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. 2020 Aug 31;9(9):2818.
doi: 10.3390/jcm9092818.

Quality Characteristics and Clinical Relevance of In-House 3D-Printed Customized Polyetheretherketone (PEEK) Implants for Craniofacial Reconstruction

Neha Sharma  1   2 , Soheila Aghlmandi  3 , Shuaishuai Cao  1   2 , Christoph Kunz  1 , Philipp Honigmann  2   4   5 , Florian M Thieringer  1   2
Affiliations

Quality Characteristics and Clinical Relevance of In-House 3D-Printed Customized Polyetheretherketone (PEEK) Implants for Craniofacial Reconstruction

Neha Sharma et al. J Clin Med. .

Abstract

Additive manufacturing (AM) of patient-specific implants (PSIs) is gradually moving towards in-house or point-of-care (POC) manufacturing. Polyetheretherketone (PEEK) has been used in cranioplasty cases as a reliable alternative to other alloplastic materials. As only a few fused filament fabrication (FFF) printers are suitable for in-house manufacturing, the quality characteristics of the implants fabricated by FFF technology are still under investigated. This paper aimed to investigate PEEK PSIs fabricated in-house for craniofacial reconstruction, discussing the key challenges during the FFF printing process. Two exemplary cases of class III (Group 1) and class IV (Group 2) craniofacial defects were selected for the fabrication of PEEK PSIs. Taguchi's L9 orthogonal array was selected for the following nonthermal printing process parameters, i.e., layer thickness, infill rate, number of shells, and infill pattern, and an assessment of the dimensional accuracy of the fabricated implants was made. The root mean square (RMS) values revealed higher deviations in Group 1 PSIs (0.790 mm) compared to Group 2 PSIs (0.241 mm). Horizontal lines, or the characteristic FFF stair-stepping effect, were more perceptible across the surface of Group 1 PSIs. Although Group 2 PSIs revealed no discoloration, Group 1 PSIs displayed different zones of crystallinity. These results suggest that the dimensional accuracy of PSIs were within the clinically acceptable range; however, attention must be paid towards a requirement of optimum thermal management during the printing process to fabricate implants of uniform crystallinity.

Keywords: 3D printing; PEEK; additive manufacturing; craniofacial; customized; dimensional accuracy; fused filament fabrication; patient-specific implants; point-of-care; reconstruction.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
An overview of the schematic representation of the optimization and the verification protocols.
Figure 2
Figure 2
Projected view of a test object showing the landmark points: green points represent the landmark points for measurements and blue signs represent that the test object has equal dimensions (20 mm) in x-, y-, and z-axes.
Figure 3
Figure 3
Illustration of three-dimensional (3D) volumetric reconstructions of craniofacial structures with patient-specific implants (PSIs). (a) Group 1 class III cranial defect reconstruction with PSI and (b) Group 2 class IV cranial defect reconstruction with PSI.
Figure 4
Figure 4
Fused filament fabrication (FFF) 3D printed polyetheretherketone (PEEK) cranial PSIs (in situ). (a) Group 1 PSI and (b) Group 2 PSI.
Figure 5
Figure 5
Main effects plot for signal-to-noise (S/N) ratio. LT, layer thickness; INFILL%, infill rate; NSHELLS, number of shells; PATTERN, infill pattern.
Figure 6
Figure 6
Descriptive data distribution for Group 1 PSIs, illustrating the difference between planned and FFF 3D printed PEEK PSIs (PSI model 1–3). (a) mean difference ± SD (mm) and (b) median difference (Q1 to Q3) (mm).
Figure 7
Figure 7
Descriptive data distribution for Group 2 PSIs, illustrating the difference between planned and FFF 3D printed PEEK PSIs (PSI model 1–3). (a) mean difference ± SD (mm) and (b) median difference (Q1 to Q3) (mm).
Figure 8
Figure 8
Color-coded deviation maps illustrating the areas of congruence or incongruence between planned and FFF 3D printed PEEK PSIs. Group 1 PSI: (a) squamous (outer) surface and (b) cerebral (inner) surface and Group 2 PSI: (c) squamous (outer) surface and (d) fronto-orbital (inner) surface.
Figure 9
Figure 9
Signs of slight discoloration (dark-brownish areas) in Group 1 PSIs.
Figure 10
Figure 10
Illustrations of the FFF PEEK 3D printing issues in the cranial implants regarding different orientations. (a) horizontally printed cranial implant showing raft detachment/warping effect (in situ); (b) horizontally printed cranial implant displaying rough internal surface; (c) vertical printed cranial implant exhibiting different levels of crystallinity (in situ); (d) 3D printed skull biomodel with the vertically printed implant after support structure removal; and (e) annealed vertically printed cranial implant displaying no discolorations.
Figure 11
Figure 11
Structural failure in the PEEK cranial implant during the FFF 3D printing process.
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