Over the past several years, Israeli hospitals have treated hundreds of victims of the Syrian civil war, but a procedure conducted on a Syrian patient last week at Rambam Hospital in Haifa was easily the most ambitious the institution has ever attempted, according to the hospital.
The patient, who sustained severe injuries as a result of fighting on the Syrian side of the Golan border, was brought by the Israeli army to the hospital for treatment. The patient’s lower jaw was completely destroyed as the result of a bullet wound. The man, in critical condition, was unable to eat or to even speak.
The hospital decided on a novel approach to help the patient: Prof. Adi Rachmiel, director of Rambam’s Department of Oral and Maxillofacial Surgery, along with Dr. Yoav Leiser, who recently underwent training in Germany, contacted an Ashdod-based company called AB Dental, one of the world’s biggest makers and distributors of advanced dental implants.
While most of AB Dental’s products are traditional plates and screws used for implants, the company also has a 3D printer made by Stratasys, a joint US-Israel 3D printing technology company (AB Dental bought its first printer in 2012, when the Israeli side of the company was still called Objet), and it was on a 3D printer the company printed out a custom-made jaw for Rambam’s Syrian patient.
3D printers are increasingly being used by dentists for advanced procedures. Producing plates, veneers, dentures, implants and the like is custom work; no two mouths are the same, as experienced dentists are wont to say.
Traditionally, dentists have used impression plates filled with silicone, sodium alginate or polyether to make models. The patient bites down on the material and leaves teeth marks, the starting point for building the needed object. Corrections are made based on the dentist’s observations, and drilling ensues, both of the item when it comes from the lab, and possibly of the teeth, in order to get it to fit.
In digital dentistry, dentists forgo physical impressions and use intra-oral scanners, which provide a full view of the anatomy of the mouth, jaws and teeth, and allow labs to build precise models that fit right on the first try. The digital file is popped into a 3D printer, which produces the right-sized object that the dentist can insert into the patient’s mouth.
It was the 3D printer that made working on the Syrian patient’s mouth feasible, said Rachmiel. In the procedure, called Patient Specific Implant (PSI), doctors created a jaw perfectly suited to the patient. In the past, such procedures demanded the connection of many plates, but thanks to 3D technology, the doctors were able to take measurements — using statistical models to take measurements of areas that had been completely blown away — and had AB Dental print out a jaw made of titanium, built to the patient’s precise specifications.
The result: One day after surgery, the patient was eating and speaking. The operation was a huge success, and now Rambam intends to perform the same procedure on three other patients in the coming weeks.
For Rambam, the operation was an opportunity to make Israeli medical history, but for the staff, said Leiser, it was the ability to help out someone in need that was primary. “We succeeded in returning his human quality,” he said of the patient.