Selective laser sintering technology for customized fabrication of facial prostheses Guofeng Wu DDS, PhDa, Bing Zhou DDSb,

Yunpeng Bi DDSc and Yimin Zhao DDS, PhDd,

a ,

Lecturer, Department of Prosthodontics. School of Stomatology, Fourth Military Medical University FMMU!, Doctoral student, Department of Prosthodontics. School of Stomatology, Fourth Military Medical University FMMU!, "i#an, $hina

"i#an, $hina
b

%raduate student, Department of Prosthodontics. School of Stomatology, Fourth Military Medical University FMMU!, "i#an, $hina Professor and Dean, School of Stomatology. School of Stomatology, Fourth Military Medical University FMMU!, "i#an, $hina

&vailable online '( )une '**+. ,raditionally, -a. or clay sculpted patterns have been used in the development of facial prostheses. /eadvances in rapid prototyping technologies have demonstrated significant advantages compared to more conventional techni0ues for fabricating facial prostheses. ,he use of selective laser sintering technology described in this report is an alternative approach for fabricating a -a. pattern for a partial nasal prosthesis. ,his ne- approach can generate the -a. nasal pattern directly and reduce labor1intensive laboratory procedures. ) Prosthet Dent '**+23**4(515*!

Article Outline
,echni0ue Discussion Summary &c6no-ledgements 7eferences 8ver the past decade, advances in rapid prototyping 7P! have continued to evolve, resulting in the development of ne- techni0ues -hich have been applied to the fabrication of ma.illofacial prostheses. Rapid prototyping is used to describe the customized production of solid models using 91dimensional 91 D! computer data, and has resulted in fabrication technologies such as stereolithography SL&, the first rapid prototyping techni0ue!, fused deposition modeling FDM!, and, more recently, selective laser sintering SLS!.3 $urrently, SL& technology is the most popular 7P technology applied in the field of ma.illofacial prosthetics, and has demonstrated significant advantages.:';, :9; and :<; ,he SL& method uses li0uid photopolymer resins that are solidified by a laser to generate ma.illofacial prototypes. =o-ever, a ma>or disadvantage of SL& technology is that it can only fabricate resin prototypes of facial prostheses, -hich cannot be directly used for laboratory processing:(; and :5;2 thus, the technicians or anaplastologists must replicate the resin prototypes in a -a. pattern using conventional dental impression?replication methods. 8bviously, these additional processes result in significantly greater comple.ity, re0uire more time, and li6ely result in greater inaccuracies. & method to eliminate the re0uired replication of SL& resin patterns is to use SLS technology, -hich enables the direct fabrication of -a. prototypes for development of facial prostheses. @n the last feyears, SLS technology has been used in the medical field. ,his approach enabled replication of a temporal bone model suitable for dissection training and education.A Fabrication of a 91D laryngeal model

for laryngeal surgery -ith the use of SLS has also been reported.+ =o-ever, the literature to date has rarely reported using SLS technology for fabrication of ma.illofacial prostheses. ,he SLS process -as developed at the University of ,e.as in &ustin, ,e., and is a patented process D,M $orp, &ustin, ,e.!. Unli6e SL&, SLS technology generates direct solid -a. patterns instead of resin patterns from -a. po-der or polystyrene po-der.B @t is a free1form fabrication method, creating patterns using thermal fusing sintering! of po-dered materials. ,he SLS models are generated directly from 91D computer data converted to S,L files, -hich are then sliced into thin layers typically about *.3 mm?*.**< inches! using the associated soft-are.B ,he laser sintering machine produces the models on a moveable platform by applying incremental layers of the pattern material. For each layer, the machine lays do-n a film of po-dered material -ith an accurate thic6ness appro.imately *.3 mm?*.**< inches!. ,he laser then melts selected areas so that they conform to the previous layer. ,he platform then moves do-n the preprogrammed layer thic6ness, a fresh film of po-der is laid do-n, and the ne.t layer is melted -ith e.posure to the laser source. ,his process continues, layer by layer, until the pattern is completed. ,he manufacture time is reduced and its cost is less, compared to the SL& approach. ,he precision of the SLS process has been reported to be -ithin 3* Cm.3 ,his article describes the use of SLS technology to create a -a. nasal pattern.

Technique
3. D.amine the patient and discuss the treatment options Fig. 3!

=igh10uality image 3*BE!Fig. 3. Patient -ith partial nasal defect. '. Seat the patient upright in a dental chair to minimize any movement. Scan the patientFs face -ith an optical digitizing scanning system 9DSS1S,D1@@2 DigitalManu $orp, Shanghai, $hina! for < seconds to obtain 3A<,(<3 data points. 9. ,ransfer and save the data to a computer Pavilion a59((cn2 =e-lett1Pac6ard, Palo &lto, $alif! as an &S$@@ file. Process the data -ith reverse engineering soft-are %eomagic Studio 3*.*2 %eomagic, 7esearch ,riangle Par6, /$!. <. %enerate a $&D model of the patientFs face Model &! Fig. ', &!. ,riangulate the topographic point cloud data to reconstruct the surface profiles. $onnect each data point to its ' nearest ad>acent points to form thousands of triangles, -hich are then interconnected automatically by the soft-are.

=igh10uality image '5*E!Fig. '. $omputer1aided design process for nasal prosthesis. &, ,hree1 dimensional model of patientFs face based on digitized data. G, Selected nasal model from 91D nose ban6. $, $&D model of nasal prosthesis prototype. (. Pic6 3 similar nasal model Model G! Fig. ', G! from a 91D nose ban6 $hinese 91D /ose Model Database2 FMMU, "i#an, $hina! to match -ith Model &. @nvite the patient to vie- the images of the nasal model on the computer screen and e.press any re0uests for corrections. Merge the ' models into 3 file to obtain the data for the development of the nasal prosthesis prototype Model $! Fig. ', $!. 5. ,ransfer Model & and Model $ into physical 91D models, respectively, using the selective laser sintering system &FS195*2 Gei>ing Long Huan 1 &utomated Fabrication System $o, Ltd, Gei>ing, $hina!. %enerate a -a. prototype Model D! Fig. 9! -ith the -a. po-der LH1I&"2 Gei>ing Long Huan 1 &utomated Fabrication System $o, Ltd! from Model $. $reate another resin prototype Model D! Fig. <! from Model & -ith the polystyrene po-der PSG132 Gei>ing Long Huan 1 &utomated Fabrication System $o, Ltd!. $ontrol the fabrication of the model using soft-are Magics 7P B.(2 Materialise %roup, Leuven, Gelgium!.

=igh10uality image +'E!Fig. 9. Ia. model of nasal prosthesis from SLS process.

=igh10uality image 5(E!Fig. <. 7esin model of nasal defect fabricated -ith SLS process. A. Place Model D on the patient for modification and correction. Dvaluate the contours and marginal fit of the nasal prosthesis. +. Set Model D on Model D Fig. (!, finalize the margins, and add the s6in te.tures to replicate the s6in characteristics of the patient.

=igh10uality image A*E!Fig. (. Ia. nasal pattern -ith resin model of nasal defect. B. Process Model D and Model D together, and fabricate the definitive nasal prosthesis in the conventional manner.
3*

@nvest Model D and D -ith the dental stone /e- Fu>iroc62 %$ Lab ,echnologies @nc, &lsip, @ll!

Fig. 5! to produce the mold, then heat the flas6 and remove the -a. prototype Model D!. Fill the mold -ith silicone material &1'3+52 Factor @@, @nc, La6eside, &riz! and polymerize it in a temperature1 controlled -ater bath. Paint the definitive nasal prosthesis -ith special colorants Functional @ntrinsic S6in $olors Eit and D.trinsic $oloration System2 Factor @@, @nc, La6eside, &riz! and evaluate it on the patientFs face Fig. A!.

=igh10uality image B*E!Fig. 5. Flas6ed -a. pattern on resin model.

=igh10uality image 3A9E!Fig. A. $ompleted partial nasal prosthesis on patient. &, Left1side vie-. G, 7ight1 side vie-.

Di cu

ion

,he techni0ue described in this article represents an innovative fabrication method that may be advantageous for the patient as -ell as the ma.illofacial prosthodontist. Using the SLS techni0ue, the need for labor1intensive?time1consuming sculpting -as significantly reduced because the nasal -a. pattern -as automatically fabricated by machine. &nother advantage of SLS -a. is its lo- cost, -hich is appro.imately 5*J less than that of the SL& photopolymer resins. ,he mar6et price of an SLS machine is appro.imately A(J of the price of an SL& machine. Furthermore, the used -a. material can be sterilized by epo.yethane and recycled. ,he precision of the computerized model allo-s for satisfactory restoration of the facial contours. @n addition, the SLS machine fabricated the polystyrene resin prototype of nasal defect Model D! in this study2 this model -as then processed -ith an SLS -a. pattern for flas6ing. ,he SLS resin model -as produced directly from the data of 91D contact1free measurements, -hich offered the advantage of not distorting the facial tissue, as can occur -ith more conventional moulage impression techni0ues. SLS models are precise replicas of the patientFs anatomy.33 ,he techni0ue described demonstrates that the SLS resin prototype -as an acceptable substitute for the conventional plaster?stone moulage cast?mold for laboratory processing. =o-ever, the SLS techni0ue has limitations. ,he e.isting SLS -a. material is designed for industrial use and needs refinement to be suitable for use in the fabrication of ma.illofacial prostheses. $urrently, the process is also relatively costly due to its limited mar6etability and e.pensive e0uipment. Dven -ith these

limitations, SLS technology has begun to ma6e an impact in medicine. SLS and other rapid prototyping techni0ues have been and -ill be applied to a -ide variety of medical applications. @n time, more advanced 7P applications -ill become available in hospitals and clinics, -here a large number of patients could benefit from this technology.

Summar!
,his article describes the use of SLS to produce a -a. prototype for the fabrication of a partial nasal prosthesis. ,his techni0ue may be an alternative to more conventional laboratory techni0ues for facial prosthesis fabrication and allo-s direct generation of definitive -a. patterns. Iith the satisfying effect of nasal defect restoration, patients may be effectively rehabilitated and derive emotional and physical benefit from the treatment provided.

Ac"no#ledgement
,he authors than6 Dr Steven P. =aug and the &merican &cademy of Ma.illofacial Prosthetics for their support of this article.

$eference
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