Academic Centre of Reconstructive Science

The Academic Centre of Reconstructive Science (ARCS) is nationally and internationally recognised as a Centre of Excellence for Maxillofacial and Craniofacial Rehabilitation.

Our clinic and research seek to reconstruct or regenerate cranio-facial structures missing due to cancer or congenital defects aiming to mitigate and, in the future eliminate the burden of facial disfigurement in affected people.

Members

Daniella Bellini

PhD student

Francois Chesnais

PhD student

Trevor Coward

Professor /Hon Consultant in Maxillofacial & Craniofacial Rehabilitation

Lucy (Luciana) Di Silvio

Professor of Tissue Engineering

Naimesha Patel

Senior Lecturer in Maxillofacial Prosthetic Education

Caroline Reed

PhD Student

Brendan Scott

Research Fellow

Lorenzo Veschini

Lecturer in Reconstructive Sciences

Sana Zahabiyoun

PhD Student

CPAP

CPAP therapy is effective in reducing sleep apnoea and less expensive than other treatments, however, some people find it extremely uncomfortable. Patients complain of feeling trapped, having chest discomfort, and skin or nose irritation, all caused by the mask. Much of the sales literature from companies that make CPAP systems focuses on the comfort of their masks. One way of helping patient comfort and compliance is to ensure that the mask fits the nose and face well and does not cause any discomfort. The material of manufacture of the mask is also important with hardness/softness, flexibility, durability, and hypo-allergenicity all considerations. Custom making the mask to fit the patient should ensure an improved level of comfort over the more generic masks which currently exist. The aim of this project is to 3D print the customised mask inserts in silicone that fit specifically to individual patients faces and within commercial companies’ generic masks.

3D Printing of Facial/Body Prostheses

Facial prostheses are required by patients who have lost eyes, ears, noses or combinations of these from trauma (road traffic accident), surgery (cancerous tumour) and congenital malformations. The current process of manufacturing prostheses involves taking an impression of defect site, pouring a working model in stone, carving/sculpturing a wax trial prosthesis, creation of a 2/3 part mould into which pigmented silicone is placed prior to curing. Finally, it is sometimes necessary to add further pigmentation when the prosthesis is fitted onto the patient. This process involves 5 to 7 patient appointments varying between 1 -1.5 hours. Adaptation of digital technology into the process could reduce the number of appointments to 2 and would be free from variability caused by individual artistic and colour interpretation skills required by the clinician. The aim of this projects is to directly 3D print facial prostheses with the desired material characteristics of skin and to match the patients surrounding natural tissue.

Innovations in prosthetic technologies - Spotlight

Perfusable, stem cells-derived blood vessels in custom lab-on-chip devices

Induced Pluripotent Stem cells (iPSC) technology holds the promise to grow specific tissues which can be used to meet the >1M annual demand for tissue and organ transplants. One bottleneck in realising this potential is achieving vascularisation of SC-derived micro-tissues, to grow functional tissues of sufficient size. To address this need we are creating lab-on-chip platforms to culture stem cells-derived Endothelial (EC) and vascular mural cells (Pericytes, Pc and Smooth Muscle Cells, SMC) under controlled perfusion conditions. With these tools we are investigating the basic mechanisms driving blood vessels assembly and maturation under defined chemical and physical conditions. This research will increase our understanding of vasculogenesis, angiogenesis and vessels maturation and deliver novel platforms to grow vascularised micro-tissues in vitro. For more information regarding this project contact Dr Lorenzo Veschini (lorenzo.1.veschini@kcl.ac.uk)

An automated design pipeline for transparent facial orthoses: A clinical study
Willis, S., Waheed, U., Coward, T. & Myant, C., 19 Dec 2022, (E-pub ahead of print) In: Journal of Prosthetic Dentistry. Research output: Contribution to journal › Article › peer-review. DOIs: https://doi.org/10.1016/j.prosdent.2022.08.012
A custom nasal obturator for velopharyngeal dysfunction: A dental technique
Reed, C., Birch, A. & Coward, T., 30 Apr 2022, (E-pub ahead of print) In: Journal of Prosthetic Dentistry. Research output: Contribution to journal › Article › peer-review. DOIs: https://doi.org/10.1016/j.prosdent.2022.02.022
A Feasible Route for the Design and Manufacture of Customised Respiratory Protection through Digital Facial Capture
Carter, L., Reed, C., Morrell, A., Fong, A., Chowdhury, R., Miller, E., Alberini, F., Khambay, B., Anand, S., Grover, L., Coward, T., Addison, O. & Cox, S., 2 Nov 2021, In: Scientific Reports. 11, 1, 21449. Research output: Contribution to journal › Article › peer-review. DOIs: https://doi.org/10.1038/s41598-021-00341-3
Outcome measures in facial prosthesis research: A systematic review
Jablonski, R., Veale, B., Coward, T., Keeling, A., Bojke, C. & Natress, B., 2020, In: Journal of Prosthetic Dentistry. p. 1-11 11 p. Research output: Contribution to journal › Article › peer-review
Effect of obturators on facial form following surgery for head and neck cancer and impact on the perception of appearance
Coward, T. J., Roberts, R., Fenlon, M. R. & Scott, B. J. J., Jan 2020, In: Journal of Dentistry. 92, 7 p., 103230. Research output: Contribution to journal › Article › peer-review. DOIs: https://doi.org/10.1016/j.jdent.2019.103230
Volume Assessment of the Effect of Obturators on Facial Form Following Surgery for Head and Neck Cancer Using Stereophotogrammetry
Coward, T. J., Richards, R., Fenlon, M. R. & Scott, B. J., 1 Apr 2019, In: Journal of Prosthodontics. 28, 4, p. 379-386 8 p. Research output: Contribution to journal › Article › peer-review. DOIs: https://doi.org/10.1111/jopr.13041
Rehabilitation of orofacial defects using titanium implants.
Watson, R. M., Coward, T. J., Eckhardt, P. & Forman, G. H., 1 Jan 1994, In: Dental Update. 21, 1, p. 8-13 6 p. Research output: Contribution to journal › Article › peer-review
Fabrication of a Wax Ear by Rapid-Process Modeling Using Stereolithography
Coward, T. J., Watson, R. M. & Wilkinson, I. C., 1 Jan 1999, In: International Journal of Prosthodontics. 12, 1, p. 20-27 8 p. Research output: Contribution to journal › Article › peer-review
Suitability of a Mobile Phone Colorimeter Application for Use as an Objective Aid when Matching Skin Color during the Fabrication of a Maxillofacial Prosthesis
Mulcare, D. C. & Coward, T. J., 2018, In: Journal of Prosthodontics. 28, 8, p. 934-943 10 p. Research output: Contribution to journal › Article › peer-review. DOIs: https://doi.org/10.1111/jopr.12955
Color stability of non-pigmented and pigmented maxillofacial silicone elastomer exposed to three different environments
Farah, A., Sherriff, M. & Coward, T. J., 5 Apr 2018, (E-pub ahead of print) In: Journal of Prosthetic Dentistry. Research output: Contribution to journal › Article › peer-review. DOIs: https://doi.org/10.1016/j.prosdent.2017.11.016

View all publications

Grant: Digitised Technology: Its use in the manufacture of Prosthetic ears

Action Research: £22,094.00

Award: Spectrophotommetry & Colour Formulation

Kings College Hospital IT Fund: £21,000

Grant: Facial Masks

DSTL: £8138

Grant: Silicone

DSTL: £1111.00

Grant: Application of Digital technology in colour measurement and formulation in Prosthetic facial rehabilitation

DSTL: £32,500

Grant: Devices

DSTL: £131,672.00

Grant: Colour Formulation Ethnic Groups

DSTL: £5000.00

Grant: No Title (undisclosed)

DSTL: £8000.00

Grant: Masks

DSTL: £4500.00

Grant: Silicone Models

DSTL: £29,030.00

Grant: Oral Lift Project

Added Dimension Dentistry Award: £21,186.00

Grant: Naked Man Project

DSTL: £24,000.00

Grant: Application of Digital technology in the manufacture of Facial / Body prostheses

DSTL: £69,000.00

Award: 3D imaging – Handheld camera

Friends of guys: £14,250

Grant: A pilot clinical trial of augmented reality wearable computer to restore the visual field of monocular patients.

Fight for Sight (British Eye Foundation): £11,169.00

Grant: 3D Models

DSTL : £6478.05

Grant: Research Epidermolysis Bullosa Orthotics

Kings Together: £26,847.18

Award: Imaging/Printing in the manufacture of Bio-compatible Silicone Sleep Apnoea Therapy Masks

KCL Seed Funding Scheme: £48,500

Grant: Improvement of Physiological relevance of pre-clinical denture adhesive Properties

GSK/EPSRC Commercial Award: £111,096.00

Award: Investigating blood vessels assembly and maturation with round-up approach employing iPSC-derived endothelial and vascular accessory cells in custom perfusion bioreactors

KCL Studentship award: £97,512.00

Grant: 3D Nano printable Nano Composite

Kings Health Partners Research & Development Challenge Fund: £9,500.00

Award: 3D Printer

Capital Bid GSTT for 3D Printer: £95,718.00

Developing advanced image analysis techniques for the phenotyping of stem cells-derived endothelial cells

Stem cells cell technology promises to deliver a potentially unlimited amount of specialised somatic cells (e.g. hepatocytes, pancreatic beta-cells, cardiomyocytes and endothelial cells) for regenerative therapies. To fulfil this promise it is necessary to refine the techniques to derive specialised cells of interest from stem cells and to phenotype them accurately to validate their identity and functions. We are using high-throughput and high-content image analysis techniques to phenotype stem cells-derived endothelial cells under different experimental conditions. Endothelial cells are phenotypically heterogeneous among different organs and tissues and this is reflected into subtle morphological and phenotypical differences. High-content image analysis allows extracting rich information on cell phenotype allowing to evaluate cell functional status and to capture differences in cell phenotype such at sub cellular level. This research is producing valuable software tools to aid refinement of stem cells differentiation protocols toward specialised endothelia. For more information regarding this project contact Dr Lorenzo Veschini (lorenzo.1.veschini@kcl.ac.uk)

In collaboration with D Danovi @the Stem Cells Hotel

ACRS has developed a 3D printing centre which is currently housed on floor 17 & 20 of Guy's Tower and is available to all staff including PDRAs, PhD and MSc students of FoDOCS for both clinical provision and research. The ACRS team already provides 3D printing services to GSTT for Restorative Dentistry, Oncology, Plastic Reconstruction, ENT and Orthognathic surgery planning, designing/ supplying preoperative templates, surgical cutting guides, surgical wafers and preoperative models for surgery planning and rehearsal.

This facility is a joint collaborative project between ACRS with the 3D commercial company iMakr, and we now have a number of 3D printers and scanners that will not only enhance the research capabilities but will add innovation and viability to clinical services of FoDOCS. Currently ACRS has 11 3D printers ranging from FDM, Multijet, DLP and a bioplotter all available for use and capable of printing in various materials (PEEK, PVA, PLA PCL, Nylon, ABS), bio-compatible light cure resins, biocompatible inks (colloidal gels, collagen, TCP and HA) and pellets (PCL) and resolutions.