Experimental findings on customized mandibular implants in Göttingen minipigs – A pilot study

Abstract

Reconstructing continuity defects of the mandible is still challenging for surgeons. The currently applied conventional titanium bridging plates have considerable rates of complications. Now, a new technology enables an individual shape-identical creation of a mandibular implant in a form-board design by the method of LaserCUSING using pure titanium. This technology has been successfully performed in previous examinations to individually reconstruct mandibular continuity defects. This pilot study evaluated the surgical procedure in 10 female Göttingen mini pigs. First, a computed tomography scan from a mini pig cranium was performed. A three-dimensional model of the mandible was designed by data conversion. Based on the data, a customized mandibular implant resembling the natural shape was virtually created and manufactured. Then, a continuity defect of the left mandible was created in a standardized way. The implants were inserted into the defect and the wounds were allowed to heal for 21, 35, 56 and 180 days. During the healing period, no signs of inflammation or infection were observed. After the sacrifice of the minipigs the mandibles were resected. Histological microsections using Donath's sawing and grinding technique were manufactured and stained with Masson Goldner trichrome staining. The histomorphological results showed a pronounced ossification at the outer and inner surface of the implants. This animal study describes a promising approach to optimize customized implants for the application in humans.

Finite element analysis of customized implant in mandibular reconstruction after tumor resection with and without using customized surgical osteotomy guide

“…Ablative tumor therapy is one of the main important causes for mandibular continuity defects. Reconstruction surgery of continuity defects of the mandible is still challenging for craniomaxillofacial (CMF) surgeons . This type of surgery becomes complex and unpredictable because of very limited visibility of closed internal structures, the presence of teeth and their relationship with bone, the influence of surgery on the airway, and interference with occlusion .…”

“…This type of surgery becomes complex and unpredictable because of very limited visibility of closed internal structures, the presence of teeth and their relationship with bone, the influence of surgery on the airway, and interference with occlusion . Mainly, different extended mandibular malignant and benign lesions and inflammation are treated using ablative surgery, which can cause continuity defects in the mandible . Furthermore, squamous cell carcinomas (SCC) of the tongue, the floor of the mouth and mandibular alveolar process are treated with ablative tumor therapy .…”

“…Mainly, different extended mandibular malignant and benign lesions and inflammation are treated using ablative surgery, which can cause continuity defects in the mandible . Furthermore, squamous cell carcinomas (SCC) of the tongue, the floor of the mouth and mandibular alveolar process are treated with ablative tumor therapy . Accurate mandibular reconstruction is needed for functional and aesthetic improvement.…”

“…Accurate mandibular reconstruction is needed for functional and aesthetic improvement. Loss of anatomical mandibular shape includes problems in speech, mastication, deglutition, and occlusion …”

“…In current practices, the most reliable therapy is an instant reconstruction of defects using musculo‐osseous flaps which are microvascularly anastomosed and, harvested from the fibula, iliac crest, or scapula . However, the instant reconstruction of continuity defects of the mandible is not always possible.…”