Clinical, technical, and economic outcomes of 3D-printed bone substitutes in maxillofacial reconstruction: a systematic review and meta-analysis

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: 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.