Towards Optimum Mandibular Reconstruction for Dental Occlusal Rehabilitation: From Preoperative Virtual Surgery to Autogenous Particulate Cancellous Bone and Marrow Graft with Custom-Made Titanium Mesh—A Retrospective Study

Abstract

The purpose of this retrospective study was to evaluate computer-assisted virtual surgery and the outcomes of mandibular reconstruction using an autogenous particulate cancellous bone and marrow (PCBM) graft combined with a custom-made titanium mesh (TiMesh) using a three-dimensional (3D) printing model. Eighteen consecutive patients were included, and preoperative virtual simulation surgery was performed using digital data. Segmental bone defects showed deviation of the mandible due to displacement of the condyle and segments, unnatural length of the mandibular body, or poorer intermaxillary relationship compared to the marginal bone defect caused by previous operations. These mandibular disharmonies could be simulated, and virtual surgery was performed on a computer with adjustment of displaced mandibular segments, length of the mandibular body, and dental arch with digital bone augmentation. TiMesh was manually pre-bent using a 3D printing model, and PCBM from the iliac crest was grafted with TiMesh. The short-term clinical results were good; reconstruction of the alveolar crest was prosthetically desirable; and minor complications were observed. In conclusion, virtual reconstruction is crucial for treating complex deviated mandibles. Accurate condylar and dental arch positions with an optimum mandibular length are important for prosthetically satisfactory mandibular reconstruction.

Axolotl mandible regeneration occurs through mechanical gap closure and a shared regenerative program with the limb

“…A similar situation seems to also occur in humans following the fracture or loss of complete segments of the mandible, in which the direction of stump displacement depends on the localization of the defect in relation to the masticatory muscles. This can lead to either a convergence of the stumps and, thus, to defect reduction, or a divergence of the stumps and, consequently, to the enlargement of the defect region (Onodera et al, 2023). In our study, the observed gap minimization may have likewise resulted from the sudden mobility of the stumps due to severance of muscles or, alternatively, from a more active process directing these mechanical tissue readjustments.…”

Integrating Virtual Surgical Planning and 3D-Printed Tools with Iliac Bone Grafts for Orbital and Zygomatic Reconstruction in Hemifacial Microsomia Patients

“…3D-printed surgical adjuncts can provide a precise fit with the bone and can transfer surgical plans to the actual operations. Additionally, autologous iliac cancellous bone is a favored choice for maxillofacial reconstruction due to its plasticity and sufficient volume, while maintaining the iliac crest's contour [15]. It presents good plasticity and can provide a sufficient quantity of bone while preserving the external contour of the iliac crest.…”