Three-dimensional printed titanium mesh combined with iliac cancellous bone in the reconstruction of mandibular defects secondary to ameloblastoma resection

Abstract

Background The reconstruction of large mandibular defects is a challenge, and the free vascularized bone flaps are most commonly used. However, the precision and symmetry of this repair are deficient, and patients have a risk of vascular embolism, flap necrosis and donor site complications. Therefore, to explore an ideal alternative in mandibular reconstruction with high surgical accuracy and low complications is indispensable. Methods Seven patients with recurrent or large-scope ameloblastoma were enrolled in this study. All patients were provided with a fully digital treatment plan, including the design of osteotomy lines, surgical guides, and three-dimensional printed titanium mesh for implantation. With the assistance of a surgical guide, ameloblastomas were resected, and custom 3D printed titanium mesh combined with posterior iliac bone harvest was used in mandibular reconstruction. The surgical discrepancy between the surgical plan and the real result was compared. At the same time, the resorption rate of the implanted bone was evaluated. Results All patients completed the fully digital treatment process successfully without severe complications. Image fusion showed that the postoperative contour of the mandible was basically consistent with surgical planning, except for a slight increase in the inferior border of the affected side. The mean error between the intraoperative bone volume and the digital planning bone volume was 2.44%±2.10%. Furthermore, the bone resorption rates of the harvested graft 6 months later were 32.15%±6.95%. Conclusions The use of digital surgical planning and 3D-printed templates can assist surgeons in performing precise surgery, and the 3D-printed titanium mesh implant can improve the patient's facial symmetry. 3D printed titanium combined with posterior iliac cancellous bone graft can be regarded as an ideal alternative in extensive mandibular reconstruction.