Copyright © 2015 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited. Application of Computer-Aided Designing and Rapid Prototyping Technologies in Reconstruction of Blowout Fractures of the Orbital Floor Sas ˇ a Z.Tabakovic´, MD,  Vitomir S. Konstantinovic´, MD, PhD, y Radivoje Radosavljevic´, MD,  Dejan Movrin, MSc, z Miodrag Hadz ˇistevic´, PhD, z and Nur Hatab, PhD y Introduction: Traumatology of the maxillofacial region represents a wide range of different types of facial skeletal injuries and encompasses numerous treatment methods. Application of compu- ter-aided design (CAD) in combination with rapid prototyping (RP) technologies and three-dimensional computed tomography tech- niques facilitates surgical therapy planning for efficient treatment. Objective: The purpose of this study is to determine the efficiency of individually designed implants of poly-DL-lactide (PDLLA) in the reconstruction of blowout fractures of the orbital floor. Methods: In the course of a surgical treatment, individually designed implants manufactured by CAD/RP technologies were used. Preoperative analysis and postoperative monitoring were conducted to evaluate the successfulness of orbital floor reconstruction using customized PDLLA implants, based on: presence of diplopia, paresthesia of infraorbital nerve, and presence of enophthalmos. Results: In 6 of the 10 patients, diplopia completely disappeared immediately after surgical procedure. Diplopia gradually disappeared after 1 month in 3 patients, whereas in 1, it remained even after 6 months. In 7 patients, paresthesia disappeared within a month after surgery and in 3 patients within 2 months. Postoperative average Orbital volume (OV) of the injured side (13.333  3.177) was significantly reduced in comparison with preoperative OV (15.847  3.361) after reconstruction of the orbital floor with customized PDLLA implant (P < 0.001). Thus, average OV of corrected orbit was not different compared with the OV of the uninjured orbit (P ¼ 0.981). Conclusions: Reconstruction of blowout fractures of the orbital floor by an individually designed PDLLA implant combined with virtual preoperative modeling allows easier preoperative preparation and yields satisfactory functional and esthetic outcomes. Key Words: Blowout fracture, computer-aided design, orbital reconstruction, poly-DL-lactide implant, rapid prototyping, three- dimensional printing (J Craniofac Surg 2015;26: 1558–1563) T raumatic injuries of craniofacial region and resulting defects due to injuries require reconstruction to establish primary function of the injured part of skeletal system. Reconstruction is based on autologous bone grafts or various types of artificial materials, like in orbital floor fracture treatment. 1 Artificial implants manufactured by modern technologies must meet physical, functional, and esthetic requirements. Implants have to be biocompatible, nontoxic, and noncarcinogenic. Also, no inflam- matory reaction or immune response could be provoked. In addition, materials used in reconstruction of orbital walls must have adequate strength to support orbital tissue. 2 Rapid prototyping (RP) and computer-aided design (CAD) are technologies that have seen fast expansion during the last couple of decades. 3 Thanks to this development and relative simplicity of three-dimensional modeling, these technologies have become avail- able to modern medicine. In general, the time required to manu- facture prototypes has been significantly reduced allowing faster interaction between all parties, especially in the process of particu- lar product. 4 Computer-aided design has gained popularity in clinical prac- tice, and the advent of RP technology has further enhanced the quality and predictability of surgical outcomes. Surgeons can efficiently and precisely target fracture restorations. Based on three-dimensional models generated from a computed tomographic (CT) scan, precise preoperative planning simulation on a computer is possible. 3,5 In the clinical practice, for the last couple of years, several studies have shown the significance of virtual modeling and RP. Cranial and maxillofacial surgical procedures can be of great benefit from these technologies, since they can provide components that are able to withstand required mechanical stresses while satisfying numerous esthetic requirements. 4,5 This is why challenges in contemporary medicine require implementation of modern technological innovations, which is especially true for reconstructive surgery. 6 Application of computer simulation and manufacture of implants represent reliable and efficient methods for reconstruction in fronto-orbital traumas, which yield satisfactory functional and esthetic outcomes. Results reported by Lo et al 7 show that such implants perfectly fit in existing defects. Moreover, the implants not only provide technological edge to surgical procedures, but also reduce stress, allow preoperative planning, and diminish costs of From the  Faculty of Medicine, Department of Dentistry, Clinic of Maxillofacial Surgery, University of Pris ˇ tina, Pris ˇ tina; y School of Dentistry, Clinic of Maxillofacial Surgery, University of Belgrade, Belgrade; and z Faculty of Technical Sciences, University of Novi Sad, Novi Sad, Serbia. Received December 26, 2014. Accepted for publication April 9, 2015. Address correspondence and reprint requests to Sas ˇ a Tabakovic ´, MD, Faculty of Medicine, Department of Dentistry, Clinic of Maxillofacial Surgery, University of Pris ˇ tina, Pere Velimirovic ´a 62/10 11000, Belgrade, Serbia. E-mail: sasataba@yahoo.com This prospective study was approved by the ethics committee of School of Dentistry, University of Belgrade (No. 36/9). Part of this research was financed with Grant No 175075 of the Ministry of Science of Serbia. The authors report no conflicts of interest. Copyright # 2015 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000001883 ORIGINAL ARTICLE 1558 The Journal of Craniofacial Surgery  Volume 26, Number 5, July 2015