A novel ‘surgeon-dominated’ approach to the design of 3D-printed patient-specific surgical plates in mandibular reconstruction: a proof-of-concept study

Yang, Wei‐En; Zhang, C.-y.; Choi, Wonyoung; Zhu, Wangyong; Li, D.T.S.; CHEN, XI; Du, Ruxu; Su, Yu‐xiong

doi:10.1016/j.ijom.2019.05.005

Cited by 47 publications

(31 citation statements)

References 22 publications

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“…More recently, the advent of 3D-printed patientspecific surgical plates has further enhanced the precise alignment and fixation of bone grafts 14,15 . In previous studies conducted by the present authors, patient-specific surgical plates have been demonstrated to enhance the overall accuracy of oncological mandibular reconstruction 14,[16][17][18][19] . However, spatial deviations of the TMJ are rarely evaluated, and whether CAS and patientspecific surgical plates contribute to the normal fossa-condyle relationship remains to be elucidated.…”

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confidence: 79%

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Spatial deviations of the temporomandibular joint after oncological mandibular reconstruction

Yang

Choi

Zhu

et al. 2022

International Journal of Oral and Maxillofacial Surgery

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Spatial deviations of the temporomandibular joint (TMJ) after oncological mandibular reconstruction are important to the aesthetic and functional rehabilitation. The aim of this study was to clarify whether and how three dimensionally (3D) printed patient-specific surgical plates, and the preservation of the condyle or ramus, affect spatial deviations of the TMJ. A total of 33 patients who underwent mandibular reconstruction via computer-assisted surgery were included. Regarding absolute deviations, patients in the 3D-printed plate group showed smaller TMJ deviations compared to those in the conventional plate group. There was no difference in absolute deviations of the TMJ regardless of whether the condyle or ramus was preserved. Regarding physiological deviations, the impact on the contralateral TMJ was smaller in the 3D-printed plate group. Patients with both the condyle and ramus removed had significantly higher deviations of the condyle and joint space. In summary, 3D-printed patient-specific surgical plates improved the spatial accuracy of the TMJ. Under physiological conditions, TMJ deviations on the operated side were mainly affected by the preservation of the condyle. Removal of both the condyle and ramus caused more severe spatial interference to the TMJ; this should be further confirmed.

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confidence: 79%

“…1, Strategy 1). 3D-printed patient-specific surgical plates were designed and applied in a novel 'surgeon-dominated' approach, which has been detailed in previous articles 16,17 . The study group has been registered at ClinicalTrials.gov (3DJP16, NCT03057223) 14,19 .…”

Section: Study Design and Participantsmentioning

confidence: 99%

Spatial deviations of the temporomandibular joint after oncological mandibular reconstruction

Yang

Choi

Zhu

et al. 2022

International Journal of Oral and Maxillofacial Surgery

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“…The implantation guide was designed for holding removable sleeves of NobelParallel Conical Connection Guided Drilling Kit (Nobel Biocare AB, Göteborg, Sweden), for preparing the implant site. The patient‐specific titanium plate was designed as the approach we described in previous study 10 . Next, the 3‐in‐1‐PSSGs were printed with ISO‐certified Resin, Bio‐compatible MED610 (Stratasys Ltd.), using Objet350 Connex3 3D Printer (Stratasys Ltd.), and the patient‐specific plates were printed with grade 2 pure titanium using the selective laser melting technology.…”

Section: Methodsmentioning

confidence: 99%

“…Previously, we have designed and fabricated novel patient‐specific surgical plates by metal three‐dimensional (3D) printing technology for jaw reconstruction, which led to precise reconstructive outcomes 8,9 . Further, we explored the workflow and technical procedures, and then proposed a novel “surgeon‐dominated” approach to the design of 3D printed patient‐specific surgical plates 10 . Since the bone height of the fibula graft is around 10 to 15 mm, which is significantly shorter than that of the mandible, the fibula graft can be segmentalized to allow the distal segment to be folded and stacked up to the proximal segment to form a double‐barrel complex.…”

Section: Introductionmentioning

confidence: 99%

“Three‐in‐one” patient‐specific surgical guides for simultaneous dental implants in fibula flap jaw reconstruction: A prospective case series

Zhu

Pow

et al. 2020

Clin Implant Dent Rel Res

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Background Conventional freehand immediate placement of dental implants is technically challenging in the jaw reconstructive surgery. Computer‐aided surgery might be the best solution, however, there has not been any standard approach to ensure the accuracy and efficiency of simultaneous dental implants in fibula flap jaw reconstruction. Purpose We aim to evaluate the clinical outcome of simultaneous dental implant in fibula flap using the “three‐in‐one” patient‐specific surgical guide (3‐in‐1‐PSSG) in an open‐label, prospective, single‐arm, and single‐center clinical trial. Materials and Methods A novel computer‐aided designed and three‐dimensional (3D) printed 3‐in‐1‐PSSG, which contains functions of fibula segmentation, surgical plate positioning and implant placement, was used to facilitate the reconstructive surgery and simultaneous dental implant placement. The intraoperative success of dental implant placement, implant survival rate and accuracy of dental implant placement were reported. Results From November 2018 to June 2020, 15 consecutive patients with 48 dental implants were enrolled in this study. Fifteen 3‐in‐1‐PSSGs were fabricated with a mean number of dental implants per guide of 3.2 ± 1.5. The intraoperative success rate of this approach was 14 out of 15. With an average follow‐up period of 40 weeks, the overall implant survival rate was 83.3% (40/48). Eight implants were removed due to two fibula flap failures. The mean deviation at the implant platform and implant apex were 2.8 mm (interquartile range [IQR]: 1.9‐3.4) and 3.2 mm (IQR: 2.0‐4.6), and the angular deviation was 2.5° (IQR: 1.1‐6.8). Conclusions Our preliminary data indicated that the 3D printed 3‐in‐1‐PSSG facilitated simultaneous dental implant in fibula flap jaw reconstruction with a favorable intraoperative success and short‐term clinical outcome. It might be a viable alternative to allow one‐step immediate oral rehabilitation in patients underwent jaw reconstruction with free flaps. Long‐term results with a larger sample size are warranted.

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“…For reconstruction of the mandible after a continuity resection and with extra‐intraoral communicating wounds, a free vascularised fibular flap is reported as the gold standard (Cordeiro, Disa, Hidalgo, & Hu, 1999). Several studies have reported an accurate and safe workflow for 3D VSP‐based fibula reconstruction of mandibular defects, occasionally in combination with a patient‐specific reconstruction plate (Essig et al., 2011; Roser et al., 2010; Schepers et al., 2015; Weijs et al., 2016; Weitz, Wolff, Kesting, & Nobis, 2018; Yang et al., 2019; Zhang et al., 2016). This paper critically reviews current methods for 3D VSP, leads for optimisation of the 3D VSP workflow and patient‐specific application of guides and implants.…”

Section: Introductionmentioning

confidence: 99%

Three‐dimensional virtual surgical planning in the oncologic treatment of the mandible

et al. 2020

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Objectives: In case of surgical removal of oral squamous cell carcinomas, a resection of mandibular bone is frequently part of the treatment. Nowadays, such resections frequently include the application of 3D virtual surgical planning (VSP) and guided surgery techniques. In this paper, current methods for 3D VSP leads for optimisation of the workflow, and patient-specific application of guides and implants are reviewed. Recent findings: Current methods for 3D VSP enable multi-modality fusion of images. This fusion of images is not restricted to a specific software package or workflow. New strategies for 3D VSP in Oral and Maxillofacial Surgery include finite element analysis, deep learning and advanced augmented reality techniques. These strategies aim to improve the treatment in terms of accuracy, predictability and safety. Conclusions: Application of the discussed novel technologies and strategies will improve the accuracy and safety of mandibular resection and reconstruction planning. Accurate, easy-to-use, safe and efficient three-dimensional VSP can be applied for every patient with malignancies needing resection of the mandible.

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A novel ‘surgeon-dominated’ approach to the design of 3D-printed patient-specific surgical plates in mandibular reconstruction: a proof-of-concept study

Cited by 47 publications

References 22 publications

Spatial deviations of the temporomandibular joint after oncological mandibular reconstruction

Spatial deviations of the temporomandibular joint after oncological mandibular reconstruction

“Three‐in‐one” patient‐specific surgical guides for simultaneous dental implants in fibula flap jaw reconstruction: A prospective case series

Three‐dimensional virtual surgical planning in the oncologic treatment of the mandible

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