Page 136 - Craniomaxillofacial Implant Surgery - Jeroen P.J. Dings

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Chapter 7
convenient when operating in small spaces, such as in the orbital- and nasal cavities. Active guided implant placement involves navigational technology, which actively tracks the position of the surgical instruments and provides real-time information about the implant position to the surgeon. Virtual registration may be executed through invasive (usage of bony fixed markers or a neurosurgical head frame) and non- invasive registration methods (i.e. 3D-surface matching). Stereotactic navigational systems enhance clinical efficiency in eliminating the need of different laboratory steps in producing surgical templates18. Advances in virtual reality and 3D-image- based reconstruction will lead to faster data processing, reducing processing times. Accessibility of real time navigation systems using enhanced visualization has the potential to lead to more precise placements of CMF implants. However, controlled cadaver studies are needed to show the difference between the use of conventional surgical templates and stereotactic navigation since each navigational system and concomitant software has its own benefits and limitations.
Future studies should also focus on further improvements in the digital design and fabrication of CMF prostheses. The 3D-surface of a patient’s face may be acquired and used to obtain an accurate representation in color. The major advantage of this method is the avoidance of conventional laboratory steps and ease in mirroring the unaffected facial region66. Although literature already reports on directly printed silicone CMF prostheses, these are still subject to refinement of manufacturing technology before they may become a valid treatment option and alternative to conventional approaches67.
In the long-run, future developments might include tissue engineering and 3D-bio- printing of patient specific organs allowing growth of natural tissue similar to the region of implantation. To date, biological scaffolds can be printed, but are still subject to clinical research with regard to ideal scaffold properties, growth factors, extracellular matrices and cells51. Although tissue engineering seems to be an attractive option, the issue of blood supply in the bio-printed constructs is, until now, an important challenge. Fortunately, with significant advances being reported, the future of this reconstructive method appears to be promising68.
In conclusion, the 3D-revolution takes a central role in implant surgery and will influence the way surgeons and maxillofacial prosthodontist will address the restoration of CMF defects.