< Home



< Back

33rd Annual Scientific Meeting proceedings

Stream: SA   |   Session: Oncological challenges in the cranium
Date/Time: 07-07-2023 (14:30 - 15:00)   |   Location: Conference Hall Complex A
New developments in maxillofacial surgery – 3D printing and beyond
Bray J*
AURA Veterinary, Guildford, United Kingdom.

Computer-Aided Design (CAD) allows complex and patient-specific three-dimensional geometries to be designed that are configured to the needs of an individual patient.  Additive Manufacturing (AM) – otherwise known as 3-D printing – allows realization of the computer-designed implant. CAD and AM provides a freedom from the design constraints of conventional manufacturing processes, whilst keeping build time and costs to a realistic level.

Previous research into maxillofacial defects has tended to use either locking plates, compression resistant matrix (CRM) infused with rhBMP-2, or autogenous bone. These techniques are largely limited to focal defects, and none provide for replacement of articulation of the mandible. In humans, reconstruction of the mandible is typically achieved by microvascular transfer of autogenous bone segments. These techniques are complicated and can have a high morbidity.

Titanium and its alloys are rapidly becoming materials of choice for biomedical implants due to many favourable properties. The advent of computer aided design and 3D printing technologies using titanium powder allows creation of an implant that is uniquely designed to fit a specific patient.  A crucial design element of the titanium implant is a porous scaffold that enables vascular and cellular ingrowth into the implant, such that new bone tissue will ultimately form on the implant surface. This potential for complete integration of the implant into the host tissues is a ‘holy grail’ for human biomedical implants; integration minimises the potential for infection and implant failure, which can be devastating for the patient.

Custom designed implants for maxillofacial reconstruction are rapidly gaining acceptance in human surgery, and have been utilised in a variety of situations, particularly for craniofacial reconstruction and joint reconstruction. Due to the precise geometric fit of the custom implant, surgical complexity and operating times are reduced, with improved cosmetic outcomes.

Veterinary experiences with 3D-printing and custom designed implants for maxillofacial conditions including extensive neoplasia and trauma will be described in this lecture. Current experience suggests these implants can be well tolerated by patients, with a low rate of complications. Crucially, rapid restoration of normal mandibular dynamics may allow wider excision of affected tissues to be considered. This may serve to improve oncologic outcomes, whilst preserving acceptable function to allow a return to independence of eating and grooming behaviour.


  1. Northrup NC, Selting KA, Rassnick KM, Kristal O, O'Brien MG, Dank G, Dhaliwal RS, Jagannatha S, Cornell KK, Gieger TL. Outcomes of cats with oral tumors treated with mandibulectomy: 42 cases. J Am Anim Hosp Assoc. 2006 Sep-Oct;42(5):350-60. doi: 10.5326/0420350
  2. Boston SE, van Stee LL, Bacon NJ, Szentimrey D, Kirby BM, van Nimwegen S, Wavreille VA. Outcomes of eight cats with oral neoplasia treated with radical mandibulectomy. Vet Surg. 2020 Jan;49(1):222-232. doi: 10.1111/vsu.13341
  3. Verran J, Whitehead K. Factors affecting microbial adhesion to stainless steel and other materials used in medical devices. Int J Artif Organs. 2005;28(11):1138-45.
  4. Bray JP, Kersley A, Downing W, Crosse KR, Worth AJ, House AK, Yates G, Coomer AR, Brown IWM. Clinical outcomes of patient-specific porous titanium endoprostheses in dogs with tumors of the mandible, radius, or tibia: 12 cases (2013-2016). J Am Vet Med Assoc. 2017 Sep 1;251(5):566-579. doi: 10.2460/javma.251.5.566
  5. Liptak JM, Thatcher GP, Bray JP. Reconstruction of a mandibular segmental defect with a customized 3-dimensional-printed titanium prosthesis in a cat with a mandibular osteosarcoma. J Am Vet Med Assoc. 2017 Apr 15;250(8):900-908. doi: 10.2460/javma.250.8.900
  6. Arzi B, Stover SM, Garcia TC, Leale DM, Verstraete FJ. Biomechanical evaluation of two plating configurations for critical-sized defects of the mandible in dogs. Am J Vet Res. 2016 May;77(5):445-51. doi: 10.2460/ajvr.77.5.445
  7. Arzi B, Verstraete FJ, Huey DJ, Cissell DD, Athanasiou KA. Regenerating Mandibular Bone Using rhBMP-2: Part 1-Immediate Reconstruction of Segmental Mandibulectomies. Vet Surg. 2015 May;44(4):403-9. doi: 10.1111/j.1532-950X.2014.12123.x
  8. Winer JN, Verstraete FJM, Cissell DD, Lucero S, Athanasiou KA, Arzi B. The application of 3-dimensional printing for preoperative planning in oral and maxillofacial surgery in dogs and cats. Vet Surg. 2017 Oct;46(7):942-951. doi: 10.1111/vsu

Back to the top of the page ^