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Additive Manufacturing and Digital Workflows in Maxillofacial Prosthetics

Aim: The study group aims to implement digital workflows in the treatment of patients with maxillo-facial defects.


Digital Workflows offer the chance to capture facial defects and reconstruct facial parts with computer-aided design (CAD) software. Thereafter these virtuell models can be transfered to facial prosthesis by means of additive manufacturing. These workflows may reduce burdens for the patients, cost and time for the treatment. However, the efficiency of particular technologies adopted into the workflow remains to be clarified.

The project involves dentists, maxillofacial surgeons, maxillofacial and dental technicians, and material science research associates.

It touches upon three areas of interest:

(1) clinical outcome,(2) process efficiency, (3) data management.(see scheme).

Focussing on particular working package in an area of interest, other working packages are concatenated in research and application.

Thus, the reseach process is synergistic and input generates multiplied output.
Furthermore, research output can be combinded, implemented and worked-up with questions aside of maxillo-facial rehabilitation. Especially, 3D head and face capturing is of interest in orthodontics and even though for congenital facial malformations in neonatology.

Recently, four separate studies have been set-up to cover various working packages (WP, see Figure).

Study #1 – Esthetic outcome of maxillofacial rehabilitation by means of digitally derived facial prostheses

A geometrical trueness to the former organ anatomy and precise marginal fit are the main factors that make a facial prosthesis more inconspicuous. This study aims to investigate the marginal adaptation (WP 1c) of various prostheses manufactured within a digital workflow and their match to the surrounding facial anatomy in terms of form trueness and positioning (WP 1b) in comparison to a conventionally constructed prosthesis. It is also intended to calculate the production time and costs needed for both conventional and digital workflows (WP 2c).

Study #2 – Quantification of the Skin Texture Reproduction Level

A well reproduced skin surface structure of an affected facial region contributes significantly to the subjective perception of prosthesis. The current study aims to quantify the depth of skin details that can be transferred into a final silicone prosthesis with the use of three AM methods in context of “indirect mold making” approaches (work packages [WP] 1d, 3c, 3d) and direct silicone printing with accordance to rapid manufacturing approach (RM) (WP 2b). Thereby the printing time and costs will be quantified to allow a trade-off calculation for the quality of skin surface reproduction (WP 2c).

Study #3 – Patients reported outcomes of maxillofacial rehabilitation in context of digital and conventional workflows

The patient reported outcomes are of major interest to underline the efficiency of the digital workflow. However, the literature lacks data about the burdens experienced by the patient during the above mentioned treatment sequence and is rather concentrated on their acceptance of the final prosthesis itself. The current study aims to investigate the patients’ perception of the treatment process within a digital workflow, particularly in comparison with a conventional one (WP 1a).

Study #4 – Creation of a digital database of facial anatomical parts to aid a quicker digital workflow of facial prostheses fabrication.

When dealing with patients that are missing only one of the symmetrical organs (ear, eye, chick), the original anatomy from the contralateral side can be adopted. However, there are also more extended defects, whereby the anatomy of both organs (ear) is missing. The restoring of the former anatomy from the very beginning even in the CAD software can be challenging and time-consuming. A database of pre-saved facial anatomical part could aid a quicker and more efficient remodeling of deficient areas. The intention of the study is to create an extensive database, which will also include the ear anatomy as well as the database of the skin surface details, according to the gender and age. Furthermore, the accessories and equipment for the prostheses retention, such as magnetic clips and scanbodies will be applied for the quicker CAD delivery of retentive mechanisms and their integration into the prosthesis prototype.