Background Maxillofacial reconstruction requires precise restoration of bone volume and anatomical alignment. Traditional bone grafting methods have limitations, such as donor site morbidity, limited availability, and suboptimal anatomical congruence. Three-dimensional (3D) printed bone substitutes offer patient-specific solutions that may overcome these challenges. Objectives To systematically evaluate and quantify the clinical efficacy of 3D-printed bone substitutes compared with traditional grafting techniques in maxillofacial reconstruction, focusing on outcomes including bone regeneration, surgical precision (distance and angular deviation), and operative duration. Methods A comprehensive search of PubMed, Scopus, and Cochrane Library was conducted up to March 2025. Randomized controlled trials and cohort studies comparing 3D-printed bone substitutes with traditional methods in maxillofacial or craniofacial surgery were included. Meta-analyses were performed using Comprehensive Meta-Analysis software v3.7, applying fixed- or random-effects models based on heterogeneity (I 2 threshold of 25%). Results In total, 12 studies (three RCTs and nine cohort studies) were included in the meta-analysis. 3D-printed bone substitutes demonstrated significantly superior outcomes in key surgical metrics compared with traditional methods. Bone regeneration volume was markedly higher in the 3D group, with a standardized mean difference (SMD) of 0.737 (95% CI: 0.640–0.834; p < 0.0001), indicating a moderate-to-large effect size. Operative efficiency also improved, with a mean reduction in surgical duration of −12.32 min (95% CI: −14.08 to −10.56; p < 0.0001). However, greater positional deviation was observed with 3D-printed plates, including distance deviation (MD = 1.328; 95% CI: 1.08–1.57; p < 0.0001) and angular deviation (MD = 1.643°; 95% CI: 1.11–2.18; p < 0.0001). Conclusions 3D-printed bone substitutes significantly improve bone regeneration and reduce operative time in maxillofacial surgery. However, greater positional and angular deviations suggest the need for enhanced surgical navigation. These findings support the integration of 3D-printing in clinical practice, with emphasis on precision improvement in future applications.
Clinical, technical, and economic outcomes of 3D-printed bone substitutes in maxillofacial reconstruction: a systematic review and meta-analysis
Fiorillo L.
2026-01-01
Abstract
Background Maxillofacial reconstruction requires precise restoration of bone volume and anatomical alignment. Traditional bone grafting methods have limitations, such as donor site morbidity, limited availability, and suboptimal anatomical congruence. Three-dimensional (3D) printed bone substitutes offer patient-specific solutions that may overcome these challenges. Objectives To systematically evaluate and quantify the clinical efficacy of 3D-printed bone substitutes compared with traditional grafting techniques in maxillofacial reconstruction, focusing on outcomes including bone regeneration, surgical precision (distance and angular deviation), and operative duration. Methods A comprehensive search of PubMed, Scopus, and Cochrane Library was conducted up to March 2025. Randomized controlled trials and cohort studies comparing 3D-printed bone substitutes with traditional methods in maxillofacial or craniofacial surgery were included. Meta-analyses were performed using Comprehensive Meta-Analysis software v3.7, applying fixed- or random-effects models based on heterogeneity (I 2 threshold of 25%). Results In total, 12 studies (three RCTs and nine cohort studies) were included in the meta-analysis. 3D-printed bone substitutes demonstrated significantly superior outcomes in key surgical metrics compared with traditional methods. Bone regeneration volume was markedly higher in the 3D group, with a standardized mean difference (SMD) of 0.737 (95% CI: 0.640–0.834; p < 0.0001), indicating a moderate-to-large effect size. Operative efficiency also improved, with a mean reduction in surgical duration of −12.32 min (95% CI: −14.08 to −10.56; p < 0.0001). However, greater positional deviation was observed with 3D-printed plates, including distance deviation (MD = 1.328; 95% CI: 1.08–1.57; p < 0.0001) and angular deviation (MD = 1.643°; 95% CI: 1.11–2.18; p < 0.0001). Conclusions 3D-printed bone substitutes significantly improve bone regeneration and reduce operative time in maxillofacial surgery. However, greater positional and angular deviations suggest the need for enhanced surgical navigation. These findings support the integration of 3D-printing in clinical practice, with emphasis on precision improvement in future applications.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
