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Printing 3D Models of Canine Jaw Fractures for Teaching Undergraduate Veterinary Medicine1

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Printing 3D Models of Canine Jaw Fractures for Teaching Undergraduate Veterinary Medicine1 ACTA CIRÚRGICA BRASILEIRA EDUCATION Printing 3D models of canine jaw fractures for teaching undergraduate veterinary medicine1 Agnes de Souza LimaI , Marcello MachadoII , Rita de Cassia Ribeiro PereiraIII , Yuri Karaccas de Carvalho I M.Sc., Postgraduate Program in Health and Animal Production, Universidade Federal do Acre (UFAC), Rio Branco-AC, Brazil. Acquisition, analysis and interpretation of data; manuscript preparation and writing. II D.Sc., Department of Anatomy, Universidade Federal do Paraná (UFPR), Curitiba-PR, Brazil. Scientific and intellectual content of the study. III M.Sc., Health and Sports Science Center, UFAC, Rio Branco-AC, Brazil. Technical procedures. IV D.Sc., Biological and Natural Sciences Center, UFAC, Rio Branco-AC, Brazil. Manuscript writing, critical revision, final approval. Abstract Purpose: To develop 3D anatomical models, and corresponding radiographs, of canine jaw fractures. Methods: A base model was generated from a mandibular bone scan. With this model it was possible to perform fracture planning according to the anatomical location. Results: The 3D base model of the canine mandible was similar in conformation to the natural bone, demonstrating structures such as canine tooth crowns, premolars and molars, mental foramina, body of the mandible, ramus of the mandible, masseteric fossa, the coronoid process, condylar process, and angular process. It was not possible to obtain detail of the crown of the incisor teeth, mandibular symphysis, and the medullary channel. Production of the 3D CJF model took 10.6 h, used 150.1 g of filament (ABS) and cost US$5.83. Conclusion: The 3D canine jaw fractures models, which reproduced natural canine jaw fractures, and their respective radiographic images, are a possible source of educational material for the teaching of veterinary medicine. Key words: Anatomy, Veterinary. Mandibular Fractures. Printing, Three-dimensional. Teaching Materials. DOI: http://dx.doi.org/10.1590/s0102-865020190090000006 Acta Cir Bras. 2019;34(9):e201900906 1 Printing 3D models of canine jaw fractures for teaching undergraduate veterinary medicine Acta Cir Bras. 2019;34(9):e201900906 Lima AS et al. ■ Introduction Selecon and dissecon of the anatomical part Mandibular fractures are commonly observed in the clinical routine of small animals and account for 1 3D Scanner approximately 3% of all reported fractures in dogs . Scanning Shining 3D® The precise diagnosis of a mandibular fracture determines the appropriate treatment and prognosis of this condition. Considering this, radiographic .stl examination is essential for identifying the exact location Modeling and construcon and extension of the fracture, enabling appropriate Meshmixer® therapeutic planning2. of 3D CJF model Undergraduate veterinary medicine fracture studies take place through books, medical images and, when Prinng and applicaon of UP! Mini 3D® there is opportunity, the follow-up of clinical cases. magnets on 3D CJF model ABS Filament Despite the frequency in the clinical routine, this condition is largely overlooked during the course of study3. This fact may be directly related to the absence of Radiography of clinical cases during study, or the limitation of teaching 3D CJF model materials that can fully demonstrate all the aspects this Figure 1 - 3D canine jaw fractures model creation flowchart. condition presents4. The use of 3D printing in general veterinary medicine Scanning of the mandibular bone was performed is already a reality. There have been great advances in using a 3D Scanner, Model EinScan-SP (Shining 3D®, the application of this technology in several areas, such Zhejiang, China), using the EinScan-SP Version 2.6.0.8 as orthopedics5, ophthalmology6, diagnostic imaging7, software included with the equipment. treatment of large animals8,9, surgical planning10,11, and Images were saved in .stl format and stored in a especially in the teaching of veterinary medicine12. In database. Subsequently, they were transferred to a 3D ® the latter, research has concentrated particularly on creation and manipulation system, Autodesk Meshmixer , © anatomy13 and surgery14. version 3.1 (Autodesk Inc. , California, United States), for modeling and composition of the 3D CJF model. Although there have been several 3D models The modeling stage consisted of separating the created that focus on teaching and research, we anatomical regions in which fractures occur. There have not found any reported attempts to reproduce was no loss of information during this process, and all canine jaw fractures (CJF) in veterinary medicine. structures of the mandible were maintained. Thus, this study aimed to produce 3D educational Fracture locations reproduced in the 3D CJF models models of CJF. were based on those reported by15-17 (Chart 1). ■ Methods Chart 1 - Classification of canine jaw fractures (CJF) by location. Experimental protocol was approved by the Animal Classification Location Research Ethics Committee of Universidade Federal do A Mandibular symphysis Acre (CEUA-UFAC), protocol number 47/18. B Mandibular parasymphysis Cadaver jaw from a healthy dog that died of natural C Canine causes was macerated and prepared for further scanning D Premolar E Molar manipulation and printing. Radiography of the 3D CJF F Coronoid process models was taken and models were generated from the G Condilar process mandibular bone scan. The creation of the 3D CJF model H Ramus of mandible was based on the bone scan, posterior virtual modeling I Angular process and 3D printing (Fig. 1). Adapted from15-17 2 Acta Cir Bras. 2019;34(9):e201900906 Printing 3D models of canine jaw fractures for teaching undergraduate veterinary medicine Lima AS et al. The constituent parts of each 3D CJF model Radiographic study of 3D CJF models were printed using UP 3D Mini® (Beijing Tiertime Four 3D CJFs were created to represent the Technology Co. Ltd., Beijing, China), which uses nine CJF types, according to anatomical location, fine quality Fused Deposition Modeling (FDM) organized as follows: I - canine/coronoid process, II - technology and ABS-grade thermoplastic material, parasymphysis/angular process/premolar, III - ramus with a 99% internal fill and a layer thickness of 0.2 of the mandible/molar, IV - mandibular symphysis/ mm. After printing, manual finishing was performed. condylar process. Neodymium magnets, 5 mm in diameter and 2 mm Representation of the different types of fractures in height, were inserted in the fracture lines of each in the 3D CJF model, and their respective radiographic segment of the model, to enable assembly and positions, are shown in Chart 2. disassembly of the parts. Chart 2 - Canine jaw fractures by model and radiographic positioning. 3D CJF model Fractures Positioning Canine Dorsoventral I Coronoid process Laterolateral Parasymphysis Dorsoventral II Angular process Laterolateral Premolar Laterolateral Ramus of the mandible Laterolateral III Molar Laterolateral Mandibular symphysis Dorsoventral IV Condylar process Dorsoventral After completion of the construction phase, models the same length and width, in addition to reproducing were taken to the Diagnostic Imaging Center to undergo the structures that identify the bone. The following radiography. 3D CJF models were X-rayed using General anatomical structures were observed: canine tooth Electric model DR-F (General Electric Company©, USA) crowns, premolar and molar teeth, mental foramina, digital X-ray equipment, with a radiation intensity of body of the mandible, ramus of the mandible, 40 kilovolt kV and exposure time of 2.51 mAs. masseteric fossa, and coronoid, condylar and angular Fracture X-rays were focused on at least one of the processes. However, it was not possible to obtain positions recommended by Fossum18, and Han and details of the incisor tooth crowns, union of the Hurd19 for mandible radiography. Images were edited mandibular symphysis or projection of the mandibular using RadiAnt DICOM Viewer® 2009-2017 software canal (Fig. 2). (Medixant®, Poznan, Poland). After production of all models, the creation time, For radiography it was necessary remove the neodymium printing time, amount of material used, and associated magnets. Therefore, we secured the fracture foci with high- costs, were estimated. This information is shown in abrasion transparent double-sided adhesive tape. Table 1, which allows an appreciation of the cost of each model, and the total cost of the 3D CJF model. Creation time refers to procedures carried out ■ Results post-scanning, i.e., the computer based manipulation The 3D base model of the mandible showed a of images, since the scanning time duration was only similar conformation as the natural bone, maintaining 5 min. 3 Printing 3D models of canine jaw fractures for teaching undergraduate veterinary medicine Acta Cir Bras. 2019;34(9):e201900906 Lima AS et al. Cp Rm C Cop MF CI P1 M2 M1 P3 P2 MF Ap Bm Cp Rm Cop MF C CI M1 P1 M2 P3 P2 Ap Ms Bm MF Ms AB Figure 2 - Canine mandible and corresponding 3D base model, (A) right side view and (B) dorsal view. I. incisor teeth; C. canine teeth; MF. mental foramina; P1. first premolar tooth; P2. second premolar tooth; P3. third premolar tooth; M1. First molar tooth; M2. second molar tooth; Bm. body of the mandible; Cp. coronoid process; Rm. ramus of the mandible; MF. masseteric fossa; Cop. condylar process; Ap. angular process; Ms. mandibular symphysis. Factors that influenced printing time were the Different types of mandibular fractures were number of fractures per model, arrangement of the represented by
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