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Cost-Effective Technique of Fabrication of Polymethyl Methacrylate Based Cranial Implant Using Three-Dimensional Printed Moulds and Wax Elimination Technique

Desai, Jimish B., MDS

Journal of Craniofacial Surgery: June 2019 - Volume 30 - Issue 4 - p 1259–1263
doi: 10.1097/SCS.0000000000005539
Clinical Studies

Objective: Cranioplasty is one of the oldest known neurosurgical procedure performed. Many materials have been used for cranioplasty since ages. Polymethyl methacrylate (PMMA) has become the workhorse for fabrication of cranial implants since World War II in cases where autologous bone is not available or cannot be harvested. The aim of the present study is to present author's experience in the management of cranioplasty using acrylic implants fabricated using 2 different techniques.

Methods: The author conducted a retrospective analysis of patients with extensive skull defects undergoing acrylic cranioplasties between October 2016 and January 2018. The surgical results were classified based on surgical time, blood loss, and the 3 scales of patient satisfaction, improvement of facial symmetry, and need for additional surgery along with the rate of wound complications.

Results: Thirty patients underwent cranioplasty with PMMA-based implants, whether fabricated using alginate impression technique (56.67%) or fabricated using 3-dimensional (3D) printed patient-specific moulds (43.33%). Complications included infection (13.3%). The authors considered the craniofacial aesthetics based on patient satisfaction excellent (69%) with the degree of improvement of craniofacial symmetry satisfactory (92.3%), and 1 patient requiring resurgery in alginate impression technique fabricated implants.

Conclusion: The author recommends a unique technique for fabrication of PMMA-based implants using 3D printed moulds to achieve a better fitting implant and highly cosmetic outcome for cranioplasty at affordable cost.

Oral and Maxillofacial Surgeon, Air Force Institute of Dental Sciences, Bangalore, India.

Address correspondence and reprint requests to Jimish B. Desai, MDS, Oral and Maxillofacial Surgeon, Air Force Institute of Dental Sciences, Old Airport Road, Agram Post, Bangalore 560007, Karnataka, India; E-mail:

Received 31 August, 2018

Accepted 5 March, 2019

The author reports no conflicts of interest.

© 2019 by Mutaz B. Habal, MD.