CUSTOM IMPLANT FOR THE MANDIBLE USING RAPIDPROTOTYPING

ASSISTED CASTING
Dr. A. M. Kuthe*
Professor
Mechanical engineering department
Visvesvaraya National Institute of Technology, Nagpur- 440010
Email: amkme2002@yahoo.com

S. W. Dahake
Ph. D Research scholar
Mechanical engineering department
Visvesvaraya National Institute of Technology, Nagpur- 440010
Email: sandeep.savali@gmail.com

Dr. A. N. Datarkar
Professor
Department of Oral and Maxillofacial Surgery
Sharad Pawar Dental College, Wardha- 442005
Email: abhaydatarkar@yahoo.com

ABSTRACT:-
Patients who undergo surgical management of oral cancer may greatly benefit from an implant-supported
prosthesis. Rapid prototyping (RP) assisted casting for denture frameworks has resulted in a technique
for fabricating a custom made mandible implant during single surgical appointment. The fabricating
procedures are performed during the initial surgery and therefore eliminate the necessity of the patient
undergoing a second surgical procedure for attachment of the implant.

Custom implant can be fabricated using 3D modelling of the implant on computer. To get the data for 3D
modelling, clay model is first made and using reverse engineering the point data is collected. Mock
surgery is carried out on the rapidprototyping model of the diseased organ. The design of the implant is
finalised after creating the clay model first and then getting the point data using reverse engineering kit. It
is possible to get the RP part of the implant which fits well to the cut portion. RP part of implant is then
used in investment casting which is different than conventional investment casting where wax pattern is
used.

In this paper, case report in which a mandible implant was fabricated for patient suffering from cancer is
discussed. Author along with the dentist fabricated the custom made implant and successfully fitted in the
patient body.

The technique can be used in fabrication of custom made implant for patient suffering from cancer,
traumatic injury or gunshot wounds of the mandible.

* Corresponding author

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INTRODUCTION- teeth. Obliteration of the buccal vestibule was
noted.
The rapid prototyping is useful to develop
customized implant and also it helps in surgical
planning. In traditional pre-surgical planning,
radiography and photography is used for
manipulating the two dimensional (2-D) data. RP
is the technique used to produce the physical
models based on the radiography image. Thus
surgeons can visualize internal and external
anatomy prior to the surgery. The anatomical
areas in which the rapid prototyping technology
has been successfully applied at the
international level are: maxillo-facial
reconstruction; knee surgery; pelvic fracture; hip
dysplasia, aseptic necrosis and epiphysiolysis;
pinal trauma; congenital and degenerative spinal
disease; skull plasticities; craniosynostosis and
orthodontic surgery [1,2]. Medical models were
built predominantly using the stereolithography Fig 1- Before operation
(STL) and the fused deposition modeling (FDM)
techniques of RP over the last few years [2]. DESIGNING AND CUSTOMIZATION
Implementing the integrated approach of the OF IMPLANT-
medical imaging, computer-aided design (CAD),
RP, computer-aided manufacturing (CAM) and
casting for fabricating the customized medical
implants reduces lead time [2,3]. The use of the
custom made or the predesigned partial and/or
the total artificial implant remains one of the
surgical alternatives for treating various
mandibular disorders when other conservative
treatments fail [4].

MATERIALS AND METHODS –

A 27 year old female presented with a complaint
of swelling in the lower right region of the mouth
for 8 to 9 months. Swelling started as small
nodular and gradually increased to the present
size (Fig. 1, 2). This patient also complained of
loosening of teeth in the lower anterior region of
the mouth over the previous 2 to 3 months.
On extraoral examination, diffuse, oval swelling
of approximately 6cm x 3cm in the right
mandibular region, extending from the
symphysis through 3cm anterior to the angle of
the mandible, was noted. The swelling was hard,
nontender, noncompressible, and nonreducible,
with a smooth surface and indistinct edges and
showed no change in temperature. On intraoral
examination, diffuse swelling of size 8 cm x 3 cm
was noted, extending from the mandibular left
lateral incisor to the lower right second molar
region. Overlying mucosa was found to be
smooth, showing indentation of the maxillary
Fig. 2- ABS diseased part
A radiograph was acquired using X-ray machine.
Radiograph image was used for creating the RP
model for the surgical planning and the
rehearsals. The 2-D data was processed by the
segmentation and the soft tissues and the bone
structures were separated to get the actual
dimensions of the bone. The dimensions, size
and shape were determined by the surgeons
based on the radiograph. For obtaining the 3D
physical model first clay model was generated
and by using reverse engineering process 3D
CAD model was developed (Fig. 3(a)). The 3-D
CAD model was converted into .STL format with
the help of CAD software (Pro/Engineer wildfire
4.0 (PTC)) and then RP model was fabricated
(Fig. 3(b)). The tailor made implant is then

2
manufactured using RP assisted casting. The then fabricated. To create metallic model (Fig.
detail approach of customized implant design 3(c)) investment casting is carried out using RP
and manufacturing is shown in table 1 and 2. model as a pattern (Fig. 3(b)). The material
selected for the casting of the implant was
Table 1- Approach of customized implant medical grade cobalt chrome, a biocompatible
design material [7]. This alloy had been selected for its
optimum combination of properties, including
1. Radiograph good casting, superior corrosion resistance, high
2. 2D Sketching elastic modulus and ultimate strength to
3. Generate clay model withstand body forces and cost effectiveness in
4. Reverse engineering to obtain 3D CAD comparison with other biocompatible metals. All
model from clay model the aspects like the age of patient, growth of
5. Conversion into .STL format bone size, working of the mandible and the load
6. Data imported into Catalyst Software of on the implant were considered while designing
RP machine the implant. The purpose of the implant design
7. Slicing of 3D model was to restore normal functioning of the
8. Feeding into RP machine mandible for all daily living activities.

Table 2-Approach of customized implant

manufacturing

1. RP machine
2. Layer by layer manufacturing of RP
model
3. Mould preparation using RP part
4. Baking of mould
5. Investment casting (using Cobalt
chromium alloy material) (a)
6. Finished implant

The radiograph of the mandible of patient was

studied meticulously and used in the
development of the implant. The dimensions of
the implant are decided based on the bone size
from the radiograph. A compact and the
customized implant along with the proper fixing
arrangement was the need. The part file in the
form of .STL file is then imported in the catalyst (b)
pre-processing software supplied along with RP
machine (Dimension BST machine, Stratasys
Inc., Ontario, CA, USA) to get the acrylonitrile
butadiene styrene (ABS) model using FDM
method of the RP. The FDM process was
chosen because of its minimum post processing
requirements and the superior mechanical
properties, like strength of the build material [5].
It has also proved that the satisfactory accuracy,
the surface quality and the economy can be
achieved using the FDM process [6].
(c)
A custom made implant conforming to the Fig 3- (a) CAD model of implant, (b) Rapid
patient’s specific anatomical morphology was prototype implant (pattern), (c) finish implant

3

Fig. 4- Casting Process
Since FDM is an additive fabrication technology,
there is no impact on the investment or delivery
schedule as the pattern becomes more complex.
Investment casting process is quite different
process when compared to the sand casting or
other similar casting process. ABS part of which
mould cavity is to be prepared is placed on
surface and around it, an enclosure is made
either of x-ray film or any other film and fix with
packing wax. With the help of Autocast
simulation software (Fig. 4), runner and pouring
basin are designed. Slurry is made by mixing
Zirconium sand with water or biosol liquid [8].
The slurry is poured into the assembly and
allowed to settle.
CONCLUSION-
This paper describes the novel method for
developing the metallic implant using RP and an
advanced manufacturing technology. The results
and the observations have revealed that the
fabrication of the customized implant with high
degree of accuracy is possible using RP.
The implant as described has several
advantages, but certain care and long-term
studies are required to put it for widespread
commercial application. The suggested
approach allowed rectifying all possible errors in
the implant shape and size prior to the surgery
and eliminates the revision surgery in case of
probable failures. The only demerit of the
customized implant was the cost of the RP
application in designing.
A RP technology has been shown to be a viable
method for the pre-surgical planning and the
development of the customized implant. Post-
operatively, the implant proved successful and
presented no major difficulties (Fig. 5). The post-
4
operative results are overwhelmingly positive,
however, the long-term results are awaited.
The drawbacks of the conventional techniques
of reconstruction are:
Limitations in the shape and size of the
material.
Increased operation time.
Time spent in the operating room to
recontour the plates and the bone grafts.
Difficulty in achieving an adequate
maxillofacial contour during intraoperative
adaptation of the implant due to lack of
visualization of the maxillofacial anatomy.
Repeated bending of the plate can be cause
of plate fracture.
The prefabricated reconstruction plate is
often applied lateral to the surgical defect,
which does not fill the gap of the defect
leading to undue movement of the bone
segments, thus resulting in undue stresses
on the implant.
Fig 5- After operation
On the other hand the advantage of the custom
made implant shows several advantages:
The quality of the preoperative planning is
greatly improved by allowing a greater
understanding of the anatomy, as well as
the extent of the disease.
Rapid prototype models provided an
excellent reference when discussing the
surgical procedure with the patients. The
validity of the informed consent was
therefore enhanced as the patients gained a
greater understanding of the technical
 difficulties and limitations of the proposed
surgery.
The best approach to the osteotomy (of
tumor) can be assessed and a more realistic
simulation of the surgical steps can be
undertaken.
Reduced undue torsional stresses were
generated during the plate bending.
Predicting the results improves with more
accurate custom implant manufacture
preplanned screw placement and osteotomy
design.
Reduce operating time.
The accuracy of virtually designed implant
models and the individual fit of the implants
can be evaluated using the physical rapid
prototype model, this evaluation allowed for
correcting all errors in implant shape before
surgery thus this reduced the risk of a
second intervention. The psychological
stress of the patient can be eliminated.
5. Ng, P., Lee, P.S.V. and Goh, J.C.H. (2002),
"Prosthetic sockets fabrication using rapid
prototyping technology", Rapid Prototyping
Journal, Vol. 8 No. l, pp. 53-9.
6. Xu, F., Loh, H.T. and Wong, Y.S. (1999),
"Considerations and selection of optimal
orientation for different rapid prototyping
systems", Rapid Prototyping Journal, Vol. 5
No. 2, pp. 54-60.
7. Balazic, M. and Kopac, J. (2007),
“Improvements of medical implants based
on modern materials and new technologies”,
Journal of Achievement in Materials and
Manufacturing Engineering, Vol. 25 No. 2,
pp. 31-34.
8. Polaczek, AB 2008, ‘Ceramic moulding
method/Investment casting-Practical’,
RWTH (RHEINISH-WESTFALISCHE
TECHNISCHE HOCHSCHULE AACHEN)

ACKNOWLEDGEMNT-

The Research was funded by Rajiv Gandhi

Science and Technology commission (Govt. of
Maharashtra, India)

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