Cutting Edge Era of Additively Manufactured Patient Specific Titanium Implants for Expeditious Extensive Cranioplasties.

Introduction: Reconstruction of a large central calvarial defect following decompressive craniectomy can be extremely complicated and challenging if the excised bone flap is either unsalvageable, or becomes infected during the course of its preservation, rendering it unusable for subsequent reconstruction. Bifrontal cranioplasty is further constrained by the necessity of accurately reproducing the precise morphology and contour of the forehead region, to restore the most prominently displayed part of a patient's face. Alloplastic materials such as Titanium meshes and Medpore implants are incapable of providing and maintaining the necessary shape and contour in this region, and further, lack the required rigidity and impact resistance to provide adequate protection to the underlying brain. They are also often plagued by failure from implant rejection, infection and exposure.Advent of the era of three-dimensional printing and additive manufacturing has revolutionised reconstructive surgery, by allowing replication and replacement of lost body structures, thus providing 'the next best thing' to the original. Material and Methods: We describe in detail the unparalleled flexibility, precision and efficiency of additive manufacturing technology in the creation of a customised patient specific cranial implant, using Grade-5 titanium (Ti6Al4V) alloy, to restore an extensive bilateral fronto-temporo-parietal calvarial bone defect in a young adult male. Results and Conclusion: The disfiguring and debilitating post-craniectomy defect was expeditiously and successfully reconstructed using an additively manufactured, state of the art, customised titanium PSI, employing three different 3D printing modalities and materials, in a successive and stage-wise manner, to create the host-bone replica, the implant prototype and lastly, the final implant. Furthermore, the virtual implant design and the fabricated implant were subjected to a series of analyses, namely, the finite element analysis and 'Gesellschaft Optische Mebtechnik' analysis, respectively, to ensure optimal quality, standardisation and precision of the final finished and polished product, thus yielding the best possible and profoundly gratifying post-cranioplasty results.