3-D imaging, digital design, and printing help military dental specialists restore jaws and faces after severe injury and disease.
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| A model of a patient’s upper jaw shows the custom titanium implant and the interim fixed teeth designed to connect to it. (Courtesy photo) |
October 15, 2026 by Sharon Holland
For patients with complex dental and facial injuries, reconstruction has traditionally depended on a combination of surgical expertise, dental technology and highly specialized restorative craftsmanship. Today, those skills are increasingly being paired with three-dimensional imaging, digital modeling and 3-D printing to create solutions tailored to an individual’s anatomy and, in some circumstances, to anatomy that is still changing.
But technology is only part of the equation. Reconstructive care requires a team approach, bringing together specialists with different areas of expertise to address the surgical, functional and esthetic needs of the patient. Oral and maxillofacial surgeons, prosthodontists and maxillofacial prosthodontists each play important roles, working together to determine how best to restore the patient’s esthetics, phonetics and function in some of the most challenging clinical situations.
“Technology has been advancing at an incredible pace, and each innovation gives us a new tool for patient care,” said Army Lt.Col. Steven Handel, a prosthodontist with training in maxillofacial prosthetics and assistant program director of the Army Postgraduate Dental School’s Advanced Education Program in Prosthodontics at Fort Gordon, Georgia, part of the Uniformed Services University of the Health Sciences Postgraduate Dental College. “But technology is only a tool. It doesn’t replace the team… it connects and enhances it, giving surgeons, prosthodontists and laboratory technicians the ability to plan together and restore a patient’s function and esthetics.”
Military prosthodontists, oral and maxillofacial surgeons and the residents they train are applying these technologies and multidisciplinary expertise to problems that can be difficult or impossible to address with conventional approaches. Their work illustrates how digital tools can help clinicians design customized implants and prostheses, respond to changing anatomy during lengthy reconstruction and restore functions that affect some of the most basic aspects of daily life, including eating, speaking and interacting with others.
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| A service member wears a skin-toned, 3-D-printed facial mask made by a maxillofacial prosthetics team. (Courtesy of Lt. Col. Steven Handel) |
One example involves patients who have too little jawbone to support conventional dental implants. Conventional implants, which are placed into the jawbone like the root of a tooth, require enough bone to hold them securely, but severe bone loss can make that approach impractical. In one recent application, computed tomography, or CT, imaging was used to create a detailed three-dimensional model of the patient’s anatomy. That model allowed clinicians to digitally design a custom titanium implant shaped to fit the bone that remained.
Unlike conventional implants, which are anchored directly into the jawbone, a subperiosteal implant sits on top of the remaining bone, beneath the periosteum, the thin membrane that covers it. Today’s custom designs are secured to the bone with small fixation screws. The approach dates back to the 1940s, but earlier versions were associated with problems including poor fit, infection and failure. Advances in CT imaging, computer-aided design and manufacturing, and 3-D-printed titanium have helped bring the concept back into consideration for patients with limited bone.
The technology also allows clinicians to prepare the restoration before surgery. In the reported treatment, the custom framework, its prosthetic connection points and an interim fixed prosthesis (a temporary set of fixed teeth) were designed in advance and checked before the operation. Yet an unexpected challenge emerged when the implant was secured to the patient’s upper jaw. Although there was no obvious distortion of the framework during surgery, the temporary teeth no longer fit once the framework had been fixed in place.
The clinicians determined that the titanium framework had undergone a small amount of distortion during fixation, changing the position of the prosthetic connection points enough to prevent the temporary teeth from fitting properly. The interim prosthesis was modified to accommodate the new position, and the prosthetic design was subsequently adjusted after healing.
The experience points to an important consideration as increasingly sophisticated digital tools are used in implant dentistry: an implant can be manufactured to an extremely precise digital design and still experience subtle changes when it is physically secured to a patient’s anatomy.
“Digital precision doesn’t automatically survive surgery,” Handel said. “A framework can fit perfectly on the model and still flex slightly when it’s screwed to the bone—just enough that the interim prosthesis won’t seat. If the team doesn’t realize that can happen, they may assume the implant was misplaced or the prosthesis was made incorrectly. Innovative solutions, such as linking the abutments with a small titanium bar during fixation, may help prevent these problems. Ultimately, combining technology with innovative thinking will continue to advance the team’s success in treatment.”
That same combination of imaging, digital design and fabrication is being applied to reconstructive challenges far beyond the jaw.
For patients who undergo emergency surgery for an aggressive disease such as acute invasive fungal sinusitis, which can destroy the palate, the resulting opening in the roof of the mouth can interfere with eating, swallowing and speech. Traditional treatment may involve creating an obturator—a custom prosthesis that seals the opening between the mouth and the sinus or nasal cavity—using a physical impression of the patient’s mouth. In an urgent clinical situation, however, obtaining such an impression may not be practical or desirable.
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| From left: a model of a patient’s mouth with an opening in the palate, a clear obturator fitted on the model, and the finished obturator. (Courtesy of Lt. Col. Steven Handel) |
Instead, clinicians were able to use a high-resolution medical CT scan in place of an impression. By separating the tongue, teeth and palate with gauze and a thin mouthguard during the scan, the team captured the anatomy they needed. The CT images were converted into a detailed three-dimensional model of the mouth and remaining palate, which was then used to create a customized obturator through 3-D printing and conventional dental materials. After the device was fitted, the patient was able to eat and drink without food or liquid escaping into the nose and returned to oral nutrition and functional, understandable speech before leaving the hospital. A feeding tube had been under consideration before the device was provided.
Digital tools can also extend the life of a prosthesis a patient already depends on. When a patient with a well-fitting metal-framework obturator lost a front tooth, Handel and colleagues used CAD-CAM technology to design an abutment (the connector that holds a crown) that was cast and soldered to the framework, then milled a ceramic crown to fit it, replacing the tooth without remaking the obturator.
The technology is also changing how clinicians approach severe facial injuries. Rather than waiting until reconstruction is complete to create a final prosthesis, they now make prosthetic treatment part of the reconstruction process itself.
Following an extremely severe facial injury associated with purpura fulminans, a rapidly progressing condition in which clotting in small blood vessels causes widespread tissue death, a 35-year-old service member underwent emergency surgeries, removal of damaged facial tissue and skin grafting. Because his face continued to change through surgeries and healing, a conventional permanent facial prosthesis could not simply be fabricated once and expected to fit throughout the process.
Instead, the maxillofacial prosthetics team became involved early, during reconstruction rather than after it. The first device was a custom facial compression mask designed to reduce swelling, protect healing and newly grafted tissue, apply pressure in areas identified by the burn team, and support speech therapy.
“Patients like this often go without prosthetic support during the long, unpredictable stretch between surgeries, when the psychological impact is greatest,” Handel said. “We wanted to close that gap.”
But the purpose of the mask evolved. The initial device was clear and distinctly medical in appearance. The patient found this uncomfortable in public and experienced social isolation because of his appearance. The team therefore began working toward a device that could continue to provide medical benefits while looking more like his face.
That required a combination of technology and artistry. Clinicians scanned the patient’s face and created a physical model of the remaining anatomy. Handel sculpted the missing portions in clay, guided by pre-injury photographs and videos, allowing the patient to review and approve the reconstruction. The clay reconstruction was then scanned, combined digitally with information from the patient’s existing anatomy and used to design a new mask. The finished device was 3-D printed and painted to approximate the patient’s skin color.
This is where the specialized expertise of dental laboratory professionals and anaplastologists becomes particularly important. Creating a facial prosthesis is not simply a matter of reproducing a three-dimensional shape. The finished prosthesis must also account for the subtleties of the patient’s appearance, including skin tone and the way color changes across different materials and thicknesses. Many military maxillofacial prosthetic technicians are trained at Bethesda, Maryland, developing the technical and artistic skills required to create highly individualized prosthetics and help them blend with the patient’s existing anatomy.
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| From left: a physical model of the patient’s face with missing features sculpted in clay, the digital mask design, and the 3-D-printed mask. (Courtesy of Lt. Col. Steven Handel) |
The process did not end with a single device. As the patient underwent additional surgeries and continued to heal, his facial anatomy changed. When a mask no longer fit, the team could scan him again, compare the new anatomy with earlier models and create another prosthesis. Over five years, 12 prostheses were made.
Handel described the case as one of the most challenging, and most meaningful, of his career. “Following him through 12 prostheses over five years was a reminder of why this field exists,” he said. “It’s not just function. It’s dignity.”
A later pre-injury video provided another valuable source of information. An eight-second video supplied by the patient allowed the team to extract dozens of images and use them to digitally recreate aspects of his facial contours that could not be captured from a single photograph.
The work also demonstrated that different materials can serve different purposes. The team developed a silicone prosthesis that provided a more realistic appearance, but the patient preferred the lighter, less adhesive 3-D-printed masks for everyday use, including military duties. The printed models also provided surgeons with templates that could assist with reconstruction planning.
The patient reported greater confidence and a return to work and social activities. After seeing a reconstruction of his pre-injury appearance, he decided not to pursue a full facial transplant and continued with reconstruction using his own tissue. The psychological benefits, however, were based on the patient’s own reports rather than standardized psychological testing, so the clinical reports do not establish a measurable cause-and-effect relationship.
The collaboration between surgical and prosthetic specialists is equally important when the challenge is not creating an entirely new facial structure, but making a prosthesis look and function as naturally as possible.
For facial prostheses made from silicone, color does not exist independently of thickness. The same color can appear different depending on how thick the silicone is, particularly around the thin edges of a prosthesis. To make that process more predictable, Handel and colleagues developed a gradated silicone shade guide, a clear silicone wedge, ranging from paper-thin at one end to 5 millimeters at the other.
The tool allows clinicians to evaluate how a selected color appears at different thicknesses before making the final prosthesis. When used to develop a new nasal prosthesis for a woman who had lost much of her nose to cancer, the approach helped the clinicians address a problem with her previous prosthesis: the color blended in the middle but not around the edges. The new approach allowed color and thickness to be evaluated together, and the patient was very satisfied with the result.
These examples underscore why maxillofacial reconstruction is inherently a team effort. Oral and maxillofacial surgeons bring expertise in the surgical management and reconstruction of complex facial anatomy. Prosthodontists with fellowship training in maxillofacial prosthetics focus on restoring structures and functions that may not be readily addressed through surgery alone. Prosthodontists more broadly contribute expertise in restoring oral function and designing dental prostheses that work within the patient’s anatomy. Dental laboratory technicians and anaplastologists add another critical dimension, translating clinical designs into precisely fabricated prostheses and using specialized artistry to reproduce the appearance of natural tissues.
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| A gradated silicone shade guide, held against a forearm, lets clinicians compare a prosthesis color with skin tone at different thicknesses. (Courtesy of Lt. Col. Steven Handel) |
Digital technology connects those disciplines in new ways. A process can begin with medical imaging and digital facial scanning, move through computer modeling and physical sculpting, and culminate in 3-D printing, color matching and customized prosthesis delivery. The work can involve prosthodontics, medical illustration, 3-D modeling and printing specialists, plastic surgeons, burn and rehabilitation therapists, ophthalmology, speech-language pathology and other disciplines, depending on the patient's needs.
Most importantly, the prosthesis no longer has to be viewed simply as the final product of reconstruction.
For a patient whose anatomy is changing, it can be part of the treatment itself. A customized device can protect healing tissue, help control swelling, support therapy, assist surgeons with reconstruction planning, restore eating or speech, improve appearance and help a patient navigate the social challenges that accompany a major facial injury.
The same principle applies to highly customized dental implants. Digital imaging and design can allow clinicians to develop a solution for anatomy that does not provide enough bone for conventional treatment, while also revealing new mechanical challenges that must be considered when a digitally designed device is translated into the physical environment of the patient.
These advances demonstrate what is possible when medical imaging, digital design, 3-D manufacturing and clinical expertise are brought together. At the same time, the published work described here consists largely of individual clinical reports rather than large clinical studies. The experiences demonstrate that these techniques can be used successfully in specific circumstances, but they do not establish how frequently particular complications occur or how effective proposed solutions will be across larger patient populations. Additional research is needed.
What they do show is a changing approach to reconstruction: rather than waiting for anatomy to stabilize and then producing a final device, clinicians can increasingly use digital tools to respond to the patient throughout the reconstruction process.
That shift also shapes how the next generation of military prosthodontists is trained. “Our residents have to be fluent in both analog and digital workflows,” Handel said. “The software is powerful, but the patient still needs someone who understands anatomy, materials and artistry—and who recognizes when the plan on the screen has to change.”
For patients facing some of the most difficult dental and facial challenges, that ability to adapt, and the team of specialists behind it, may be just as important as the technology itself.