Total 3D planned mandibular reconstructions using CAD–CAM reconstruction plates and guided implant placement in free vascularized fibula grafts

Background and objectives: New developments in 3D computerized planning now allow for the inclusion of precise dental implant placement in the fibula as well as pre-operatively CAD–CAM produced reconstruction plates. In the research phase for the development of a new commercially available CAD CAM produced reconstruction plate a cadaver and clinical study was performed. Several items were studied: (1) The development of a new design of a 3D printed guide allowing implant insertion, pre drilling of screw holes as well as segmentation of the fibula. (2) The precision of placement of a CAD CAM produced reconstruction plate, dental implants and the segmentation of fibula bone.

Methods: Complex fibula reconstructions of large mandibular C-defects were performed in cadavers and a patient using a new protocol. With pre-operative computer planning the original shape of the mandible was obtained by segmentation of the fibula. Also the optimal position of the implants was located and finally the reconstruction plate was designed. 3D planning of the plate allows placement of the screw holes free from the implant location. One guide for implant placement, pre-drilling of the screw holes in the fibula and segmentation was designed. All procedures were performed while the fibula was still attached to the vessels in the lower leg.

Results: This protocol resulted in a deviation of less than 1 mm of the reconstruction compared to the plan! Pre drilling of screw holes in the fibula did not interfere with implant placement. The CAD CAM plate had an excellent fit. It was possible to plan new screw holes around pre-existing holes from previously inserted plates.

Conclusions: There is a clear advantage of using 3D planned guides for implant placement, segmentation and pre drilling of screw holes. CAD CAM produced plates have an excellent fit.

Key words: mandibular reconstruction; 3D printing; reconstruction plate; dental implants

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Jan 21, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Total 3D planned mandibular reconstructions using CAD–CAM reconstruction plates and guided implant placement in free vascularized fibula grafts
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