Wednesday 21 December 2016

Low cost human face prosthesis with the aid of 3D printing

Dear friends,

It is with great honor and joy that I communicate my participation, for the first time in fact, in the preparation of a human facial prosthesis. I started my studies in early 2016 with Dr. Rodrigo Salazar, who materialized the prosthesis and was kind enough to invite me, as a 3D designer, to compose the group led by Dr. Luciano Dib. The team, made up of specialists from the Paulista University (UNIP) at São Paulo, University of Illinois at Chicago and Information Technology Center. This scanning is a basis for a digital preparation of the prosthesis made on Blender 3D software, with the help of the 3DCS addon developed by our team (myself, Dr. Everton da Rosa and Dalai Felinto). What we did with the innovative techniques of 3D modeling so as to optimize the quality of prototypes of prostheses, the merit is all of doctors Salazar, Dib and team.

Authors of rehabilitation:
Rodrigo Salazar
Cicero Moraes
Rose Mary Seelaus
Jorge Vicente Lopes da Silva
Crystianne Seignemartin
Joaquim Piras de Oliveira.
Luciano Dib.

Publisher and infographics:
Cicero Moraes

Rodrigo Salazar

How the technique works

Based on: Salazar-Gamarra et al. Monoscopic photogrammetry to obtain 3D models by a mobile device: a method for making facial prostheses. Journal of Otolaryngology Head & Neck Surgery 2016;45:33
Infographics: Cicero Moraes

The first part of the process consists in photographing the patient in 5 different angles with 3 heights each angle, totaling 15 photos.

These photos can be made with a mobile phone, then they are sent to an online photogrammetry service (3D scanning per photo) called Autodesk® Recap360.

In about 20 minutes the server completes the calculations and returns a three-dimensional mesh corresponding to the patient's scanned face (first column on the left).

This face is mirrored in order to supply the missing structure, using the face complete as a parameter. Through a Boolean calculation the excesses of the mirrored part are excluded, resulting from the process a digital prosthesis that fits the missing region (second column on the left).

The digital prosthesis is sent to a 3D printer that materializes the piece. Then the structure is positioned on the patient to see if there is a fitting (third column on the left).

Once the structure has fit, a wax replica of the 3D print is generated. The purpose of this replica is to improve the marginal regions of docking and prepares the region that will receive the glass eye (fourth column on the left).

Finally a mold is generated from the replica in wax. This mold receives several layers of silicone. Each layer is pigmented to make colors compatible with the patient's skin. At the end of the process the prosthesis is obtained and can be adapted directly on the face of the patient (first column on the right).

A little of history

The doctors Prof. Dr. Luciano Dib, MSc. Rodrigo Salazar and MAMS. Rose Mary Seelaus are members of the Latin American Society of Buccomaxillofacial Rehabilitation. Among the activities developed by the society is the biannual event, where the members selected speakers who would speak at the event. In the April 2014 event, one of these invited speakers was MAMS. Rosemary Seelaus (anaplastologist), a specialist in facial prostheses for humans for almost 20 years.

At this event In early 2014, during one of the congresses organized by the association, Dr. Dib instigated Dr. Salazar to do a master's degree, of which he would be the advisor. Both were interested in the sophisticated techniques of Rose Mary Seelaus and intended to approach her in the studies, but they found a barrier, because at that time the prostheses were made with high operating costs, making it difficult to apply in Latin American public hospitals like Brazil.

The specialists then approached Dr. Seelaus, inquiring her whether it would be possible to assist them in adapting the technique to the Brazilian reality, reducing costs and, in the face of this, popularizing it to be used by the greatest number of Health professionals, thus benefiting those people who would not have access through the classical methodology, because its high cost.

Rodrigo Salazar, Rosemary Seelaus, Jorge Vicente Lopes da Silva e Luciano Dib at DT3D of CTI Renato Archer, Campinas-SP

Dr. Salazar began his master's studies in 2015. In March of that year, after preliminary studies on photogrammetry (3D digitalization by photos), via the online 123D Catch solution, the researchers sought the CTI Renato Archer (ProMED), to helping them to carry out the project to create a low-cost facial prosthesis.

During that time, CTI/ProMED not only supported the project with the necessary 3D printing (tests and final versions), but also helped in the training of the team members, through specific guidelines and necessary for the evolution of technology, always with the support from the head of the DT3D sector, Dr. Jorge Vicente Lopes da Silva.

In December of 2015 the article about the initial methodology was written and sent for publication (which occurred in May 2016).

The researchers were successful because the technique developed by them matched the classical technology in the results, but the cost has declined considerably.

Cicero Moraes and Rodrigo Salazar, Lima, Peru

Also at the end of the year, Dr. Salazar started the talks with me about the project and the possibilities of helping the development of the technique at a higher level using my know-how in computer graphics applied to the health sciences.

Because of the two full agendas, we spent some time communicating, but we resumed the dialogue in early 2016 and in February I began my studies in this field.

In a few months thanks to the versatility of the free software and the support of Dr. Salazar, Dr. Dib and CTI / ProMED, we were able to further develop the technique of facial scanning and prosthesis making.

Tests of human facial scanning in high resolution from photogrammetry. Moraes and Salazar-Gamarra (2016)

We did a series of tests, comparisons and discussions until we proceeded with the production of a real prosthesis. In the first half of December a patient received this piece and the procedure was successful, with an impressive result.

Now, after the help that I humbly proposed to offer and the help of the specialists in each phase, the quality of the prosthesis, according to the own team, has surpassed the methodology of high cost!

I am extremely honored to be a part of this project and to be able to help people with an accessible and robust technology, born of a team work and very, very study, which obviously has a lot to develop yet.

Happy of the society that will receive all the result of the successes. Whether through procedures that elevate self-esteem and contribute to a full life for those who have been victims of cancer, or for those who want to access and help improve the technology with us.

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