David Dean, PhD, associate professor in the department of plastic surgery at The Ohio State University in Columbus, has been making use of 3-D printing for clinical cases since the late 1990s, studying how to print replacements for skull bone as well as the tools and guides needed to properly set them. Implants for the skull must be carefully designed because they could inadvertently pinch off arteries to the scalp or press on the brain and cause damage.
Today, through a grant from the Department of Defense Armed Forces Institute of Regenerative Medicine, Dean is focused on facial reconstruction, specifically for soldiers, including those injured by improvised explosive devices, or IEDs. "Craniomaxillo-facial injuries make up more than one-quarter of today's battlefield injuries," he says.
Dean 3-D prints porous, resorbable implants, which are then seeded with bone progenitor cells. Those cells are cultured in a way that results in a bonelike coating of the implant prior to its implantation. Once implanted, the body replaces the implant with bone. During the replacement process, the 3-D printed resorbable polymer fully resorbs in time for the bone to remodel itself, a necessary process if the bone is to become strong.
Dean's current research is focused on the lower jaw because the blood supply in the upper jaw is more challenging. This research is expected to go to clinical trial at the end of 2018.
While 3-D printing is decidedly the wave of the future, who will absorb the costs is not yet wholly decided. At Mercy Medical Center in Baltimore, Chief of Orthopedics Marc Hungerford, MD, MBA, has worked with the hospital's 3-D printing vendor to even out costs.
Mercy uses a qualified Boston-based factory to manufacture perfect matches of patients' knees using 3-D printing, along with kits of customized instruments to set them.