## 4 Discussion
The use of a customized 3D-printed template can reduce the time spent on intraoperative manipulation and adjustment of the implant to fit the defect, since it would have been designed to fit precisely [20; 23]. This can decrease the total surgery time, which can in turn reduce the risks associated with longer surgical procedures including infection or anesthesia complications. Furthermore, streamlined surgical process may contribute to better overall surgical efficiency. Previous studies found that using 3D-printed implants reduced surgical times from an average of 93.3 min with standard implants to 48.3 min [20]. However, our study did not identify any significant difference in surgical times between the two methods. The fracture size and shape were analyzed using CT scanning before surgery in the manual group of the present study. If the preoperative analysis time (10 min) of the implant using CT scans was accounted for, the operation time would be longer in the manual group than in the 3D group, which was consistent with the findings of previous studies. The volumes of the fractured orbits of all cases in the present study, and the contralateral orbit volume were 23.04 \(\pm\) 2.95 cm\({}^{3}\) and 21.88 \(\pm\) 2.74 cm\({}^{3}\). A previous study [24] that used the Eclipse Treatment Planning System (version 13.0, Varian Medical Systems, Palo Alto, CA, USA) to measure orbital volume in patient with blowout fracture obtained results similar to those in our study. That study determined that the volume was 23.01 \(\pm\) 2.60 cm\({}^{3}\) for the fractured orbits and 21.31 \(\pm\) 2.50 cm\({}^{3}\) for the contralateral orbits. Orbital volume is typically considered to be smaller in females than in males and smaller in children than in adults [25]. However, there were no differences in age or sex between the two groups in the present study. The previous findings imply that our orbital volume measurements were performed accurately and were free from potential bias related to age and sex, thereby enhancing their reliability. Several types of 3D printing technology exist, including direct 3D printing and 3D-printed standardized implants. However, the direct printing technique is currently expensive, time consuming, and requires specific equipment. The choice of implant material also remains restricted to titanium. Population-based pre-bent standardized implants have indeed shown superior outcomes compared with conventional-plane 2D implants (as indicated in references [2; 26]). Nonetheless, these methods have their limitations as they are unable to fully exploit the potential of 3D printing technology to fabricate entirely personalized implants. This is due to the fact that individual patients possess distinct orbital morphologies, necessitating a more tailored approach to implant design and manufacturing. The orbital implant template method we present here has several advantages over existing technologies. We placed the implants between the upper and lower portions of the templates, and applied pressure to mold them into the desired shape (Figure 2). First, using a 3D-printed template based on patient-specific imaging data is potentially more accurate than using pre-bent implants based on population averages that are highly unlikely to exactly match the anatomy of each patient. Second, [PERSON] et al. found that the 3D-printed template method has advantages of a shorter manufacturing time and lower cost [11]. The 3D-printed mold costs around US$100, which is much cheaper than the cost of US$3700-6200 for direct 3D printing [12]. Third, our method does not require any specialized equipment, with a standard 3D printer being sufficient. Indeed, the adaptability of the 3D template printing method is a significant advantage, especially in developingcountries, as it allows for easy implementation. Any clinic equipped with a 3D printer and suitable software can readily adopt this technology.