Implementation of 3D Printing and Computer-Aided Design and Manufacturing (CAD/CAM) in Craniofacial Reconstruction.

Introduction: The need for precision in craniomaxillofacial surgery has necessitated the evolution of new technology to improve patient outcomes and subsequently augment the road to recovery. Surgical planning has variables that may influence outcomes, including the image quality, image acquisition and image processing. Our review focuses on the advancement of three dimensional (3D) printing to create patient-specific constructs and therefore aims to study the current trends in the implementation of 3-D printing in craniofacial surgeries, including preferred 3-D printing techniques and materials, computer-aided design and manufacturing techniques, and outcomes as measured by recent studies.

Methods: The authors conducted a systematic review following PRISMA guidelines to query PubMed, Embase, Cochrane library and ProQuest electronic databases. Mesh combinations and synonyms of "3Dprinting", "3Dprinted", "Craniofacial" were used. The authors included all original human studies that focused on the surgical implementation of 3D-printed implants for craniofacial defects.

Results: After screening 1253 studies, the authors included 49 articles consisting of a total of 745 subjects for qualitative analysis. Titanium (n = 13) and polycaprolactone (n = 6) were the most common 3D printed materials studied while Color Jet Printing (n = 12) and Stereolithography (n = 11) were the most common techniques. All studies that compared implants acquired by 3D printing with those acquired by conventional approaches showed a significantly better prognosis, and reductions in operative time, length of stay, and immediate complications.

Conclusions: The use of patient-specific alternative materials, planning software and 3-D printing techniques shows satisfactory results in craniofacial reconstruction. Future studies should include standard levels of objective measurements to make better comparisons.