Influencer Interview: Dr. Raymond Wong, Singapore

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Dr. Raymond Wong graduated with a Bachelor of Dental Surgery from the University of Malaya. While there, he won the University Entrance Scholarship and won the Book Prize for Excellence for the First, Second and Final Professional Examinations (Part 1). He then pursued his specialist training in Oral and Maxillofacial Surgery (OMFS) at the National University of Singapore under the Association of Southeast Asian Nations (ASEAN) Post Graduate Scholarship, graduating with a Master of Dental Surgery (OMFS). He subsequently went on to work as a Specialist Registrar at the Sunderland Royal Hospital and a Clinical Fellow at Morriston Hospital, Swansea, Wales in the United Kingdom while on a Health Manpower Development Program under the Ministry of Health Singapore. He obtained a Ph.D. in Medical Sciences from the Radboud University of Nijmegen, the Netherlands. He is a Senior Consultant and Assistant Professor in OMFS at the National University Centre for Oral Health and the National University of Singapore. At the University Level, he is the co-thrust lead for Dentistry, AM.NUS. Dr. Wong was a Past President, Association of Oral and Maxillofacial Surgeons Singapore, sits on the Specialist Training Committee, OMFS, represents Singapore as Country Councilor on the Asian Association of Oral and Maxillofacial Surgeons as well as holds a Councilor at Large post on the Executive Council of the Asian Association of OMFS and the International Association of OMFS as Singapore Councilor. He serves as a Regional Faculty, Association for the Study of Internal Fixation (AO) Craniomaxillofacial Surgery (AOCMF) at the Asia Pacific region. AOCMF is a nonprofit educational organization dedicated to the teaching of head and neck surgery to surgeons from all specialties. He is also currently the Organizing Chairman, Asian Conference on Oral and Maxillofacial Surgery, 2020 in Singapore. Dr. Wong will be speaking in our upcoming August 28th, 2019 3DHEALS Singapore Annual Event.

Jenny: When was the first encounter you had with 3D printing? What was that experience like?

Dr. Wong: I first tried 3D printing in 2008 when I had a case that needed a surgical cutting guide to be fabricated. At that time the place where I worked had bought the Z-Corp printer which essentially had powder base bound by an inkjet and then needed strengthening with cyanoacrylic glue. It didn’t find much use because there was no allocation for a technician and no one knew how to use it. So it became a white elephant and the powder kept on having to be discarded as it had expired. I found the process interesting but quite painful and realized that we needed trained personnel to do this. It was very difficult for busy clinicians to learn how to perform segmentation of the radiologic images, exporting in STL format and deciding on how to position the print on the platform. Essentially I did it by trial and error in between patients and after work with little guidance. That took me the better part of 2 weeks. The computer where we installed the segmentation software kept on hanging and running out of memory and had to be re-booted repeatedly. The first model I printed crumbled and I had to print it again taking 8 hours. The second model I managed to remove from the build chamber but part of it crumbled when I used an air-jet to remove excess powder as recommended by the manufacturer. Another 8 hours later, I managed to use the cyanoacrylic strengthener but my glove got stuck to the model and I managed to peel most of it out individually with a scalpel.

Jenny: What inspired you to start your journey in 3D printing ?

Dr. Wong: The recognition that we already had technological advances at hand but there was little implementation because, for many surgeons, it felt too difficult to learn or little impetus to change since the old methods worked. My argument against that is that there are always better ways to do things and the use of these technologies is not just fancy toys but you actually reduce the incidence of bad complications and improve the frequency of good outcomes.

Jenny: Who inspired you the most along this journey in 3D printing ?

Dr. Wong: The late Emeritus Professor Henk Tideman, University of Hong Kong, who was my Ph.D. supervisor-he made me realize that you need to keep up to date on the latest advances-he was much older than me but more in tune with technology than me. The second person who comes to mind is Prof Adrian Sugar of Morriston Hospital, Wales. He was, again, older than me but in the forefront of advanced digital technology for head and neck surgery.

Jenny: What motivates you the most for your work?

Dr. Wong: I am never content to accept the current way we do something is the best way. There are always ways to improve things.

Jenny: What do you think are the biggest challenge(s) in 3D Printing/bio-printing? What do you think the potential solution(s) is (are)?

Dr. Wong:

Challenges:

Lack of trained personnel

Lack of funding for equipment, training and employing such personnel

Solutions:

Having a centralized centre like that available in NUS (AM.NUS) is a possible way forward for institutions.

Jenny: What were/was the best investment you made in 3D printing? 

Dr. Wong: Spending the time to learn how to clean radiologic images, performing segmentation, learning how to design with a CAD program and doing my own printing. It gave me a deep understanding of the nuances and intricacies involved.

Jenny: What was/is the biggest risk you took in your career?

Dr. Wong:  Using 3D planning for surgery and printing surgical guides exclusively without any backup (in case the printed guides didn’t fit or work). I did the first orthognathic jaw surgery case in Singapore planned using computer virtual planning and then fabricate 3D printed guides in 2011. Prior to that, I had done a difficult post-traumatic deformity case in 2010 using a combination of 3D planning and 3D printed cutting and positioning guides for facial surgery.

Jenny: What is your favorite quote? Why?

Dr. Wong: I like this quote from Prof Ryan Bell- Everyone can have a bad day in the office. For surgeons, a bad day in the office implies a poor outcome for a patient with its own cost and morbidity. The use of digital technology improves good outcomes and increases the frequency of good outcomes. 

This phrase means a lot because as surgeons, things that we do can impact a patient negatively. Not using the best tools at our disposal for treatment and even training is difficult to defend especially when such technologies are not exactly that new.

Related Articles:

Maxillofacial Surgery and 3D printing: Past and Present

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Interview: Renata Vano, 3D Printing in Prosthodontics, Brazil

Interview: Dr. Pedro Martinez Seijas, Oral and Maxillofacial Surgeon at Donostia University Hospital

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