The Application of Virtual Planning and Navigation Devices for Mandible Reconstruction and Immediate Dental Implantation

Abstract

Reconstruction of skeletal defects is crucial in modern maxillofacial surgery. Commonly these defects are results of radicalism of ablative surgery and might be associated with significant impact on anatomy, function, and esthetics, which provoke deterioration of overall quality of life (QoL) of the patient. Nevertheless, the most difficult task in the facial reconstruction is the reconstruction of the frontal part of the mandible because of its convex-concave anatomy and specific impact of mandible on function and esthetics of the whole face. Various flaps and techniques are available for the reconstruction of subtotal defects of the mandible, including free fibula, iliac crest, etc. 1 Yet free fibula seems to be work Keywords ► virtual planning ► dental implants ► free fibula transfer ► navigation guide AbstractRoutine reconstruction of subtotal defects of the mandible and orthopedic rehabilitation supported by dental implants is achieved by means of detailed planning and lasts over a year. This article shows the outcomes of single-stage surgical treatment and immediate orthopedic rehabilitation performed with the help of preoperative virtual computer simulation. 3D investigation of pathological and donor sites, virtual simulation of tumor resection, positioning of the dental implants into fibula, virtual flap bending and transfer, virtual bending of fixing reconstruction plates, and fabrication of navigation templates and bridge prosthesis supported by dental implants were done preoperatively. The surgery included tumor resection, insertion of dental implants into fibula, elevation of fibula osteocutaneous free flap, rigid fixation within recipient site, and immediate loading by bridge orthopedic device. On 10-month follow-up, functional and esthetic results were asses as reasonable. Radiography showed dental implants to be integrated and positioned appropriately. We found that successful rehabilitation of the patients with extensive defects of the jaws could be achieved by ablative tumor resection, dental implants insertion prior to flap elevation guided by navigation templates, further osteotomy, modeling of the flap based on navigation template, flap transfer, and rigid fixation within recipient site by prebended plates, with application of prefabricated prosthesis.

Reconstruction the Postablative Lower Jaw Defects with Vascularized Free Fibula Flap with Further Endosteal Implants

“…3D modeling of the bone graft also allows the creation of templates for contour osteotomy, which saves the surgeon time and maximizes bone-to-bone contact, promoting strong bone fusion. Mandibular reconstruction using computer-aided design and computer-aided manufacturing: an analysis of surgical results [37][38][39][40].…”

Mixed Reality in the Reconstruction of Orbital Floor: An Experimental and Clinical Evaluative Study

“…In the case of preoperative planning in most of the publications, the general idea was to use the haptic device, immersive workbench, 3D eyewear, or 3D displays to simulate real-time surgery, thus finding the best option for every clinical case. This approach was used for preplanning of orthognathic surgery,[ 21 ] facial contouring surgery,[ 22 ] mandibular reconstructive surgery,[ 23 24 ] cleft lip repair surgery, and craniomaxillofacial complex fracture reduction. [ 25 26 ] Described technology was also used in hip fracture reduction surgery,[ 27 ] femur fracture reduction surgery planning,[ 28 ] orthopaedic fracture reduction surgery,[ 29 ] orthopaedic burring simulation,[ 30 ] and spinal fixation simulation.…”

Application of computer-assisted navigation in treating congenital maxillomandibular syngnathia: A case report

“…In the present case, we applied computer-assisted navigation to instruct our surgical approach. Computer navigation has emerged as an essential technology for guiding and verifying operations, such as reconstruction of mandible or orbital bone, orthognathia, and many other of craniofacial surgeries[9,10]. We can understand the correlations among surgical devices, incisions, and peripheral anatomic sites in real-time easily via computer navigation, and also can check the distance between the operation positions to the position designed preoperatively.…”