K, Nazir N, Girod DA, et al. Comparison of Modern Rigid Fixation Plating Outcomes for Segmental Mandibular Microvascular Reconstruction. Laryngoscope. 2019; 129: 1081-6. [DOI] [PubMed]

[58] Taylor SL, Ibeh AJ, Jakus AE, Shah RN, Dunand DC. NiTi-Nb micro-trusses fabricated via extrusion-based 3D-printing of powders and transient-liquid-phase sintering. Acta Biomater. 2018; 76: 359-70. [DOI] [PubMed]

[59] Kang HW, Lee SJ, Ko IK, Kengla C, Yoo JJ, Atala A. A 3D bioprinting system to produce human-scale tissue constructs with structural integrity. Nat Biotechnol. 2016; 34: 312-9. [DOI] [PubMed]

[60] Marquardt MD, Cowen E, Fenberg R, von Windheim N, Lashutka M, Reid AE, et al. Mandibular reconstruction outcomes for in-house patient-specific solutions. 3D Print Med. 2025; 11: 31. [DOI] [PubMed] [PMC]