Abstract Background: Maxillofacial implant design has traditionally relied on static optimization techniques that fail to accommodate real-time intraoperative variables and patient-specific biomechanical responses. Such limitations can hinder implant efficacy and anatomical integration. Methods: The proposed system leverages a real-time adaptive surrogate model (RTASM), a recurrent neural network trained to predict stress distributions under variable loading conditions. This surrogate model works in conjunction with a topology optimization controller to minimize stress concentrations while maintaining anatomical accuracy. The framework replaces conventional mesh inputs with a signed distance function representation, facilitating efficient geometric feature extraction and adaptation through dynamic transfer learning. Additionally, a heterogeneous pore distribution algorithm is employed to construct patient-specific lattice structures. The implant designs are validated using in silico finite element analysis (FEA), with discrepancies triggering automated updates to the surrogate model. Material heterogeneity is incorporated via targeted hydroxyapatite coating in osseointegration-critical zones. Results: The closed-loop system demonstrated real-time adaptability to intraoperative biomechanical changes and achieved significant improvements in mechanical integrity and morphological accuracy. Enhanced stress distribution and structural fidelity were confirmed through repeated FEA simulations. Conclusion: This framework establishes a new paradigm for patient-specific maxillofacial implant design, uniting intelligent modeling, real-time optimization, and biological enhancement in a unified workflow. Its ability to dynamically adapt to patient-specific data and validate implant performance intraoperatively positions it as a promising solution for personalized surgical reconstruction.
Aldooh et al. (Wed,) studied this question.