Q: Dr. Eppley, first I appreciate your answers to the questions that I asked you about custom made facial implants. Recently I read of computer or CAD/CAM designed implants. What is the difference between them? The CAD/CAM designed implants would work well for the reconstruction. While custom made implants designs are made by hand, computer designed implants models could be created by using computer soft ware. If it is such, I think that the CAD/CAM designed implants would be more suitable for my case to restore the exact defects. Could you design and manufacture jaw angle implants through CAD/CAM system?
A: Custom made facial implants is a general term that relates to several methods of manufacture. Handmade custom implants are done using a prefabricated skeletal model (made off of a 3D CT scan) where either a technician or the surgeon makes the desired shape of the implants which is then transferred into a final implant design. CAD/CAM designed implants is done digitally by a technician using a 3D
CT scan of the patient. There are advantages and disadvantages to either approach. When there is a very specific facial bone defect and a normal side to compare it to, the CAD/CAM approach is a good one because the computer has a definitive target from which to shape the implant. When one is after general aesthetic augmentation of any facial skeletal area, there is no specific or predictable target. Whether it is done by hand or the computer, the exact implant design is still a guessing game so to speak in terms of what will create the desired aesthetic effect.
Dr. Barry Eppley