February 19, 2016 -- A 68-year-old Evansville, Ind., man is the first to benefit from a transformative Indiana University School of Dentistry process of fabricating artificial facial parts using digital technology. Among the benefits: The patient has gotten back something most people take for granted -- a face.
Dr. Travis Bellicchi, a second-year maxillofacial prosthodontics resident in the IU School of Dentistry at Indiana University-Purdue University Indianapolis, started developing the new process after being challenged with producing the largest facial prosthesis ever made at the dental school. The prosthesis was for Shirley Anderson, a 68-year-old retired maintenance mechanic, who had his Adam's apple removed as well as his mandible, leaving him without a chin.
"This was a unique case," Bellicchi said. "It's a much larger prosthesis than what we normally work on. Typically we might do a nose or an ear. This is maybe four or five times larger." Because of the size of the prosthesis, Bellicchi found traditional materials were bulky and cumbersome to use. "So I began pursuing a digital solution," he said.
With his training in prosthodontics and as an IU School of Medicine Maxillofacial Prosthetics Fellow, Bellicchi serves as a bridge between restorative dental and medical specialties for patients who have had cancer surgery or facial trauma such as from a car accident, gunshot wound or burn. "My training allows me to provide prostheses when surgical intervention or reconstructions are insufficient to provide a good aesthetic or a functional result," he said. "Then I come in and make something out of silicone or acrylic resin that would restore function or, in this case, aesthetics." Asked about his reaction to the prosthesis Bellicchi made for him, Anderson wrote two words on a whiteboard: "True Amazement."
Anderson was first diagnosed with tongue cancer in 1997. Treated with radiation, Anderson believed he was cancer-free after 15 years had passed. But the tongue cancer recurred in 2012, with devastating consequences. After being treated with radiation again, Anderson developed osteoradionecrosis of the jaw, or bone death, a severe side effect of radiation therapy. Head and neck surgeons made several attempts to reconstruct Anderson's mandible, including using pieces of bone from his fibula and a titanium bar.
"Despite their best efforts," Bellicchi said, "the healing just wasn't there. The efforts just didn’t take." Anderson now breathes through a tracheotomy and is fed through a tube in his stomach. He lost almost half his body weight. When he doesn't wear the prosthesis, he wears a mask in public to hide the holes where his face and neck once were. Anderson is hoping that some semblance of normal will return with the increasingly better-looking and better-fitting digitally designed prosthetic devices Bellicchi and his team are creating.
"My main interest now is using digital imaging, digital design, and 3-D printing to streamline the prosthesis fabrication process, making it much quicker and with much less patient involvement in far fewer appointments," Bellicchi said. To accomplish that goal, Bellicchi has enlisted medical, information technology, design and engineering experts from schools at IUPUI, including the dental school, the School of Informatics and Computing, School of Engineering and Technology, and the Herron School of Art and Design. The IUPUI interdisciplinary team is creating is a hybrid digital/analog approach, using 3-D printing to create the mold so that mold has a negative space inside of it. That negative space becomes the prosthesis itself.
"Then I use traditional materials, for now, to fill that space," Bellicchi said. "My motivation to use traditional materials is that they are predictable, they are biocompatible, they have research behind them, and we know how to do the characterization to make them lifelike." Bellicchi expects they will produce a prototype 3-D printed prosthesis for Anderson soon, having already completed digital imaging and digital modeling of his face.
"Shirley really believes in helping us as an institution," Bellicchi said. "He totally gets the work we are trying to do on the discovery side of this as well as the patient-care side. He is a problem-solver and a funny guy. I couldn’t have asked for a better person to spend a year with as I come up with different prosthesis solutions and explore the digital protocol."
When it comes to naming the new digital protocol, Bellicchi and Anderson know exactly what they want to call it: the IU Shirley Technique.