Accuracy of fibula reconstruction using patient-specific CAD/CAM reconstruction plates and dental implants: A new modality for functional reconstruction of mandibular defects

Combination of biomechanical evaluation and accurate placement of dental implants: a new concept of virtual surgery in maxillary and mandibular functional reconstruction

“…As numerous studies have reported, fibular segments are usually located parallel to the lower margin of the remaining maxilla or mandible without consideration of the biomechanical aspects. 8,[17][18][19] The substantial effect of maxillofacial reconstruction on biomechanics indicates that the bone may not regenerate, but be absorbed instead, 6,7 because the most suitable position for a graft is probably not at the low margin, according to the FEA assessment. In addition, the low vertical position of dental implants in the fibula leads to prosthodontic difficulties such as thick, overstuffed, soft tissue and excessive height of the dental crown, which increases the risk of peri-implantitis.…”

“…6,7 The concentration of stress from the marginal implantation site, or the use of sloped dental implants, increases the risks of failure of these implants. 8,9 Several studies have provided detailed information about the finite-element analysis (FEA) of the biomechanical properties of reconstructed maxillas and mandibles with dental implantation. 10,11 However, these data were calculated from standard defect models and cannot be applied directly to surgical operations because the site of the defect and the bone structure of each patient are unique.…”

Introduction of an algorithm for planning of autologous fibular transfer in mandibular reconstruction based on individual bone curvatures

“…Within that back‐transformation, the angulated cutting planes are maintained, defining thus the positions and rotations of each individual cut at the donor site. Transforming these virtual cuts into a surgical guide is a well‐established procedure . The approach that is currently used in the present process chain relies on similar techniques to design the cutting guides.…”

“…Today, CAS plays a fundamental role in mandibular reconstruction. Different techniques such as pre‐bent plates, pre‐shaped titanium mesh implants and transplant cutting guides have evolved over time. Today, the use of transplant cutting guides for graft harvest is the most common approach for bony mandibular reconstructions …”

“…After the creation of three‐dimensional objects by segmentation and visualization of the defect, the software operator defines the ideal transplant position and required osteotomies for the best possible functional and aesthetic outcome. To transfer the virtual planning to the operating room, a transplant cutting guide and a defect model are produced, often via generative manufacturing techniques.…”