Accuracy of computer-assisted mandibular reconstructions using patient-specific implants in combination with CAD/CAM fabricated transfer keys

Mascha, F.; Winter, Karsten; Pietzka, Sebastian; Heufelder, Marcus; Schramm, Alexander; Wilde, Frank

doi:10.1016/j.jcms.2017.08.028

Cited by 68 publications

(38 citation statements)

References 34 publications

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“…However, 88% of the measurements were performed in the 10 cases. Mascha et al (Mascha et al, ) evaluated 18 cases of mandibular reconstruction (10 cases involving solely alloplastic reconstruction, and eight involving microvascular osseous reconstruction) using surgical guides made by CAD/CAM procedures, and reported that the mean deviation after microsurgical reconstruction (2.47 mm) was greater than that after alloplastic reconstruction (0.80 mm). Recent CAD/CAM procedures have been used to produce surgical guides for mandibular resection, bone harvesting, and repositioning of the mandible.…”

Section: Discussionmentioning

confidence: 99%

“…(a) The mandibular defect areas were classified as symphysis defect (SD), lateral body defect (LB), angle defect (AG), and ramus defect (RA) (Mascha et al, ). (b) The six bilateral corresponding anatomical landmarks used for the measurement of the postoperative transversal deviation of the ascending rami of the mandible.…”

Section: Methodsmentioning

confidence: 99%

“…The accuracy of the mandibular positioning was evaluated by measuring the postoperative transversal deviation of the ascending rami of the mandible relative to the preoperative position, in accordance with the method used by Mascha et al (Mascha et al, ). Computer software (Real INTAGE, Cybernet Systems Co., Ltd.) was used to measure the distances between six bilateral corresponding anatomical landmarks on 3D images; A (A′): innermost point of the mandibular condyle, B (B′): outermost point of the mandibular condyle, C (C′): lowest point of the mandibular notch, D (D′): lingual tip of the mandible, E (E′): tip of the coronoid process, and F (F′): most caudal point of the mandibular angle (Figure b).…”

Section: Surgical Techniquesmentioning

confidence: 99%

“…After mandibular resection, the resin subsidiary plate combined with the reconstructive plate was allocated to the mandible. Since this F I G U R E 1 (a) The mandibular defect areas were classified as symphysis defect (SD), lateral body defect (LB), angle defect (AG), and ramus defect (RA) (Mascha et al, 2017). The points of view for the measurements were calibrated to reduce the error.…”

Section: Surgical Techniquesmentioning

confidence: 99%

“…Surgical guides need to be accurate, versatile, and cost‐effective. However, these techniques are costly and require complex preparation (Mascha et al, ; Mazzoni et al, ; Wilde et al, ). In this report we introduced a new mandibular reconstruction techniques using a resin subsidiary plate combined with a reconstructive plate.…”

Section: Introductionmentioning

confidence: 99%

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Microsurgical mandibular reconstruction using a resin surgical guide combined with a metal reconstructive plate

et al. 2019

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Introduction In mandibular reconstruction, repositioning the mandibular position is still challenging and time consuming. We invented a new re‐positioning technique using a resin plate combined with a reconstructive plate in reconstructing the mandible with an osteocutaneous free flap. The purpose of this report is to introduce this technique and evaluate the accuracy of mandibular reconstruction using free flaps. We hypothesized that this technique is precise and can reduce intraoperative plate bending at a low cost and short preparation period. Methods Mandibular reconstruction was successfully performed in a total of 10 cases without any complications. In this technique, a pre‐bent reconstructive plate was prepared in accordance with a three‐dimensional model, and then coated with resin. Intraoperatively, the mandibles were secured by fitting these plates snugly and fixing them using a reconstructive plate. Then the resin was removed and free osteocutaneous free flaps were transfer to the defect. Ten patients with a mean age of 68.2 who underwent mandibular resection for aggressive benign (n = 1) or malignant disease (n = 9) were reconstructed using this technique. Seven cases were reconstructed using fibular osteocutaneous free flaps, while scapular osteocutaneous free flaps were used in the remaining cases. The resections entailed: unilateral symphysis and lateral body in four cases, angle to ipsilateral angle in two, ramus to symphysis in two, and lateral body plus angle to symphysis in one case. The deviation of the mandible was evaluated by measuring the preoperative versus postoperative differences in the distances between six bilateral landmarks. Results There were no complications and flap failure in any of the 10 cases. No further intraoperative plate bending was required. One case underwent additional mucosal resection due to recurrence of cancer. Three cases were referred to postoperative chemoradiotherapy. Two patients expired during follow‐up due to recurrence of cancer. Six cases were put back on a normal diet. The other cases who lacked opposing teeth had to remain on a soft diet. The mean follow‐up period was 46.2 months. The average of the absolute deviation values was 1.45 mm. This value was 0.94 mm in six cases with mandibular body defects and 2.26 mm in four cases with mandibular defects involving the ramus. Conclusions The present novel technique is simple, quick to prepare, and accurate. This technique can be a viable option for microsurgical mandibular reconstruction.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Surgical Techniquesmentioning

confidence: 99%

Section: Surgical Techniquesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Microsurgical mandibular reconstruction using a resin surgical guide combined with a metal reconstructive plate

et al. 2019

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Analysis of the accuracy of computer‐assistedDCIAflap mandibular reconstruction applying a novel approach based on geometric morphometrics

et al. 2022

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Background: This study evaluated the accuracy of computer-assisted surgery (CAS)-driven DCIA (deep circumflex iliac artery) flap mandibular reconstruction by traditional morphometric methods and geometric morphometric methods (GMM).Methods: Reconstruction accuracy was evaluated by measuring distances and angles between bilateral anatomical landmarks. Additionally, the average length of displacements vectors between landmarks was computed to evaluate factors assumed to influence reconstruction accuracy. Principal component analysis (PCA) was applied to unveil main modes of dislocation.Results: High reconstruction accuracy could be demonstrated for a sample consisting of 26 patients. The effect of the number of segments and length of defect on reconstruction accuracy were close to the commonly used significance threshold (p = 0.062/0.060). PCA demonstrated displacement to result mainly from sagittal and transversal shifts.Conclusions: CAS is a viable approach to achieve high accuracy in mandibular reconstruction and GMM can facilitate the evaluation of factors influencing reconstruction accuracy and unveil main modes of dislocation in this context.

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Advances and Innovations in Reconstruction of the Maxilla and Midface Utilizing Computer-Assisted Surgery: Technology, Principal Consideration, and Clinical Implementation

Rana

Wilkat

2021

Innovations and New Developments in Craniomaxillofacial Reconstruction

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Accuracy of computer-assisted mandibular reconstructions using patient-specific implants in combination with CAD/CAM fabricated transfer keys

Cited by 68 publications

References 34 publications

Microsurgical mandibular reconstruction using a resin surgical guide combined with a metal reconstructive plate

Microsurgical mandibular reconstruction using a resin surgical guide combined with a metal reconstructive plate

Analysis of the accuracy of computer‐assistedDCIAflap mandibular reconstruction applying a novel approach based on geometric morphometrics

Advances and Innovations in Reconstruction of the Maxilla and Midface Utilizing Computer-Assisted Surgery: Technology, Principal Consideration, and Clinical Implementation

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