## 4 Discussion  
The precise restoration of the fractured orbital structure plays a crucial role in achieving both the restoration of the normal structure and volume without any aesthetic or functional complications. This restoration necessitates accurate reformation of the orbit and proper spatial positioning of the globe [14]. However, accomplishing the restoration of the premorbid bony contour [10; 14] presents a challenging task due to the intricate 3D nature of the orbit. Even a minor alteration in orbital volume can lead to significant enophthalmos [15; 16; 17]. An inadequately positioned orbital implant can result in diplopia and ocular movement restriction caused by entrapment of the extraocular muscle and soft tissue (Figure 5). The use of 3D printing technology was postulated to enable more precise molding compared with conventional implants. Considering this, the present study aimed to determine the clinical efficacy of personalized orbital implants using a 3D-printed template for orbital volume reconstruction. The volume on the postoperative injured side did not differ significantly from that on the contralateral unaffected side in the 3D group, but these did differ significantly in the manual group. A large orbital fracture also tended to be undercorrected in the manual group, while preoperative fracture size did not affect the postoperative orbital volumes of the restorations in the 3D group (Figure 4). Considering that the orbital volumes on the contralateral unaffected, preoperative, and postoperative injured sides did not differ significantly in both groups (Table 2), the surgical outcome of the 3D group was superior. The findings of the current study were consistent with the previous research, which also highlighted the effectiveness of the 3D-printed implant in restoring orbital volume. Recent studies found that using 3D-printed implant surgery resulted in a significantly greater volume reduction compared with conventional manual bending methods [18; 19]. Those authors concluded that 3D-printed implants for orbital bone fracture reconstruction led to better outcomes by achieving accurate anatomical reconstruction. Moreover, the improved fit and reduced need for tissue handling could have the additional benefit of reducing postoperative edema risk [20]. By utilizing 3D printed templates, the risk of intraoperative implant deformation or errors related to manual bending can be reduced (Figure 5). They conform to the individual anatomy of the patient and could potentially lead to improved aesthetic and functional outcomes, such as improved ocular alignment and reduced risk of complications such as  
Figure 5: The preoperative facial bone CT images and nine-gaze photographs of 57-year-old male patient who underwent left inferior blowout fracture surgery using the conventional manual technique (**A–C**). Despite the positive outcome in terms of orbital volume restoration, immediate postoperative images (**D–F**) reveal that the posteriorly misaligned orbital implant compressed the inferior rectus muscle (arrowhead, (**E**)), which restricted the elevation of the left eye (arrow, (**F**)). implant migration or extrusion. This result could benefit quality control and potentially lead to more predictable surgical outcomes and safer procedure. The 3D implant can also be a valuable tool for surgical training [21; 22]. Surgeons, especially those with less experience of complex procedures such as orbital fracture repair, can practice their accuracy in trimming and molding of orbital implants by observing 3D implants manufactured according to specific dimensions of different patients. The 3D implants can also compensate for the lack of experience as a patient-specific surgical guide. This allows them to reduce their learning curve and refine their techniques and helps to improve surgical outcomes regardless of fracture size and surgeon's experience.