A true world first was performed during an operation at the Orbis Medical Centre in Sittard in the Netherlands in June last year when an elderly Dutch woman received a completely new titanium mandible, perfectly imprinted one layer at a time by a 3D printer.

After an infection caused serious damage to her own mandible,  it had to be removed completely. Such a serious intervention is always followed by  reconstructive microsurgery that could take  up to sixteen hours and involves the fixing of various donor components. Considering the age of the patient, doctors decided to opt instead for a single, custom-made implant designed in Hasselt and manufactured in Louvain.

An operation involving the implanting of a mandible takes less than four hours. “In this way the woman was spared a long and risky intervention,” says Jules Poukens of the Hasselt University and co-designer of the artificial mandible with colleagues Ivo Lambrichts and Ingeborg van Kroonenburgh. Shortly after waking from her anaesthetic, the patient could utter a few words, and a day later she could talk and swallow normally.”

The mandible as well as articular bones were printed in layers by the Louvain company LayerWise, using a laser printer with titanium powder for ink. During the printing process the powder melted together, making it unnecessary to use glue or a fixative. The printed operated with such extreme precision that the artificial mandible also contains cavities to which muscles can be attached and grooves to direct veins and mandible nerves.

“The job was done in a matter of hours,” says engineer Peter Mercelis of LayerWise. If the classical implant manufacturing techniques cutting and moulding had been used, a procedure like this would have taken a few days. The mandible was finally given a bioceramic coating compatible with the patient’s tissue by BioCeramics in Leiden. Weighing 107 grams, it is only 30 grams heavier than a human mandible and not at all uncomfortable for the patient, Mercelis states.  

The use of a 3D printer to produce implants for the medical industry is nothing new as such and nearly a million people across the globe have tooth implants in their mouth which have been manufactured by variants of this technique. “But a complete mandible? No, that has never happened before,” confirms Mercelis. Meanwhile the patient is doing exceptionally well. “In two weeks’ time she will receive artificial roots in her mandible on which we will screw the dentures”, says Mercelis.