Time matters – Differences between computer-assisted surgery and conventional planning in cranio-maxillofacial surgery: A systematic review and meta-analysis

Nilsson, Johanna; Hindocha, Nishma; Thor, Andreas

doi:10.1016/j.jcms.2019.11.024

Cited by 42 publications

(28 citation statements)

References 41 publications

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“…This was also shown by Ritschl et al (43) who also revealed no significant differences between these groups (43). In contrast, other researchers reported shorter operation times in patients with CAD/CAM implants compared to conventionally performed operations (14,15,40). The results of this study are consistent with the current literature by Rustemeyer and Ritschl who determined no significant differences in operating times.…”

Section: Discussionsupporting

confidence: 92%

“…Comparing the inpatient length of stay of the two groups showed no significant differences. The same conclusion was reached by other researchers who examined the hospital stay between PSI and CR (12,15,43). The average length of stay of patients with PSI was approximately 9 days longer compared to patients with CR.…”

Section: Discussionsupporting

confidence: 75%

“…In CAD/CAM implants, intraoperative steps can be performed more effectively and efficiently compared to conventional methods in terms of minimizing the burden for patients as well as the risks of postoperative complications (1,14,15,(39)(40)(41). This approach was also followed by Rustemeyer et al in their investigation of intraoperative times in osseous reconstructions with free fibular grafts.…”

Section: Discussionmentioning

confidence: 99%

“…Advancements in computer-assisted surgery (CAS), particularly with regard to computer-aided design/computer-aided manufacturing (CAD/CAM) technology, are beneficial compared to the traditional method of mandibular reconstruction with handbent plates (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). The accuracy of CAD/CAM or selective laser melting plates is superior to the manually bent reconstruction plates.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the Accuracy and Clinical Parameters of Patient-Specific and Conventionally Bended Plates for Mandibular Reconstruction

et al. 2021

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ObjectivesThis retrospective study compared two mandibular reconstruction procedures—conventional reconstruction plates (CR) and patient-specific implants (PSI)—and evaluated their accuracy of reconstruction and clinical outcome.MethodsOverall, 94 patients had undergone mandibular reconstruction with CR (n = 48) and PSI (n = 46). Six detectable and replicable anatomical reference points, identified via computer tomography, were used for defining the mandibular dimensions. The accuracy of reconstruction was assessed using pre- and postoperative differences.ResultsIn the CR group, the largest difference was at the lateral point of the condyle mandibulae (D2) -1.56 mm (SD = 3.8). In the PSI group, the largest difference between preoperative and postoperative measurement was shown at the processus coronoid (D5) with +1.86 mm (SD = 6.0). Significant differences within the groups in pre- and postoperative measurements were identified at the gonion (D6) [t(56) = -2.217; p = .031 <.05]. In the CR group, the difference was 1.5 (SD = 3.9) and in the PSI group -1.04 (SD = 4.9). CR did not demonstrate a higher risk of plate fractures and post-operative complications compared to PSI.ConclusionFor reconstructing mandibular defects, CR and PSI are eligible. In each case, the advantages and disadvantages of these approaches must be assessed. The functional and esthetic outcome of mandibular reconstruction significantly improves with the experience of the surgeon in conducting microvascular grafts and familiarity with computer-assisted surgery. Interoperator variability can be reduced, and training of younger surgeons involved in planning can be reaching better outcomes in the future.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of the Accuracy and Clinical Parameters of Patient-Specific and Conventionally Bended Plates for Mandibular Reconstruction

et al. 2021

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“…It is unknown, whether in the long term, these additional costs are supplanted by the cost of prosthetic and orthodontic adjustments, and additional procedures that are inevitably required to achieve a functional rehabilitation. Recent systematic reviews and meta‐analysis highlight this uncertainty and acknowledge the need for detailed data collection in long‐term prospective series 21,22 …”

Section: Discussionmentioning

confidence: 99%

Maxillofacial reconstruction with prefabricated prelaminated osseous free flaps

Diab

Leinkram

Wykes

et al. 2021

ANZ Journal of Surgery

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Background The prefabricated fibula flap is an advanced method of occlusal‐based reconstruction that combines placement of osseointegrated dental implants with prelamination, using a split skin graft on the fibula, weeks prior to the definitive reconstruction. This approach is resource intensive but has several advantages including eliminating the delay from reconstruction to dental rehabilitation. Methods A retrospective cohort study of all prefabricated fibula flaps used for mandible and maxillary reconstruction from 2012 to 2020 was performed. Outcome measures were implant survival, implant utilization and functional dental rehabilitation. Results A total of 17 prefabricated fibula flaps were performed including two analogue and 15 digital plans. There were nine maxillary and eight mandibular reconstructions, of which 11 were primary and seven were secondary. There were no free flap failures. A total of 65 implants were placed (average 3.8, median 3 implants). There was one implant failure at 6 years giving a 1.5% failure rate. There was 91% implant utilization and 94% functional dental rehabilitation. Conclusion The prefabricated fibula flap provides outstanding dental rehabilitation in well‐selected patients.

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Evaluating the benefit of virtual surgical planning on bony union rates in head and neck reconstructive surgery

Sabiq,

Cherukupalli,

Khalil

et al. 2024

Head & Neck

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ObjectivesVirtual surgical planning (VSP) has gained acceptance because of its benefits in obtaining adequate resection, achieving cephalometric accuracy, and reducing operative time. The aim of this study is to compare the rate of union between VSP and free‐hand surgery (FHS), identify predictors of non‐union and evaluate the difference in operative time.MethodsPost‐operative CT were retrospectively reviewed for 123 patients who underwent maxillary or mandibular reconstruction between 2014 and 2021 using either VSP or FHS. Each apposition was graded as complete, partial or non‐union. The rate of union, risk difference and inter‐rater reliability were calculated. The difference in operative time was assessed. Predictors of non‐union were identified using logistic regression.ResultsA total of 326 appositions were graded (VSP n = 150; FHS n = 176). The rates of complete and partial union were higher with VSP than FHS (74.7% vs. 65.3%; 18% vs. 15.9%, respectively, p = 0.01). Non‐union was found at a higher rate with FHS than with VSP (18.7% vs. 7.3%). The non‐union risk difference was 11.4. FHS, major complications and apposition at the native bone were predictors of non‐union (OR 2.9, p = 0.02; OR 3.4, p = 0.01; OR 2.5, p = 0.05, respectively). The mean surgical time was shorter with VSP than with FHS (265.3 vs. 381.5 min, p < 0.001). The inter‐rater agreement was high (k = 0.85; ICC = 0.86).ConclusionVSP demonstrated significantly higher bony union rates and shorter operative time. FHS, development of major complications and apposition with native bone correlated with non‐union.

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Time matters – Differences between computer-assisted surgery and conventional planning in cranio-maxillofacial surgery: A systematic review and meta-analysis

Cited by 42 publications

References 41 publications

Comparison of the Accuracy and Clinical Parameters of Patient-Specific and Conventionally Bended Plates for Mandibular Reconstruction

Comparison of the Accuracy and Clinical Parameters of Patient-Specific and Conventionally Bended Plates for Mandibular Reconstruction

Maxillofacial reconstruction with prefabricated prelaminated osseous free flaps

Evaluating the benefit of virtual surgical planning on bony union rates in head and neck reconstructive surgery

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