Customized prosthesis made for patients by a digital planning platform

The Oral and Maxillofacial Surgery Service at Vall d’Hebron University Hospital has a new tools to make the recovery of patients easier. Together with the company Avinent, this service developed a new digital planning platform, pioneer, which allows surgeons to prepare the intervention and also allows them to contact engineers and technical staff who design customized prosthesis for each patient. Dr. Jordi Pamias, member of the Service and the person who leads the project, highlighted that this is a “multidisciplinary network”, between different services of the Hospital, which incorporated from the beginning the engineers involved in the fulfilling of customized prosthesis. The initiative was presented at the European Association for Cranio Maxillo-Facial Surgery congress held at London and at Materialise Mimics Innovation Conference held at Leuven, Belgium.

29 patients benefited from the possibilities which the new platform offers to experts. The patients are people affected by malignant injuries in the oral cavity or rare tumors in the jaws and the sinuses, which include sarcomas, salivary glands tumors and odontogenic tumors. This group is the one where the tool can be more useful despite Dr. Coro Bescós, head of the service, highlighted that the tool is also used in cases of facial traumatology and congenital deformations, orbital surgery and orthognatic surgery (to position maxillar and mandibular bones in cases of prominent jaws and hypoplastic maxillars).

The collaboration between Hospital and Avinent professionals allows not only to have the prosthesis, but also the guides required to reproduce virtually planned interventions with a better precision and a reduction of the time required at the operating room. This new technique enabled a high sophistication level in the reconstruction, solving the complex facial defects through the use of parts of the fibula of the patient, taking into account the simultaneous placing of dental implants and the use of customized facial prosthesis which achieve the complete restitution of the function and the esthetical aspect in order to fasten the patient return to social and working life. The security and confidentiality of personal data are guaranteed by the system.

Pioneers in computer assisted surgery

The Oral and Maxillofacial Service became in 2014 the first service in Catalonia in using the computer assisted surgery in their interventions. This meant a paradigm shift and also a change in the surgical practice based in the collaboration of different medical professionals: Oral and Maxillofacial Surgery, Medical Oncology, Radiation Oncology, Radiology and Pathological Anatomy and also engineers and technical staff to progress in the diagnosis and treatment of this kind of pathologies with the latest technology.

The computer assisted surgery, which includes an intraoperative browser similar to a GPS, enables a three-dimensional view and a real time position where the instruments are situated, improving the accuracy and reliability. The improving of the scan and image processing technology in turn allows making virtual simulation of any surgery, known as virtual preoperative planning and also the simulation of the esthetical results, known as Morphing 3D.

The possibility of designing customized prosthesis due to the network connection with engineers means a new step improving the patients’ quality of life. With the images of the intervention, he surgeons can perform a virtual planning and design customized implants for each case. This means a more accurate surgery, less hours in the operating room and a lower risk for the patient.

The next step is designing new biocompatible tissues, which is one of the research lines of the CIBBIM-Nanomedicine from the Vall d’Hebron Institute of Research (VHIR). The group of CIBBIM-Nanomedicine-New Technologies and Craniofacial Microsurgery will study the application of new biomaterials for facial reconstructive surgery, cellular therapies with stem cells in Oncology and when using new devices and biomarkers for the early diagnosis of oral cancer.