3D Biomodelling

José Domingos Santos

jdsantos@fe.up.pt
3-D Biomodelling

Bone structures
Structural complexity and Biofunctionality
CT, MRI, Ultra-sounds…
2-D and 3-D Visualization
3-D Biomodelling

Convert the 2-D views

Axial, Coronal, Sagittal

MEDICAL
3-D Virtual Model OUTPUT

MEDICAL
3-D Physical Model OUTPUT
3-D Biomodelling
• 3-D visualization computerized and physical
models of the anatomy.
• Possibility of pre-surgical planning, which will be
important to diminish surgical risks and to
achieve a much better definition of all surgical
acts.
• Easier communication between patient and
surgeons.
• Establishment of biofuncionality criteria.
• Fabrication of custom-made implants and
prostheses specifically adapted to the host site of
implantation of a particular patient.
 3-D Biomodelling

Benefits (%)

3D Biomodel +
Surgeons Images ≠
Images
Operative planning 44,09 82,21 38.12
Diagnosis 65,63 95,23 29.60
Dimensions calculation error 44,14 7,91 36.23
Operative time reduction - - 17.63

3D Biomodels
Patients Images ≠
Images
Understanding of planned
63,53 88,45 24.92
operation
3-D Biomodelling
“The ability to replicate the morphology of a biological
structure and the processing of such data by a computer to
generate de code required to manufacture the structure by
rapid prototyping apparatus”
Rapid prototyping
• Stereolithography (SLA)
• Selective Laser sintering (SLS)
• 3-D Printing
• Termojet Printing
• Laminated Object Manufacturing (LOM)
Rapid Prototyping

Surgical
Sterilization
Technology Field of Price Colour Workability
Capability
use

SLA High 2 Moderate

SLS Medium 1 Moderate

16
3D Printing Low
Millions Easy
Stereolithography (SLA)
Clinical applications
Maxillofacial surgery
Clinical Case

• The patient was diagnosed ameloblastome of

the mandible.

• Total resection of the tumour followed by

vascularized autologous bone graft implantation
that was collected from patient’s peroneal
bone.

• The required volume, length, angles and the

general morphology of the bone graft was
obtained from the 3-D model.
Maxillofacial surgery
Maxillofacial surgery
Maxillofacial surgery
Maxillofacial surgery
Clinical Case

• The patient was victim of a gunshot on the face

with partial destruction of the mandible and of
other bone structures.
• In a previous surgery carried out elsewhere a Ti
plate was implanted.
• The required volume, length, angles and the
general morphology of free-flaps was obtained
from the 3-D model.
• Fabrication of surgical guides with recovery of
the occlusion plan.
Maxillofacial surgery

• Half mandible defect

• Mandible dislocation
• Crossed-bite
• Bone defect
Computer manipulation
Surgical guides (SLA)
Free-flap designing
Radiological examination

Pre-Op Post-Op
Orthognatic surgery

24M
Free-flap designing
Free-flap designing
Maxillofacial surgery

Clinical Case

• The patient suffered from spinocellular carcinoma

in the mouth.
• He was submitted to extensive excision of the
mandible.
• Reconstruction with osteofasciacutaneous
peroneal free-flap.
Free-flap designing
Free-flap designing
Implantology

24M
Implantology
Pre-Op

Post-Op
Rare syndromes
Pectus excavatum
Treacher Collins Syndrome

Also called mandibulofacial dysostosis, affects the

head and face
Epitheses

3D Steriolithographic master of the Aspect of the epithesis produced

mirrored ear, the implant support peace using the silicone soft tooling mould.
and the silicone soft tooling mould.

Adaptation of the epithesis to the host site.

Custom-made prostheses
Custom-made prostheses
Custom-made prostheses
Custom-made prostheses
Orthopaedics
Orthopaedics
Customised Bioactive prostheses
Customised Titanium prostheses

Bone defect evaluation and implant design

Stereolitographic model and tools for implant production

 3D Biomodelling
Estudo Europeu de validação – Phidias

A técnica de Biomodelação foi usada por 54 cirurgiões de 9 países Europeus e o inquérito

abordou cerca de 50 aspectos relacionados com as patologias em questão:

Aspecto considerado Inquiridos favoráveis

Redução de tempo cirúrgico 58%

Melhoria da qualidade do diagnóstico 43%
Utilização de Biomodelos na Sala de Operações 39%
Vantagens da simulação e intervenção no Biomodelo 46.8%

Redução do tempo de cirurgia entre 30 min a 1 hora. 26%

Redução do tempo de cirurgia em mais de 2 horas. 26%

Redução do tempo de cirurgia, num âmbito geral. 58%

Dimensão da amostra: 466 pacientes com idade média de 46 anos (Desvio-padrão:20,82, min: 0,3;
max: 93)
Fonte: Medicine Meets Virtual Reality (2003), J. D. Westwood et al., IOS Press
 3D Biomodelling

Estudo australiano envolvendo 45 pacientes

A Biomodelação foi avaliada por comparação com a utilização de imagem médica e o estudo
produziu os seguintes resultados:

Cirurgiões Imagens Imagens Modelos 3D Melhoria

Planeamento cirúrgico 49% 82% 33%
Diagnóstico 66% 95% 29%
Probabilidade de erro 44% 8% 36%
Redução tempo cirúrgico - - 18%

Pacientes Imagens Imagens Modelos 3D Melhoria

Consentimento informado 64% 89% 25%

Fonte: Journal of Cranio-Maxillofacial Surgery (1999), European Association for Cranio-

Maxillofacial Surgery.
 3D Biomodelling

Estudo publicado no British Journal of Oral & Maxillofacial Surgery

Este estudo concluiu que a redução do tempo cirúrgico, a menor

necessidade de cuidados intensivos e a diminuição do tempo de
permanência no hospital, estimam uma poupança de 24.600,00€ a
27.500,00€/paciente.
3D Biomaterials structures