Clinical Evaluation of Patient-Specific 3D-Printed Titanium Implants for Facial Reconstruction.

Background:

Facial bone defects and contour deformities may result from congenital anomalies, trauma, tumor resection, cystic lesions, or developmental deficiencies. Conventional reconstructive techniques often rely on standard implants or intraoperative modification of grafts, which may not provide optimal anatomical adaptation or aesthetic outcomes.

Recent advances in three-dimensional (3D) imaging, computer-aided design (CAD), and additive manufacturing technologies have enabled the production of patient-specific titanium implants tailored to the unique anatomy of individual patients. These implants may improve surgical precision, reduce operative time, enhance facial symmetry, and provide more predictable functional and aesthetic outcomes.

Objective:

This clinical study aims to evaluate the effectiveness, safety, and clinical performance of patient-specific 3D-printed titanium facial implants in the reconstruction and aesthetic correction of facial defects.

Methods:

Eligible adult patients presenting with facial bone defects, facial asymmetry, congenital deformities, post-traumatic defects, or aesthetic indications requiring customized facial augmentation will undergo preoperative imaging using computed tomography (CT). Patient-specific titanium implants will be designed using computer-aided design software and manufactured using 3D-printing technology.

Clinical evaluation will include assessment of implant fit accuracy, facial symmetry, aesthetic outcomes, postoperative complications, patient satisfaction, and overall treatment success. Follow-up assessments will be performed at regular intervals for up to 12 months after surgery.

Expected Outcomes:

The study is expected to demonstrate that patient-specific 3D-printed titanium implants provide accurate anatomical reconstruction, improved facial aesthetics, high patient satisfaction, and acceptable safety profiles when used for facial reconstruction and contour correction.

• Patient-specific titanium implants for facial reconstruction (Procedure): Patient-specific 3D-printed titanium implants will be used for reconstruction of facial bone defects and correction of facial deformities. Each implant will be individually designed based on high-resolution computed tomography (CT) imaging and three-dimensional virtual surgical planning (VSP) using computer-aided design (CAD) software to accurately match the patient's anatomical defect. The implants will be manufactured from medical-grade titanium alloy (Ti6Al4V) using selective laser melting (SLM) additive manufacturing technology. Post-processing will include surface finishing and sterilization prior to surgical use. Surgical placement will be performed under general anesthesia following standard maxillofacial surgical protocols. The customized implants will be fixed to the native bone using titanium fixation screws when required to restore facial contour, structural support, and symmetry. Postoperative follow-up will include clinical and radiological assessment using CT imaging t

Primary outcomes

• Postoperative Complication Rate [From surgery up to 6 months postoperatively]: Assessment of postoperative complications following reconstruction with patient-specific 3D-printed titanium implants. Complications include infection, implant exposure, implant failure, or the need for revision surgery. Each patient will be assigned a binary score: 0 = no postoperative complication and 1 = presence of one or more postoperative complications. The outcome will be evaluated and recorded by the treating surgeon during the follow-up period. Higher values indicate a greater complication rate.
• Outcome Measure Title: Implant Geometric Accuracy Assessed by 3D Deviation Analysis [Immediately after laser-based 3D printing of the implant and before surgical implantation.]: Assessment of the geometric accuracy of the patient-specific 3D-printed titanium implant by performing three-dimensional scanning of the manufactured implant and comparing it with the original digital design using 3D deviation analysis software. Accuracy will be quantified as the root mean square (RMS) deviation between the scanned implant and the planned digital model. Lower deviation values indicate higher manufacturing accuracy.
• Aesthetic Improvement Score [3 months after surgery]: Assessment of facial symmetry following reconstruction using a standardized 5-point facial symmetry scale evaluated by an independent plastic surgeon. Scores range from 1 (severe asymmetry) to 5 (excellent symmetry). Higher scores indicate better aesthetic outcomes.

Secondary outcomes

• Total Operative Time (Minutes) [During surgery]: Assessment of the total duration of the surgical procedure, measured from skin incision to wound closure and recorded in minutes. Operative time will be compared with historical data from conventional reconstruction techniques. Lower values indicate greater surgical efficiency.
• Patient Satisfaction Score Using a 10-Point Visual Analog Scale (VAS) [3 months after surgery]: Assessment of patient satisfaction with the reconstructive outcome using a 10-point Visual Analog Scale (VAS). The scale ranges from 0 to 10, where 0 indicates complete dissatisfaction and 10 indicates complete satisfaction. Higher scores indicate greater patient satisfaction.

Sex: All, ages: 18 Years to 60 Years

Inclusion Criteria:

* Age 18 years or older.
* Presence of facial bone defects resulting from cystic or tumoral osteolytic lesions.
* Acquired or congenital facial deformities associated with bony defects or facial asymmetry.
* Patients requiring patient-specific 3D-printed titanium implants for maxillofacial reconstruction.
* Aesthetic indications requiring custom facial implant design, including microgenia (chin retrusion).
* Ability to provide written informed consent.

Exclusion Criteria:

* Active pathological lesions at the time of enrollment.
* Age below 18 years.
* History of radiotherapy within 12 months prior to enrollment.
* Chronic untreated vitamin D deficiency.
* Uncontrolled diabetes mellitus.
* Inability or unwillingness to comply with follow-up requirements.

• Results publication: Mayo W, Mohamad AH, Zazo H, Zazo A, Alhashemi M, Meslmany A, Haddad B. Facial defects reconstruction by titanium mesh bending using 3D printing technology: A report of two cases. Ann Med Surg (Lond). 2022 May 20;78:103837. doi: 10.1016/j.amsu.2022.103837. eCollection 2022 Jun. PMID 35734651
• Results publication: Almudarris BA, Rajput T, Singh V, Feroz SMA, Qurishi AA, Kumar J, Homeida HE. Outcomes of Using 3D-Printed Titanium Implants in Mandibular Reconstruction. J Pharm Bioallied Sci. 2025 Jun;17(Suppl 2):S1529-S1531. doi: 10.4103/jpbs.jpbs_1816_24. Epub 2025 Jun 18. PMID 40655799
• Results publication: Lim HK, Choi YJ, Choi WC, Song IS, Lee UL. Reconstruction of maxillofacial bone defects using patient-specific long-lasting titanium implants. Sci Rep. 2022 May 9;12(1):7538. doi: 10.1038/s41598-022-11200-0. PMID 35534499
• Results publication: Zhang WB, Yu Y, Mao C, Wang Y, Guo CB, Yu GY, Peng X. Outcomes of Zygomatic Complex Reconstruction With Patient-Specific Titanium Mesh Using Computer-Assisted Techniques. J Oral Maxillofac Surg. 2019 Sep;77(9):1915-1927. doi: 10.1016/j.joms.2019.03.014. Epub 2019 Mar 23. PMID 31002789

• Basim A Slim, Study chair, Latakia University