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Kang YF, Ge YJ, Ding MK, Liu-Fu JF, Cai ZG, Shan XF. A comparison of accuracy among different approaches of static-guided implant placement in patients treated with mandibular reconstruction: A retrospective study. Clin Oral Implants Res 2024; 35:251-257. [PMID: 38031527 DOI: 10.1111/clr.14219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 10/18/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE This study aimed to evaluate the differences in the accuracy of immediate intraoral, immediate extraoral, and delayed dental implant placement with surgical guides (static computer-aided implant surgery) in patients treated with mandibular reconstruction. METHODS This was a retrospective study. The patients were divided into three groups: immediate intraoral placement (IIO), immediate extraoral placement (IEO), and delayed placement (DEL). Four variables were used to compare the planned and actual implant positions: angular deviation, three-dimensional (3D) deviation at the entry point of the implant, 3D deviation at the apical point of the implant, and depth deviation. RESULTS The angular deviation was significantly higher in the IIO group than in the IEO (p < .05) and DEL (p < .05) groups. The 3D deviation at the entry point was significantly higher in the IIO group than in the IEO (p < .05) and DEL (p < .01) groups. The 3D deviation at the apical point was significantly higher in the IIO group than in the IEO (p < .01) and DEL (p < .01) groups. The depth deviation was significantly higher in the IIO group than in the IEO (p < .05) and DEL (p < .05) groups. There was no statistical difference between the IEO and DEL group in angular and 3D deviation. CONCLUSION With surgical guides, among the different approaches for implant placement, delayed implant placement remains the most accurate approach for patients treated with mandibular reconstruction.
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Affiliation(s)
- Yi-Fan Kang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
- National Center of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, National Medical Products Administration Key Laboratory for Dental Materials, Beijing, China
| | - Yan-Jun Ge
- National Center of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, National Medical Products Administration Key Laboratory for Dental Materials, Beijing, China
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Meng-Kun Ding
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
- National Center of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, National Medical Products Administration Key Laboratory for Dental Materials, Beijing, China
| | - Jian-Feng Liu-Fu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
- National Center of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, National Medical Products Administration Key Laboratory for Dental Materials, Beijing, China
| | - Zhi-Gang Cai
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
- National Center of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, National Medical Products Administration Key Laboratory for Dental Materials, Beijing, China
| | - Xiao-Feng Shan
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
- National Center of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, National Medical Products Administration Key Laboratory for Dental Materials, Beijing, China
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The Precision of Different Types of Plates Fabricated With a Computer-Aided Design and Manufacturing System in Mandibular Reconstruction With Fibular-Free Flaps. J Craniofac Surg 2023; 34:187-197. [PMID: 36168132 DOI: 10.1097/scs.0000000000009037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/27/2022] [Indexed: 01/11/2023] Open
Abstract
Computer-assisted surgery (CAS) has been introduced to mandible reconstruction with fibular-free flap in cutting guide placement. When CAS cooperates with different plate fixations, the results show various degrees of errors by which this study aimed to evaluate. Mock surgeries were conducted in 3D-printed mandibles with 2 types of defects, limited or extensive, reconstructed from 2 ameloblastoma patients. Three types of fixations, miniplate, manually bending reconstruction plate, and patient-specific plate, are tested, each of which was performed 3 times in each type of defect, adding up to 18 surgeries. One with the least errors was selected and applied to patients whose 3D-printed mandibles were derived. Finally, in vivo errors were compared with the mock. In limited defect, average errors show no statistical significance among all types. In extensive defect, patient-specific plate had a significantly lower average condylar error than manually bending reconstruction plate and miniplate (8.09±2.52 mm vs. 25.49±2.72 and 23.13±13.54 mm, respectively). When patient-specific plate was applied in vivo , the errors were not significantly different from the mock. Patient-specific plates that cooperated with CAS showed the least errors. Nevertheless, manually bent reconstruction plates and miniplates could be applied in limited defects with caution.
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Novel and accurate 3D-Printed surgical guide for mandibular reconstruction with integrated dental implants. Comput Biol Med 2022; 151:106327. [PMID: 36442275 DOI: 10.1016/j.compbiomed.2022.106327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/25/2022] [Accepted: 11/14/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Patients with mandibular defects due to trauma or infiltrated disease are in a need of functional mandibular implants that will completely restore the function of their lower jaw. One of the most important roles of well-functioning jaw is mastication, a complex mechanism. A conventional approach used in oral and maxillofacial surgery accomplish this aim via two major surgeries- mandibular reconstruction and surgical placement of dental implants. Little work has been done on combining the two surgeries into with using Additive Manufacturing (AM) and digital planning. MATERIAL AND METHODS This case study offers a mandibular implant design solution with pre-positioned dental implants that can reduce the requirement to only one surgery. Mandibular implant was designed using 3-Matic software (Materialise, Belgium). Positions for dental implants were restoratively-driven and planned on the designed mandibular implant in Blue Sky Plan 4 software (Blue Sky Bio, USA) and placed prior to mandibular reconstruction using a 3D-printed surgical guide. Finite Element Analysis (FEA) was used to evaluate the mechanical behaviour of the 3D-printed surgical guide during dental implant placement. RESULTS The surgical guide was fabricated using SLA and stress distribution was evaluated in ANSYS Workbench FEM software (Ansys Inc Swanson, Houston, USA). Results showed that the designed surgical guide can withstand the forces occurring during the surgery. CONCLUSION The proposed method substantially reduces the surgical procedure and recovery time, increases the accuracy, and allows for a predictable restorative solution that can be visualised from the beginning.
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Custom-Made 3D Titanium Plate for Mandibular Reconstruction in Surgery of Ameloblastoma: A Novel Case Report. SURGICAL TECHNIQUES DEVELOPMENT 2022. [DOI: 10.3390/std11030009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Ameloblastoma is a benign yet locally invasive odontogenic neoplasm, characterised by slow growth and painless swelling. The treatment for ameloblastoma varies from curettage to en bloc resection, with recurrence commonly occurring. The safety margin of resection is hence essential to avoid recurrence. Understanding the three-dimensional anatomy for reconstruction of mandibular defects after tumour resection often poses problems for head and neck surgeons. Historically, various autografts and alloplastic materials have been used in the reconstruction of these types of defects. Over time, advances in technology with computed tomography scanners and three-dimensional images enhance the surgical planning and management of maxillofacial tumours. The development of new prototyping systems provides accurate 3D biomodels on which surgery can be simulated, especially in cases of ameloblastoma, in which the safety margin is vital for the clinical outcome. The objective of this paper was to report a clinical case of employing these methodologies for reconstruction after an extensive mandibular resection. The clinical outcomes were observed. A case of follicular ameloblastoma of the mandible is depicted in the following paper, where a 3D biomodel was used throughout the surgery. A 3D printed patient-specific titanium implant was manufactured and placed intraoperatively for reconstruction. The treatment had satisfactory postoperative results without complications. Titanium implants being bioinert, customisable and easily workable, especially with the help of 3D virtual planning techniques, can be considered as ideal alloplastic materials for mandibular reconstruction.
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Mandibular Body Reconstruction Utilizing a Three-Dimensional Custom-Made Porous Titanium Plate: A Four-Year Follow-Up Clinical Report. Case Rep Dent 2022; 2022:5702066. [PMID: 35251720 PMCID: PMC8896956 DOI: 10.1155/2022/5702066] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/20/2022] [Accepted: 02/03/2022] [Indexed: 11/17/2022] Open
Abstract
A clinical case of a 42-year-old woman patient, who had a mandibular reconstruction utilizing a three-dimensional (3D) custom-made porous titanium plate dental restoration, is presented. She showed a recurrence of a unicystic ameloblastoma involving the left hemimandible. The patient declined to be managed by a bone-free flap. A mandibular resection in the healthy areas was provided, followed by reconstruction utilizing a 3D custom-made porous titanium plate dental restoration with a hybrid dental prosthesis. The 3D rehabilitation was created considering slim tomodensitometric sections. The cutting guides and custom-created 3D plate were fabricated employing medical software via computer-aided design and fabricating with locations planned for healing abutments. The patient was contented with the rehabilitation, and the condition continued stable at the four-year follow-up.
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Grecchi F, Grecchi E, Del Fabbro M, Goker F. Simultaneous Le Fort I osteotomy and zygomatic implant placement. J Craniomaxillofac Surg 2021; 50:114-123. [PMID: 34895830 DOI: 10.1016/j.jcms.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 11/04/2021] [Accepted: 12/01/2021] [Indexed: 11/26/2022] Open
Abstract
The aim of this retrospective study was to evaluate the outcomes of simultaneous LeFort I osteotomy and zygomatic/dental implant placement for oral rehabilitation of patients with extremely atrophic/dysmorphic edentulous maxilla. Simultaneous LeFort I osteotomy and zygomatic/dental implant placement was performed with patient-specific anatomical models and surgical guides produced through three-dimensional virtual planning methods. All patients received their final prosthesis, with immediate loading, on the day after surgery. The primary outcome variables were the implant survival rate, and the incidence of intra/postoperative complications. In total, 15 zygomatic implants and 33 conventional dental implants were inserted in eight patients. The mean follow-up of the patients was 38.5 months. The implant survival rate was 93.3% for zygomatic implants and 100% for dental implants. No intra/postoperative complications were observed. Simultaneous LeFort I osteotomy associated with zygomatic/dental implant surgery can be considered as a valuable treatment option for rehabilitation of patients with extremely atrophic edentulous maxilla and esthetic issues of the face.
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Affiliation(s)
- Francesco Grecchi
- IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi, 4, 20161, Milano, Italy.
| | - Emma Grecchi
- University of Milano, Department of Biomedical, Surgical and Dental Sciences, Milan, Italy.
| | - Massimo Del Fabbro
- IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi, 4, 20161, Milano, Italy; University of Milano, Department of Biomedical, Surgical and Dental Sciences, Milan, Italy.
| | - Funda Goker
- University of Milano, Department of Biomedical, Surgical and Dental Sciences, Milan, Italy.
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Yang WF, Choi WS, Zhu WY, Zhang CY, Li DTS, Tsoi JKH, Tang AWL, Kwok KW, Su YX. Spatial deviations of the temporomandibular joint after oncological mandibular reconstruction. Int J Oral Maxillofac Surg 2021; 51:44-53. [PMID: 33865661 DOI: 10.1016/j.ijom.2021.02.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/01/2021] [Accepted: 02/17/2021] [Indexed: 12/15/2022]
Abstract
Spatial deviations of the temporomandibular joint (TMJ) after oncological mandibular reconstruction are important to the aesthetic and functional rehabilitation. The aim of this study was to clarify whether and how three dimensionally (3D) printed patient-specific surgical plates, and the preservation of the condyle or ramus, affect spatial deviations of the TMJ. A total of 33 patients who underwent mandibular reconstruction via computer-assisted surgery were included. Regarding absolute deviations, patients in the 3D-printed plate group showed smaller TMJ deviations compared to those in the conventional plate group. There was no difference in absolute deviations of the TMJ regardless of whether the condyle or ramus was preserved. Regarding physiological deviations, the impact on the contralateral TMJ was smaller in the 3D-printed plate group. Patients with both the condyle and ramus removed had significantly higher deviations of the condyle and joint space. In summary, 3D-printed patient-specific surgical plates improved the spatial accuracy of the TMJ. Under physiological conditions, TMJ deviations on the operated side were mainly affected by the preservation of the condyle. Removal of both the condyle and ramus caused more severe spatial interference to the TMJ; this should be further confirmed.
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Affiliation(s)
- W-F Yang
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - W S Choi
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - W-Y Zhu
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - C-Y Zhang
- Guangzhou Janus Biotechnology Co., Ltd, Guangzhou, China
| | - D T S Li
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - J K-H Tsoi
- Dental Materials Science, Division of Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - A W-L Tang
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong SAR, China
| | - K-W Kwok
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong SAR, China
| | - Y-X Su
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
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Meyer S, Hirsch JM, Leiggener CS, Msallem B, Sigron GR, Kunz C, Thieringer FM. Fibula Graft Cutting Devices: Are 3D-Printed Cutting Guides More Precise than a Universal, Reusable Osteotomy Jig? J Clin Med 2020; 9:jcm9124119. [PMID: 33419329 PMCID: PMC7766794 DOI: 10.3390/jcm9124119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/13/2020] [Accepted: 12/17/2020] [Indexed: 11/23/2022] Open
Abstract
Individual cutting guides for the reconstruction of lower jaw defects with fibular grafts are often used. However, the application of these osteotomy tools is costly and time intensive. The aim of this study was to compare the precision of osteotomies using a 3D-printed guide with those using a universal, reusable, and more cost-efficient Multi-Use Cutting Jig (MUC-Jig). In this non-blinded experimental study, 10 cranio-maxillofacial surgeons performed four graft removals each in a randomized order using the same osteotomy angle, both proximally (sagittal cut) and distally (coronal cut), of a graft (45°, 30°, 15°, or 0°), first with the MUC-Jig then with the 3D-printed cutting guide. The 40 fibula transplants (Tx) of each method (n = 80) were then analyzed concerning their Tx length and osteotomy angles and compared to the original planning data. Furthermore, the surgeons’ subjective perception and the duration of the two procedures were analyzed. The mean relative length and mean relative angle deviation between the MUC-Jig (−0.08 ± 1.12 mm; −0.69° ± 3.15°) and the template (0.22 ± 0.90 mm; 0.36° ± 2.56°) group differed significantly (p = 0.002; p = < 0.001), but the absolute deviations did not (p = 0.206; p = 0.980). Consequently, clinically comparable osteotomy results can be achieved with both methods, but from an economic point of view the MUC-Jig is a more cost-efficient solution.
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Affiliation(s)
- Simon Meyer
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (S.M.); (C.K.); (F.M.T.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
| | - Jan-Michaél Hirsch
- Department of Surgical Sciences, Oral and Maxillofacial Surgery, Uppsala University, SE-751 85 Uppsala, Sweden;
- Department of Research & Development Public Dental Services Folktandvården AB, SE-118 27 Stockholm, Sweden
| | - Christoph S. Leiggener
- Clinic of Oral and Cranio-Maxillofacial Surgery, Kantonsspital Aarau, CH-5001 Aarau, Switzerland;
| | - Bilal Msallem
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (S.M.); (C.K.); (F.M.T.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
- Correspondence:
| | - Guido R. Sigron
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
- Clinic of Oral and Cranio-Maxillofacial Surgery, Kantonsspital Aarau, CH-5001 Aarau, Switzerland;
| | - Christoph Kunz
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (S.M.); (C.K.); (F.M.T.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
| | - Florian M. Thieringer
- Clinic of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland; (S.M.); (C.K.); (F.M.T.)
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, CH-4123 Allschwil, Switzerland;
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“One-piece” patient-specific reconstruction plate for double-barrel fibula-based mandibular reconstruction. Int J Oral Maxillofac Surg 2020; 49:1016-1019. [DOI: 10.1016/j.ijom.2019.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 11/06/2019] [Accepted: 12/17/2019] [Indexed: 11/21/2022]
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Trends in Utilization of Virtual Surgical Planning in Pediatric Craniofacial Surgery. J Craniofac Surg 2020; 31:1900-1905. [PMID: 32604283 DOI: 10.1097/scs.0000000000006626] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION While the use of virtual surgical planning (VSP) has been well described in the adult craniofacial literature, there has been little written about pediatric uses or trends. The purpose of this study is to evaluate the evolving utilization of VSP for pediatric craniofacial procedures. METHODS The authors' prospective institutional review board-approved craniofacial registry was queried for index craniofacial procedures from January 2011 through December 2018. Data was collected regarding utilization of traditional surgical planning versus VSP, as well as the extent of VSP's influence on the operative procedure. These data were analyzed for trends over time and compared using appropriate statistics. RESULTS During the study period, a total of 1131 index craniofacial cases were performed, of which 160 cases (14.1%) utilized VSP. Utilization of VSP collectively increased over time, from 2.0% in 2011 to 18.6% in 2018 (P < 0.001). Utilization rates of VSP varied across procedures from 0% of craniosynostosis cases and fronto-orbital advancement cases to 67% of osteocutaneous free tissue transfers (P < 0.001). The most profound contributor to increase in VSP utilization was orthognathic surgery, utilized in 0% of orthognathic procedures in 2011 to 68.3% of orthognathic procedures in 2018 (P < 0.001). CONCLUSIONS Utilization of virtual surgical planning for pediatric craniofacial procedures is increasing, especially for complex orthognathic procedures and osteocutaneous free tissue transfers. Utilization patterns of individual components of the VSP system demonstrate unique footprints across the spectrum of craniofacial procedures, which reinforces the specific and variable benefits of this workflow for treating pediatric craniofacial disorders.
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Souza ATP, Lopes HB, Freitas GP, Ferraz EP, Oliveira FS, Almeida ALG, Weffort D, Beloti MM, Rosa AL. Role of embryonic origin on osteogenic potential and bone repair capacity of rat calvarial osteoblasts. J Bone Miner Metab 2020; 38:481-490. [PMID: 32078052 DOI: 10.1007/s00774-020-01090-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 01/31/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate the in vitro osteogenic potential of osteoblasts from neural crest-derived frontal bone (OB-NC) and mesoderm-derived parietal bone (OB-MS) and the bone formation induced by them when injected into calvarial defects. MATERIALS AND METHODS Calvarial bones were collected from newborn Wistar rats (3-day old) and characterized as frontal and parietal prior to OB-NC and OB-MS harvesting. The cells were cultured, and several parameters of osteoblast differentiation were evaluated. These cells, or PBS without cells (control), were locally injected into 5-mm rat calvarial defects (5 × 106 cells/defect) and after 4 weeks bone formation was evaluated by morphometric and histological analyses. RESULTS The characterization of frontal and parietal bones assured the different embryonic origin of both cell populations, OB-NC and OB-MS. The OB-NC presented higher proliferation while the OB-MS presented higher alkaline phosphatase (ALP) activity, extracellular matrix mineralization and gene expression of runt-related transcription factor 2, Alp, bone sialoprotein and osteocalcin revealing their high osteogenic potential. µCT analysis indicated that there was higher amount of bone formation in defects injected with both OB-NC and OB-MS compared to the control. Moreover, the bone tissue formed by both cells displayed the same histological characteristics. CONCLUSIONS Despite the distinct in vitro osteogenic potential, OB-NC and OB-MS induced similar bone repair in a rat calvarial defect model. Thus, osteoblasts, irrespective of their in vitro osteogenic potential linked to embryonic origins, seem to be suitable for cell-based therapies aiming to repair bone defects.
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Affiliation(s)
- Alann Thaffarell Portilho Souza
- Bone Research Lab, School of Dentistry of Ribeirão Preto, University of São Paulo, Av do Café s/n, Ribeirão Preto, SP, 14040-904, Brazil
| | - Helena Bacha Lopes
- Bone Research Lab, School of Dentistry of Ribeirão Preto, University of São Paulo, Av do Café s/n, Ribeirão Preto, SP, 14040-904, Brazil
| | - Gileade Pereira Freitas
- Bone Research Lab, School of Dentistry of Ribeirão Preto, University of São Paulo, Av do Café s/n, Ribeirão Preto, SP, 14040-904, Brazil
| | - Emanuela Prado Ferraz
- Department of Maxillofacial Surgery, Prosthesis and Traumatology, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - Fabiola Singaretti Oliveira
- Bone Research Lab, School of Dentistry of Ribeirão Preto, University of São Paulo, Av do Café s/n, Ribeirão Preto, SP, 14040-904, Brazil
| | - Adriana Luisa Gonçalves Almeida
- Bone Research Lab, School of Dentistry of Ribeirão Preto, University of São Paulo, Av do Café s/n, Ribeirão Preto, SP, 14040-904, Brazil
| | - Denise Weffort
- Bone Research Lab, School of Dentistry of Ribeirão Preto, University of São Paulo, Av do Café s/n, Ribeirão Preto, SP, 14040-904, Brazil
| | - Marcio Mateus Beloti
- Bone Research Lab, School of Dentistry of Ribeirão Preto, University of São Paulo, Av do Café s/n, Ribeirão Preto, SP, 14040-904, Brazil
| | - Adalberto Luiz Rosa
- Bone Research Lab, School of Dentistry of Ribeirão Preto, University of São Paulo, Av do Café s/n, Ribeirão Preto, SP, 14040-904, Brazil.
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Yang WF, Choi WS, Wong MCM, Powcharoen W, Zhu WY, Tsoi JKH, Chow M, Kwok KW, Su YX. Three-Dimensionally Printed Patient-Specific Surgical Plates Increase Accuracy of Oncologic Head and Neck Reconstruction Versus Conventional Surgical Plates: A Comparative Study. Ann Surg Oncol 2020; 28:363-375. [PMID: 32572853 PMCID: PMC7752789 DOI: 10.1245/s10434-020-08732-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Indexed: 12/11/2022]
Abstract
Background Surgeons are pursuing accurate head and neck reconstruction to enhance aesthetic and functional outcomes after oncologic resection. This study aimed to investigate whether accuracy of head and neck reconstruction is improved with the use of three-dimensionally (3D)-printed patient-specific surgical plates compared with conventional plates. Methods In this comparative study, patients were prospectively recruited into the study group (3DJP16) with 3D-printed patient-specific surgical plates. The patients in control group with conventional surgical plates were from a historic cohort in the same unit. The primary end point of the study was the accuracy of head and neck reconstruction. The secondary end points were accuracy of osteotomy, intraoperative blood loss, total operative time, and length of hospital stay. Results The study recruited of 33 patients, including 17 in the study group and 16 in the control group. The patients’ baseline characteristics were similar between the two groups. The absolute distance deviation of the maxilla or mandible was 1.5 ± 0.5 mm in the study group and 2.1 ± 0.7 mm in the control group [mean difference, − 0.7 mm; 95% confidence interval (CI) − 1.1 to − 0.3; p = 0.003], showing superior accuracy of reconstruction for the patients with 3D-printed patient-specific surgical plates. Improved accuracy of reconstruction also was detected in terms of bilateral mandibular angles and bone grafts. Concerning the secondary end points, the accuracy of the osteotomy was similar in the two groups. No difference was found regarding intraoperative blood loss, total operative time, or length of hospital stay. Conclusions This is the first study to prove that compared with conventional plates, 3D-printed patient-specific surgical plates improve the accuracy of oncologic head and neck reconstruction. Electronic supplementary material The online version of this article (10.1245/s10434-020-08732-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wei-Fa Yang
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Hong Kong SAR, China
| | - Wing Shan Choi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Hong Kong SAR, China
| | - May Chun-Mei Wong
- Dental Public Health, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Warit Powcharoen
- Oral and Maxillofacial Surgery, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Wang-Yong Zhu
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Hong Kong SAR, China
| | - James Kit-Hon Tsoi
- Applied Oral Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Marco Chow
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong SAR, China
| | - Ka-Wai Kwok
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong SAR, China
| | - Yu-Xiong Su
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Hong Kong SAR, China.
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Full-staged digital and prosthetic guided protocol for the insertion of dental implants in autogenous free bone grafts after reconstruction of segmental mandibular defects. Oral Maxillofac Surg 2020; 24:189-201. [PMID: 32291548 DOI: 10.1007/s10006-020-00839-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 03/08/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This study aims to evaluate the clinical and radiographic outcomes of dental implants, inserted in consolidated free bone grafts; postsegmental mandibular resection, after following a fully guided staged protocol, which established a systematic approach that correlates the grafted bone and the enclosed implants to the undisturbed mandibular segments and the maxillary occlusal plane. METHODS Seven patients were enrolled in the study; all were diagnosed for mandibular locally aggressive tumors. All of the patients were subjected to computer-guided segmental mandibular resections, secondary free iliac crest bone graft; aided by computer-guided harvest and prosthetic guidance of the graft positioning and fixation. Finally, the guided bone grafts; after being consolidated, received twenty-nine computer-guided dental implants. RESULTS By the end of the period of osseointegration, the predetermined criteria of implant success judged the success of twenty-five implants, versus the failure of four implants, with (86.2%) percentage of success. CONCLUSION The clinical and radiographic assessments demonstrated sound base bone grafts, which succeeded not only to restore the native mandibular continuity and configuration but also to direct the fair-sized embedded dental implants into favorable coastal locations and axial projections, which influenced a smooth prosthetic rehabilitation.
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Development of a template tool for facilitating fibula osteotomy in reconstruction of mandibular defects by digital analysis of the human mandible. Clin Oral Investig 2020; 24:3077-3083. [PMID: 31955270 DOI: 10.1007/s00784-019-03177-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 12/19/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Mandibular reconstruction after segmental mandibulectomy can be challenging without virtual surgical planning and osteotomy guides. The purpose of this study was to analyze anatomic parameters to facilitate the evaluation of ideal fibula wedge osteotomies to reconstruct the neomandibula in a simple and cost-effective manner without the need for preoperative virtual planning. MATERIALS AND METHODS Computed tomography scans were acquired from randomly selected patients, and all images were obtained from routine clinical diagnostics, e.g., tumor staging, or preoperatively before reconstruction. Data was used to calculate stereolithographic models of the mandible for length and angle measurements. Statistical analysis was performed (p < 0.05). RESULTS CT scans of 100 patients were analyzed: 39 were female and 61 were male patients, mean age was 59.08a. The mandibular arch angle proved to be constant with 241.07 ± 2.39°. The outside B-segment length was 80.05 ± 5.16 mm; the anterior S-segment length was 27.69 ± 3.16 mm. The angle of the mandibular arch showed differences in means (p = 0.004) between age groups, but effect was proved low. No relevant statistical significances were detected. CONCLUSIONS The development of a mandible reconstruction template tool would benefit the majority of head and neck patients, which is due to a constant mandibular arch angle and symphysis segment length throughout the general patient population, allowing the mimicking of a harmonic mandibular arch with up to three fibula segments. CLINICAL RELEVANCE The developed mandible reconstruction template tool can facilitate the fibula wedge osteotomies necessary for reconstruction of an ideal neomandibula providing a novel approach which is simple and cost-effective.
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A novel ‘surgeon-dominated’ approach to the design of 3D-printed patient-specific surgical plates in mandibular reconstruction: a proof-of-concept study. Int J Oral Maxillofac Surg 2020; 49:13-21. [DOI: 10.1016/j.ijom.2019.05.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/03/2019] [Accepted: 05/31/2019] [Indexed: 11/24/2022]
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16
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Yan C, Jia HC, Xu JX, Xu T, Chen K, Sun JC, Shi JG. Computer-Based 3D Simulations to Formulate Preoperative Planning of Bridge Crane Technique for Thoracic Ossification of the Ligamentum Flavum. Med Sci Monit 2019; 25:9666-9678. [PMID: 31847005 PMCID: PMC6929566 DOI: 10.12659/msm.918387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background The bridge crane technique is a novel surgical technique for the treatment of thoracic ossification of the ligamentum flavum (TOLF), but its preoperative planning has not been studied well, which limits the safety and efficacy of surgery to some extent. The purpose of this study was to investigate the method of application and effect of computer-aided preoperative planning (CAPP) on the bridge crane technique for TOLF. Material/Methods This retrospective multi-center included 40 patients with TOLF who underwent the bridge crane technique from 2016 to 2018. According to the utilization of CAPP, patients were divided into Group A (with CAPP, n=21) and Group B (without CAPP, n=19). Comparisons of clinical and radiological outcomes were carried out between the 2 groups. Results The patients in Group A had higher post-mJOA scores and IR of neurological function than those in Group B (p<0.05). Group A had shorter surgery time, fewer fluoroscopic images, and lower incidence of complications than Group B. In Group A, there was a high consistency of all the anatomical parameters between preoperative simulation and postoperative CT (p>0.05). In Group B, there were significant differences in 3 anatomical parameters between postoperative simulation and postoperative CT (p<0.05). In Group B, the patients with no complications had higher post-SVOR and lower SVRR and height of posterior suspension of LOC in postoperative CT than those in postoperative simulation (p<0.05). Conclusions CAPP can enable surgeons to control the decompression effect accurately and reduce the risk of related complications, which improves the safety and efficacy of surgery.
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Affiliation(s)
- Chen Yan
- Second Department of Spine Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China (mainland).,Undergraduate Incubation Center, Navy Medical University, Shanghai, China (mainland)
| | - Huai-Cheng Jia
- Second Department of Spine Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China (mainland).,Undergraduate Incubation Center, Navy Medical University, Shanghai, China (mainland)
| | - Jia-Xi Xu
- Second Department of Spine Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China (mainland).,Undergraduate Incubation Center, Navy Medical University, Shanghai, China (mainland)
| | - Tao Xu
- Department of Orthopedic Surgery, No. 906 Hospital of the People's Liberation Army (PLA), Ningbo, Zhejiang, China (mainland)
| | - Kun Chen
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong, China (mainland)
| | - Jing-Chuan Sun
- Second Department of Spine Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China (mainland)
| | - Jian-Gang Shi
- Second Department of Spine Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China (mainland)
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17
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Meyer S, Hirsch JM, Leiggener CS, Zeilhofer HF, Thieringer FM. A simple, effective, universal, and reusable osteotomy tool for jaw reconstructions with microvascular fibula transplants. J Plast Reconstr Aesthet Surg 2019; 73:98-102. [PMID: 31711860 DOI: 10.1016/j.bjps.2019.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/31/2019] [Accepted: 06/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Precise, expensive individual saw guides are used with increasing frequency for the reconstruction of mandibular defects with fibular grafts. In this report, an alternative is presented - the Multiuse Cutting Jig (MUC-Jig, proprietary development). It is reusable, suitable for all patients, requires simple planning based on conventional CT imaging, and is more economical. METHODS To investigate its precision, we conducted a nonblinded experimental study, with ten participating craniomaxillofacial surgeons. Osteotomies of four different fibula segments were carried out at the same angulation, with groups defined according to the proximal and distal fixed angulation: 45°, 30°, 15°, or 0°. The sagittal cut was performed proximally, with the coronal cut performed distally. The resulting 40 segments (n = 40) were analyzed with their Tx length (primary endpoint) and osteotomy angles, and compared to the original planning. RESULTS The mean (SD) relative deviation of all grafts from the original planning was -0.08 mm (1.12) in length and -0.71° (3.15) for the angle. Only 45° (-2.04 ± 3.71°) and 30° (-1.07 ± 2.52°) cuts differed significantly (p < 0.05) from smaller angle grafts. The mean (SD) absolute deviation was 0.81 mm (0.27) in length and 2.13° (0.93) in graft angles. For individual transplants, 45° cuts (1.28 ± 1.03 mm) differed significantly (p < 0.005) from others. We observed no differences in relative length or absolute angle deviation. CONCLUSIONS The MUC-Jig is precise and cost-effective for osteotomies with medium angles and smooth reconstructions of template-guided procedures.
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Affiliation(s)
- Simon Meyer
- Clinic for Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Jan-Michaél Hirsch
- Department of Surgical Sciences, Oral and Maxillofacial Surgery, Uppsala University Hospital, Sjukhusvägen, 751 85 Uppsala, Sweden
| | - Christoph S Leiggener
- Clinic for Oral and Cranio-Maxillofacial Surgery, Kantonsspital Aarau, Tellstrasse 25, 5001 Aarau, Switzerland
| | - Hans-Florian Zeilhofer
- Clinic for Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Florian M Thieringer
- Clinic for Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland.
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Abstract
To preserve the continuity of the mandible after resection or traumatic bone loss, the defect is usually reconstructed with a bone graft fixed by a reconstruction plate. The fate of these plates is the objective of this study. Twenty-three patients (4 females and 19 males) required a reconstructive procedure to restore the discontinuity defect in the mandible by a mandibular reconstruction plate. Postoperative follow-up was performed to assess the outcomes of these plates. The mean age of the patients was 28.22 years. The most common cause of the discontinuity defect was bullet injury. The mean follow-up period was 3.65 years. The most common postoperative complication was the surgical site infection. The reconstruction plate of the mandible is associated with long-term success and body acceptance in the hands of an experienced surgeon.
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Chepelev L, Wake N, Ryan J, Althobaity W, Gupta A, Arribas E, Santiago L, Ballard DH, Wang KC, Weadock W, Ionita CN, Mitsouras D, Morris J, Matsumoto J, Christensen A, Liacouras P, Rybicki FJ, Sheikh A. Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG): guidelines for medical 3D printing and appropriateness for clinical scenarios. 3D Print Med 2018; 4:11. [PMID: 30649688 PMCID: PMC6251945 DOI: 10.1186/s41205-018-0030-y] [Citation(s) in RCA: 136] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/19/2018] [Indexed: 02/08/2023] Open
Abstract
Medical three-dimensional (3D) printing has expanded dramatically over the past three decades with growth in both facility adoption and the variety of medical applications. Consideration for each step required to create accurate 3D printed models from medical imaging data impacts patient care and management. In this paper, a writing group representing the Radiological Society of North America Special Interest Group on 3D Printing (SIG) provides recommendations that have been vetted and voted on by the SIG active membership. This body of work includes appropriate clinical use of anatomic models 3D printed for diagnostic use in the care of patients with specific medical conditions. The recommendations provide guidance for approaches and tools in medical 3D printing, from image acquisition, segmentation of the desired anatomy intended for 3D printing, creation of a 3D-printable model, and post-processing of 3D printed anatomic models for patient care.
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Affiliation(s)
- Leonid Chepelev
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Nicole Wake
- Center for Advanced Imaging Innovation and Research (CAI2R), Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU School of Medicine, New York, NY USA
- Sackler Institute of Graduate Biomedical Sciences, NYU School of Medicine, New York, NY USA
| | | | - Waleed Althobaity
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Ashish Gupta
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Elsa Arribas
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Lumarie Santiago
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO USA
| | - Kenneth C Wang
- Baltimore VA Medical Center, University of Maryland Medical Center, Baltimore, MD USA
| | - William Weadock
- Department of Radiology and Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI USA
| | - Ciprian N Ionita
- Department of Neurosurgery, State University of New York Buffalo, Buffalo, NY USA
| | - Dimitrios Mitsouras
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | | | | | - Andy Christensen
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Peter Liacouras
- 3D Medical Applications Center, Walter Reed National Military Medical Center, Washington, DC, USA
| | - Frank J Rybicki
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Adnan Sheikh
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
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Souza ATP, Freitas GP, Lopes HB, Ferraz EP, Oliveira FS, Beloti MM, Rosa AL. Effect of cell therapy with allogeneic osteoblasts on bone repair of rat calvaria defects. Cytotherapy 2018; 20:1267-1277. [PMID: 30196010 DOI: 10.1016/j.jcyt.2018.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/15/2018] [Accepted: 06/22/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND AIMS Regenerative medicine strategies based on cell therapy are considered a promising approach to repair bone defects. The aims of this study were to evaluate the effect of subculturing on the osteogenic potential of osteoblasts derived from newborn rat calvaria and the effect of these osteoblasts on bone repair of rat calvaria defects. METHODS Cells were obtained from 50 newborn rat calvaria, and primary osteoblasts (OB) were compared with first passage (OB-P1) in terms of osteogenic potential by assaying cell proliferation, alkaline phosphatase (ALP) activity, extracellular matrix mineralization and gene expression of the osteoblastic markers RUNX2, ALP, osteocalcin and bone sialoprotein. Then, 5-mm calvaria defects were created in 24 Wistar rats, and after 2 weeks, they were locally injected with 50 µL of phosphate-buffered saline containing either 5 × 106 osteoblasts (OB-P1, n = 12) or no cells (control, n = 12). Four weeks post-injection, the bone formation was evaluated by micro-computed tomography and histological analyses. Data were compared by analysis of variance, followed by the Student-Newman-Keuls's test or Student's t-test (P ≤ 0.05). RESULTS OB-P1 showed high proliferation and ALP activity, and despite the reduced gene expression of osteoblastic markers and extracellular matrix mineralization compared with OB, they displayed osteogenic potential, being a good choice for injection into calvaria defects. The micro-tomographic and histological data showed that defects treated with OB-P1 presented higher bone formation compared with control defects. DISCUSSION Our results indicate that cells derived from newborn rat calvaria retain osteoblastic characteristics after subculturing and that these osteoblasts stimulate bone repair in a rat calvaria defect model.
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Affiliation(s)
| | - Gileade Pereira Freitas
- Cell Culture Laboratory, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Helena Bacha Lopes
- Cell Culture Laboratory, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Emanuela Prado Ferraz
- Cell Culture Laboratory, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Fabiola Singaretti Oliveira
- Cell Culture Laboratory, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Marcio Mateus Beloti
- Cell Culture Laboratory, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Adalberto Luiz Rosa
- Cell Culture Laboratory, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
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De Souza N, Kamat S, Chalakkal P, Khandeparker RV. Use of 3D printed model as an aid in surgical removal of a rare occurrence of a compound odontome in the anterior mandible associated with impacted teeth. J Clin Exp Dent 2018; 10:e721-e725. [PMID: 30057718 PMCID: PMC6057080 DOI: 10.4317/jced.54654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 05/09/2018] [Indexed: 11/20/2022] Open
Abstract
The use of 3D printing in the medical field has been well documented, with significant developments in fabrication of tissues, organs, customized prosthetics, implants, and anatomical models as well as pharmaceutical research. Its use in dentistry, however has been limited mainly to maxillofacial surgery and reconstruction, orthognathic surgery and trauma. Compound odontomes are usually prevalent in the anterior maxilla, however, their occurrence in the anterior mandibular region is rare. This case report highlights the effective usage of 3D printing as an aid in the surgical removal of a compound odontome and impacted incisors in the mandibular anterior region. The surgery was carried out under general anesthesia. A full thickness muco-periosteal flap was reflected and the compound odontome along with the impacted incisors were removed. The defect was restored using a mixture of autogenous scrapes harvested from the chin, xenograft and platelet-rich fibrin. Wound closure was done using 4-0 vicryl. A CBCT scan taken 1 year later confirmed uneventful healing and complete bone regeneration of the surgical defect.
Key words:3D printing, model, compound odontome, impacted, incisors.
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Affiliation(s)
- Neil De Souza
- MDS, Lecturer, Department of Pedodontics and Preventive Dentistry, Government Dental College and Hospital, Bambolim, Goa
| | - Saurabh Kamat
- MDS, Lecturer, Department of Oral surgery, Government dental college, Bambo-lim Goa
| | - Paul Chalakkal
- MDS, Associate Professor, Department of Pedodontics and Preventive Dentistry, Government Dental College and Hospital, Bambolim, Goa
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Sun J. [Virtual surgical planning and intraoperative navigation for mandibular reconstruction: from accurate to minimal invasive]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:821-826. [PMID: 30129302 DOI: 10.7507/1002-1892.201806027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Simultaneous restoration of function and appearance should be performed in mandibular reconstruction. Option of reconstructive techniques is determined by cause, location, extent, and classification of the mandibular defects. Vascularize bone graft is one of the most popular technique in current clinical practice of mandibular reconstruction. Fibula is the most common donor site for mandibular reconstruction. The disadvantage of low height of neo-mandible reconstructed by single fibular segment can be solved by vascularized double barrel fibula graft. Using virtual surgical planning and intraoperative navigation for mandibular reconstruction leads to simplify surgical procedure, reduce operating time and injury, and decrease donor site morbidity so that accurate mandibular reconstruction could be completed. Direction of minimal invasive surgery for mandibular reconstruction will be developed by intraoral approach and intraoral anastomosis.
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Affiliation(s)
- Jian Sun
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Research Center of Stomatology, Shanghai, 200011,
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Lee YW, You HJ, Jung JA, Kim DW. Mandibular reconstruction using customized three-dimensional titanium implant. Arch Craniofac Surg 2018; 19:152-156. [PMID: 29921117 PMCID: PMC6057131 DOI: 10.7181/acfs.2018.01830] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/08/2018] [Indexed: 11/25/2022] Open
Abstract
Mandibular defects lead to severe deformation and functional deficiency. Vascularized osteocutaneous tissue has been widely used to reconstruct the mandible. However, it is technically challenging to shape this type of grafts in such a manner that they resemble the configuration of the mandible. A 48-year-old female patient who underwent anterolateral thigh (ALT) flap coverage after a tongue cancer excision was diagnosed with a tumor recurrence during the follow-up. A wide excision mandibulectomy and mandibular reconstruction with an ALT flap and a titanium implant were performed. The prefabricated titanium implant was fixed to the condyle. Then, an ALT flap was harvested from the ipsilateral thigh and anastomosed. After confirming that the circulation of the flap was intact, the implant was fixed to the parasymphysis. On the radiograph taken after the surgery, the prosthesis was well positioned and overall facial shape was acceptable. There was no postoperative complication during the follow-up period, 1 year and 2 months. The prefabricated implant allows the restoration of facial symmetry without harvesting autologous bone and it is a safe and effective surgical option for mandibular reconstruction.
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Affiliation(s)
- Yun-Whan Lee
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, Korea
| | - Hi-Jin You
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, Korea
| | - Jae-A Jung
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, Korea
| | - Deok-Woo Kim
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, Korea
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Arce K, Waris S, Alexander AE, Ettinger KS. Novel Patient-Specific 3-Dimensional Printed Fixation Tray for Mandibular Reconstruction With Fibular Free Flaps. J Oral Maxillofac Surg 2018; 76:2211-2219. [PMID: 29802815 DOI: 10.1016/j.joms.2018.04.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 10/17/2022]
Abstract
Segmental mandibular defects secondary to infectious, traumatic, and pathologic conditions can be debilitating because of their impact on function and facial esthetics. Several reconstructive techniques are available, with vascularized flaps commonly used for the reconstruction of large bony or composite segmental defects. The free fibular flap for mandibular reconstruction is well documented and remains a commonly used flap because of its bone length, versatility, distant location from the head and neck region that allows for a 2-team approach, and ability to simultaneously place endosseous implants. Virtual surgical planning (VSP) and guided resection and reconstruction of maxillofacial defects have facilitated complex 3-dimensional (3D) reconstruction. The accuracy and fidelity of VSP are dependent on the intraoperative execution of the VSP, with computer-aided design and computer-aided modeling of patient-specific cutting guides and hardware providing a template for its execution. The goal of this report is to describe the authors' experience with the use of a novel 3D printed fixation tray designed from the VSP data. It provides dual functionality by aiding in alignment and stabilization of the fibular segments and concomitantly providing patient-specific anatomic references for indexing of bony and soft tissue components. This tray enables rapid ex vivo configuration of the fibula segment(s) with the reconstruction bar relative to the native mandibular segments and allows the compiled construct to be transferred to the head and neck for insetting as a precisely configured single unit.
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Affiliation(s)
- Kevin Arce
- Assistant Professor of Surgery and Program Director, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN.
| | - Samir Waris
- Resident, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN
| | - Amy E Alexander
- Biomedical Engineer, Biomechanics Research, Anatomical Modeling Laboratory, Mayo Clinic, Rochester, MN
| | - Kyle S Ettinger
- Mayo Clinic Scholar, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN; Head and Neck Oncologic Surgery and Microvascular Reconstruction Fellow, Division of Head and Neck Surgery, Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL
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25
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Ren W, Gao L, Li S, Chen C, Li F, Wang Q, Zhi Y, Song J, Dou Z, Xue L, Zhi K. Virtual Planning and 3D printing modeling for mandibular reconstruction with fibula free flap. Med Oral Patol Oral Cir Bucal 2018; 23:e359-e366. [PMID: 29680849 PMCID: PMC5945234 DOI: 10.4317/medoral.22295] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/24/2018] [Indexed: 11/26/2022] Open
Abstract
Background This study was to evaluate the use of virtual planning and 3D printing modeling in mandibular reconstruction and compare the operation time and surgical outcome of this technique with conventional method. Material and Methods Between 2014 and 2017, 15 patients underwent vascularized fibula flap mandibular reconstruction using virtual planning and 3D printing modeling. Titanium plates were pre-bent using the models and cutting guides were used for osteotomies. 15 patients who underwent mandibular reconstruction using fibula flap without aid of virtual planning and 3D printing models were selected as control group. The operation time was recorded and compared in two groups. Accuracy of reconstruction was measured by superimposing the preoperative image onto the postoperative image of mandible. The selected bony landmark, distance and angle were measured. Results The mean total operation time and reconstruction time were 1.60±0.37 and 5.54±0.50 hours in computer-assisted group, respectively; These were 2.58±0.45 and 6.54±0.70 hours in conventional group, respectively. Both operation time and reconstruction time were shorter in computer-assisted group. The difference between the preoperative and postoperative intercondylar distances, intergonial angle distances, anteroposterior distances and gonial angles were 2.92±1.15 and 4.48±1.41mm, 2.93±1.19 and 4.79±1.48mm, 4.31±1.24 and 5.61±1.41mm, 3.85±1.68° and 5.88±2.12° in the computer-assisted and conventional group, respectively. The differences between the preoperative and postoperative mandible is smaller in the computer-assisted group. Conclusions Virtual planning and 3D printing modeling have the potential to increase mandibular reconstruction accuracy and reduce operation time. we believe that this technology for mandibular reconstruction in selected patients will become a used method and improve the quality of reconstruction. Key words:Mandibular reconstruction, fibula flap, virtual planning, computer-assisted design, 3D printing.
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Affiliation(s)
- W Ren
- Department of Oral and Maxillofacial Surgery, The affiliated hospital of Qingdao University, No.1677, Wutai mountain Road, Qingdao, Shandong, P. R. China. 255666
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Ettinger KS, Alexander AE, Arce K. Computed Tomographic Angiography Perforator Localization for Virtual Surgical Planning of Osteocutaneous Fibular Free Flaps in Head and Neck Reconstruction. J Oral Maxillofac Surg 2018; 76:2220-2230. [PMID: 29730061 DOI: 10.1016/j.joms.2018.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 04/03/2018] [Accepted: 04/03/2018] [Indexed: 11/30/2022]
Abstract
Virtual surgical planning (VSP), computer-aided design and computer-aided modeling, and 3-dimensional printing are 3 distinct technologies that have become increasingly employed in head and neck oncology and microvascular reconstruction. Although each of these technologies have long been utilized for treatment planning in other surgical disciplines such as craniofacial surgery, trauma surgery, temporomandibular joint surgery, and orthognathic surgery, its widespread use in head and neck reconstructive surgery remains a much more recent advent. In response to the growing trend of VSP being used for the planning of fibular free flaps in head and neck reconstruction, some surgeons have questioned the technology's implementation based upon its perceived inadequacy in addressing other reconstructive considerations beyond hard tissue anatomy. Detractors of VSP for head and neck reconstruction highlight its lack of capability in accounting for multiple reconstructive factors, such as recipient vessel selection, vascular pedicle reach, need for dead space obliteration, and skin paddle perforator location. It is with this premise in mind that we report a simple technique for anatomically localizing peroneal artery perforators during VSP for osteocutaneous fibular free flaps in which both bone and a soft tissue skin paddle are required for ablative reconstruction. The technique allows for anatomic perforator localization during the VSP session based solely upon data existent within the preoperative computed tomographic angiography (CTA) and it does not require any modifications to preoperative clinical workflows. It is the authors' presumption that many surgeons in the field are unaware of this planning capability within the context of modern VSP for head and neck reconstruction. The primary purpose of this manuscript is to introduce and further familiarize surgeons with the technique of CTA perforator localization as a method of improving intraoperative fidelity for VSP of osteocutaneous fibular free flaps.
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Affiliation(s)
- Kyle S Ettinger
- Mayo Clinic Scholar, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN; Head and Neck Oncologic Surgery and Microvascular Reconstruction Fellow, Department of Oral and Maxillofacial Surgery, Division of Head and Neck Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL.
| | - Amy E Alexander
- Biomedical Engineer, Anatomic Modeling Lab, Mayo Clinic, Rochester, MN
| | - Kevin Arce
- Assistant Professor of Surgery and Program Director, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN
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Yang WF, Choi WS, Leung YY, Curtin JP, Du R, Zhang CY, Chen XS, Su YX. Three-dimensional printing of patient-specific surgical plates in head and neck reconstruction: A prospective pilot study. Oral Oncol 2018; 78:31-36. [DOI: 10.1016/j.oraloncology.2018.01.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/14/2017] [Accepted: 01/09/2018] [Indexed: 10/18/2022]
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Ma J, Ma L, Wang Z, Zhu X, Wang W. The use of 3D-printed titanium mesh tray in treating complex comminuted mandibular fractures: A case report. Medicine (Baltimore) 2017; 96:e7250. [PMID: 28682875 PMCID: PMC5502148 DOI: 10.1097/md.0000000000007250] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Precise bony reduction and reconstruction of optimal contour in treating comminuted mandibular fractures is very difficult using traditional techniques and devices. The aim of this report is to introduce our experiences in using virtual surgery and three-dimensional (3D) printing technique in treating this clinical challenge. PATIENT CONCERNS A 26-year-old man presented with severe trauma in the maxillofacial area due to fall from height. DIAGNOSIS Computed tomography images revealed middle face fractures and comminuted mandibular fracture including bilateral condyles. INTERVENTIONS AND OUTCOMES The computed tomography data was used to construct the 3D cranio-maxillofacial models; then the displaced bone fragments were virtually reduced. On the basis of the finalized model, a customized titanium mesh tray was designed and fabricated using selective laser melting technology. During the surgery, a submandibular approach was adopted to repair the mandibular fracture. The reduction and fixation were performed according to preoperative plan, the bone defects in the mental area were reconstructed with iliac bone graft. The 3D-printed mesh tray served as an intraoperative template and carrier of bone graft. The healing process was uneventful, and the patient was satisfied with the mandible contour. LESSONS Virtual surgical planning combined with 3D printing technology enables surgeon to visualize the reduction process preoperatively and guide intraoperative reduction, making the reduction less time consuming and more precise. 3D-printed titanium mesh tray can provide more satisfactory esthetic outcomes in treating complex comminuted mandibular fractures.
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Affiliation(s)
| | - Limin Ma
- Department of Orthopedics, Guangdong Key Laboratory of Orthopedic Technology and Implant Materials, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China
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Abbasi AJ, Azari A, Mohebbi SZ, Javani A. Mandibular Rami Implant: A New Approach in Mandibular Reconstruction. J Oral Maxillofac Surg 2017; 75:2550-2558. [PMID: 28672137 DOI: 10.1016/j.joms.2017.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 05/19/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The mandible is an essential esthetic and functional component of the lower third of the face and its reconstruction has always been a challenge, especially after severe post-traumatic injuries. The purpose of the present report was to introduce a new approach of mandibular reconstruction in a patient who had lost the entire mandible except for the rami after being severely injured in a blast. MATERIALS AND METHODS A new approach using a titanium mandibular rami implant technique was applied using computer-aided 3-dimensional virtual planning and rapid prototyping technology. A prosthetic component was supported by the mandibular implant, which achieved occlusion and dedicated function for the patient. RESULTS This method offered precise adaptation of the implant and prosthesis and an easier surgical procedure, providing a shortened operation time, no donor site morbidity, and more predictable outcomes. CONCLUSION This new technique allows reconstruction of large-scale mandibular defects that is not possible by conventional surgical methods.
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Affiliation(s)
- Amir Jalal Abbasi
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Sina Hospital, and Craniomaxillofacial Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Azari
- Associate Professor, Prosthodontics Department, Dental School, Tehran University of Medical Sciences, Tehran, Iran.
| | - Simin Z Mohebbi
- Associate Professor, Community Oral Health Department, Dental School, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezoo Javani
- Resident, Department of Oral and Maxillofacial Surgery, School of Dentistry, and Craniomaxillofacial Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Castro-Núñez J, Shelton JM, Snyder S, Sickels JV. Virtual Surgical Planning for the Management of Severe Atrophic Mandible Fractures. Craniomaxillofac Trauma Reconstr 2017; 11:150-156. [PMID: 29892332 DOI: 10.1055/s-0037-1601865] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/05/2017] [Indexed: 10/19/2022] Open
Abstract
Severely atrophic mandible fractures are frequently a challenge to treat. Virtual surgical planning (VSP) uses three-dimensional computed tomographic (CT) scans that can be translated into stereolithographic models to fabricate surgical templates, facilitating intraoperative procedures. The purpose of this article is to describe the reconstruction of two cases of severe atrophic mandible fracture using VSP. Two elderly edentulous/partially dentate patients who presented with fractures of their mandibles and who underwent reconstruction using VSP were included. Both had Class III atrophy at the region of the fracture. While both fractures were complex, the mechanism of injury differed with one being a tractor accident and the other being a pathologic fracture. Both patients presented with critical medical conditions. CT scans were obtained on both. The displaced segments were aligned virtually using mirror images and the midline of the maxilla. Three-dimensional models were fabricated to allow preoperative contouring of 2.5-mm reconstruction plates. Patients were operated under general anesthesia and fractures reduced and stabilized with 2.5-mm reconstruction plates placed at the lateral border of the mandible. Average treatment time for both patients was a little over 2 hours. There was good reduction with both. VSP is a valuable tool to assess and reduce complex fractures with less surgical time and predictable results.
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Affiliation(s)
- Jaime Castro-Núñez
- Division of Oral and Maxillofacial Surgery, University of Kentucky, Lexington, Kentucky.,Institución Universitaria Colegios de Colombia. Bogotá, Colombia
| | - Jared M Shelton
- Division of Oral and Maxillofacial Surgery, University of Kentucky, Lexington, Kentucky
| | - Susan Snyder
- Division of Oral and Maxillofacial Surgery, University of Kentucky, Lexington, Kentucky
| | - Joseph Van Sickels
- Division of Oral and Maxillofacial Surgery, University of Kentucky, Lexington, Kentucky
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Automatic segmentation and user-friendly software techniques for virtual surgical planning of mandibular reconstruction. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:2512-2515. [PMID: 28268834 DOI: 10.1109/embc.2016.7591241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Compared to conventional mandibular reconstruction surgery, a recent approach of virtual planning can reduce surgical time providing reliable surgical outcomes. We present our virtual surgical planning software using automatic segmentation and user-friendly techniques. Evaluation experiments compared with a commercial software prove that the proposed software can achieve successful surgical planning in reduced time with reliable accuracy.
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Wang Y, Zhang H, Fan S, Zhang D, Huang Z, Chen W, Ye J, Li J. Mandibular reconstruction with the vascularized fibula flap: comparison of virtual planning surgery and conventional surgery. Int J Oral Maxillofac Surg 2016; 45:1400-1405. [DOI: 10.1016/j.ijom.2016.06.015] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/22/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
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Weitz J, Bauer F, Hapfelmeier A, Rohleder N, Wolff KD, Kesting M. Accuracy of mandibular reconstruction by three-dimensional guided vascularised fibular free flap after segmental mandibulectomy. Br J Oral Maxillofac Surg 2016; 54:506-10. [DOI: 10.1016/j.bjoms.2016.01.029] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 01/27/2016] [Indexed: 12/18/2022]
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Morphological results of customized microvascular mandibular reconstruction: A comparative study. J Craniomaxillofac Surg 2016; 44:697-702. [DOI: 10.1016/j.jcms.2016.03.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 03/16/2016] [Accepted: 03/17/2016] [Indexed: 11/24/2022] Open
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Kadowaki M, Kubo T, Fujikawa M, Tashima H, Nagayama H, Ishihara O, Yamada R, Otake I, Hosokawa K. A two-tiered structure device based on stereolithography for residual mandible repositioning in mandibular reconstruction with fibular flap. Microsurgery 2016; 37:509-515. [PMID: 27098198 DOI: 10.1002/micr.30062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 03/07/2016] [Accepted: 04/07/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We invented a two-tiered structure device based on stereolithography for residual mandible repositioning in mandibular reconstruction with fibular flap, and examined its usefulness. PATIENTS AND METHODS A total of eight patients (six carcinomas and two osteomyelitis) who had undergone mandibular reconstruction with fibular flap were included. Mandibular defects according to Jewer's classification were L for five, LC for two, and H for one patient (range of bone defect size, 7.7-13.3 cm). Based on a stereolithographic mandibular model, a two-tiered structure device was made preoperatively with resin, and was applied during surgery to define the accurate position of residual mandible following segmental mandibulectomy. Postoperative aesthetic and functional outcomes, including dental status, diet, and speech were evaluated. RESULTS The device was applied without any problems during surgery. Follow-up period ranged from eight to twenty-two months. Good postoperative alignment of the grafts and occlusion were also achieved in all eight patients. Five patients were able to return to eating meals as they had pre-surgery, and two patients required dental rehabilitation with dentures. As for speech, four patients scored ten points, three patients scored eight points, and one patient scored four points in Hirose's scoring system, which means that seven patients was rated as excellent, and one patient was rated as poor. Aesthetic outcomes were excellent in three patients, good in three patients, and fair in two patients. CONCLUSION Our device was easy to prepare, successfully maintained the precise position of the residual mandible, and facilitated bone graft cutting and insetting during reconstruction. © 2016 Wiley Periodicals, Inc. Microsurgery 37:509-515, 2017.
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Affiliation(s)
- Miki Kadowaki
- Department of Plastic Surgery, Osaka General Medical Center, Osaka, Japan
| | - Tateki Kubo
- Department of Plastic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masakazu Fujikawa
- Department of Plastic Surgery, Osaka General Medical Center, Osaka, Japan
| | - Hiroki Tashima
- Department of Plastic Surgery, Osaka General Medical Center, Osaka, Japan
| | - Hiromi Nagayama
- Department of Plastic Surgery, Osaka General Medical Center, Osaka, Japan
| | - Osamu Ishihara
- Department of Oral and Maxillofacial Surgery, Osaka General Medical Center, Osaka, Japan
| | - Ryuhei Yamada
- Department of Oral and Maxillofacial Surgery, Osaka General Medical Center, Osaka, Japan
| | - Ippei Otake
- Department of Oral and Maxillofacial Surgery, Osaka General Medical Center, Osaka, Japan
| | - Ko Hosokawa
- Department of Plastic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Surgical navigation-assisted mandibular reconstruction with fibula flaps. Int J Oral Maxillofac Surg 2016; 45:448-53. [DOI: 10.1016/j.ijom.2015.08.1006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 06/28/2015] [Accepted: 08/25/2015] [Indexed: 11/23/2022]
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Matsushita Y, Fujita S, Yanamoto S, Yamada SI, Rokutanda S, Yamashita K, Ikeda T, Umeda M. Spindle cell variant of ameloblastic carcinoma: a case report and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121:e54-61. [DOI: 10.1016/j.oooo.2015.06.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 06/10/2015] [Accepted: 06/22/2015] [Indexed: 11/26/2022]
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Computer-Assisted Surgery for Segmental Mandibular Reconstruction with the Osteoseptocutaneous Fibula Flap. Plast Reconstr Surg 2016; 137:963-970. [DOI: 10.1097/01.prs.0000479998.49928.71] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lim SH, Kim MK, Kang SH. Precision of fibula positioning guide in mandibular reconstruction with a fibula graft. Head Face Med 2016; 12:7. [PMID: 26818457 PMCID: PMC4728821 DOI: 10.1186/s13005-016-0104-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 01/18/2016] [Indexed: 12/03/2022] Open
Abstract
Background This study examined the usefulness of the fibula positioning guide for boosting the accuracy of mandible reconstructions. Methods Thirty mandibular rapid prototype (RP) models were allocated to experimental (N = 15) and control (N = 15) groups. For reference, we prepared a reconstructed mandibular RP model with a three-dimensional printer, based on surgical simulation. In the experimental group, a fibula positioning guide template and fibula cutting guide, based on simulation, were used to reconstruct the mandible with a fibula graft. In the control group, only the fibula cutting guide, with reference to the reconstructed RP mandible model, was used to reconstruct the mandible with a fibula graft. The two mandibular reconstructions were compared to the surgical simulation by registering images with the non-surgical right side of the mandible. On the reconstructed side, 3D measurements were compared between the surgical simulation and actual surgery, and the sum of differences was taken as the total error. Results The combined use of the fibula cutting and positioning guides produced a smaller total error (mean ± SD: 10.0 ± 7.9 mm) than the fibula cutting guide alone (12.8 ± 8.8 mm; p = 0.015). The greatest point error was the vertical error at the mesial point of the anterior fibula segment. The anteroposterior and lateral errors were not significantly different between groups. These results showed that these two methods were not significantly different, except in the total and vertical errors. Conclusions Considering the CAD/CAM processes required for creating positioning devices, the benefit provided with a positioning guide justified its use over the fibula cutting guide alone.
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Affiliation(s)
- Se-Ho Lim
- Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.
| | - Moon-Key Kim
- Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea. .,Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Republic of Korea.
| | - Sang-Hoon Kang
- Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea. .,Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Republic of Korea.
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Kim JY, Kim WS, Choi EC, Nam W. The Role of Virtual Surgical Planning in the Era of Robotic Surgery. Yonsei Med J 2016; 57:265-8. [PMID: 26632411 PMCID: PMC4696964 DOI: 10.3349/ymj.2016.57.1.265] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 01/19/2015] [Accepted: 02/06/2015] [Indexed: 11/27/2022] Open
Abstract
Among various surgical methods introduced to optimize esthetic results, robotic surgery has gradually expanded in scope. As incision, approach, and operation view in robotic surgery differ from existing surgical methods, we should consider reconstruction from a different perspective. We recently experienced two mandibular reconstruction cases after tumor ablative surgery with robotic neck dissection using the conventional reconstruction method and virtual surgical planning (VSP), respectively. We found that the conventional reconstruction method is inappropriate in modified facelift incision in robotic neck dissection because it provides limited surgical scope, restricts access to the defect area, and therefore, consumes considerable time before anastomosis. For these reasons, the authors consider VSP far more viable in the era of robotic surgery.
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Affiliation(s)
- Jae Young Kim
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea
| | - Won Shik Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Chang Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea.
| | - Woong Nam
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea
- Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, Korea.
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ZHI LIQIANG, LI MENG, LIU KAI, MA XING. ADVANCED 3D RAPID PROTOTYPING BIOMODELING TECHNIQUE FOR KNEE SURGERY. J MECH MED BIOL 2015. [DOI: 10.1142/s0219519415400503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Advanced three-dimensional (3D) models have played more and more essential roles in orthopedics surgical interventions. In order to improve the clinical outcomes of knee surgery (KS) including minimally invasive knee surgery (MIKS), the melted extrusion modeling (MEM), a rapid prototyping (RP) technique, was used efficiently to fabricate real life-size 3D physical models of interesting knees. The applications and advantages of the tangible RP-constructed 3D models in KS were elucidated in this study. As a result, better preparation including optimal preoperative planning was made so that KS could be performed in an accurate, safe and fast manner for each case. Besides, the surgical skills of MIKS were substantially improved. Therefore, the results suggest that KS can benefit much from the advanced 3D modeling technique.
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Affiliation(s)
- LI-QIANG ZHI
- Department of Orthopedics The First Affiliated Hospital of Xi’an Jiaotong University Xi’an 710061, China
| | - MENG LI
- Department of Orthopedics The First Affiliated Hospital of Xi’an Jiaotong University Xi’an 710061, China
| | - KAI LIU
- Department of Orthopedics The First Affiliated Hospital of Xi’an Jiaotong University Xi’an 710061, China
| | - XING MA
- Department of Orthopedics The First Affiliated Hospital of Xi’an Jiaotong University Xi’an 710061, China
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Rahimov CR, Farzaliyev IM, Fathi HR, Davudov MM, Aliyev A, Hasanov E. The Application of Virtual Planning and Navigation Devices for Mandible Reconstruction and Immediate Dental Implantation. Craniomaxillofac Trauma Reconstr 2015; 9:125-33. [PMID: 27162568 DOI: 10.1055/s-0035-1566159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 07/05/2015] [Indexed: 10/22/2022] Open
Abstract
Routine 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.
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Affiliation(s)
- Chingiz R Rahimov
- Department of Oral and Maxillofacial Surgery, Azerbaijan Medical University, Baku, Azerbaijan
| | - Ismayil M Farzaliyev
- Department of Oral and Maxillofacial Surgery, Azerbaijan Medical University, Baku, Azerbaijan
| | - Hamid Reza Fathi
- Department of Plastic and Reconstructive Surgery, Teheran University of Medical Science, Teheran, Islamic Republic of Iran
| | - Mahammad M Davudov
- Department of Oral and Maxillofacial Surgery, Azerbaijan Medical University, Baku, Azerbaijan
| | - Anar Aliyev
- Department of Dentistry, Azerbaijan Medical University, Baku, Azerbaijan
| | - Emin Hasanov
- Department of Stomatology, Hospital of Ministry of Internal Affairs, Baku, Azerbaijan
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Li Z, Zou D, Zhang J, Shao Y, Huang P, Chen Y. Use of 3D reconstruction of emergency and postoperative craniocerebral CT images to explore craniocerebral trauma mechanism. Forensic Sci Int 2015; 255:106-11. [DOI: 10.1016/j.forsciint.2015.07.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 06/17/2015] [Accepted: 07/07/2015] [Indexed: 11/30/2022]
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Mandibular reconstructions using computer-aided design/computer-aided manufacturing: A systematic review of a defect-based reconstructive algorithm. J Craniomaxillofac Surg 2015; 43:1785-91. [PMID: 26355023 DOI: 10.1016/j.jcms.2015.08.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 07/10/2015] [Accepted: 08/11/2015] [Indexed: 11/21/2022] Open
Abstract
Modern planning techniques, including computer-aided design/computer-aided manufacturing (CAD-CAM) can be used to plan reconstructive surgery, optimising aesthetic outcomes and functional rehabilitation. However, although many such applications are available, no systematic protocol yet describes the entire reconstructive procedure, which must include virtual planning, custom manufacture, and a reconstructive algorithm. We reviewed current practices in this novel field, analysed case series described in the literature, and developed a new, defect-based reconstructive algorithm. We also evaluated methods of mandibular reconstruction featuring virtual planning, the use of surgical guides, and laser printing of custom titanium bony plates to support composite free flaps, and evaluated their utility.
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Huang JW, Shan XF, Lu XG, Cai ZG. Preliminary clinic study on computer assisted mandibular reconstruction: the positive role of surgical navigation technique. Maxillofac Plast Reconstr Surg 2015; 37:20. [PMID: 26247007 PMCID: PMC4518132 DOI: 10.1186/s40902-015-0017-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/23/2015] [Indexed: 11/24/2022] Open
Abstract
Background The objectives of the present study were to investigate the reliability and outcomes of computer-assisted techniques in mandibular reconstruction with a fibula flap and verify whether the surgical navigation system was feasible in mandible reconstructive surgery. Methods Eight cases were enrolled in the computer assisted surgery (CAS) group and 14 cases in the traditional group. The shaping and fixation of the fibula grafts were guided by computer assisted techniques, which could be monitored with the BrainLAB surgical navigation system. The variation of mandible configuration was evaluated by CT measurement in the Mimics software, including the variation of length, width, height and gonial angle of the mandible. The 3D facial soft tissue alteration was also analyzed in 3D chromatogram by Geomagic software. Results All 22 fibula flaps survived. The mandibular configurations and facial contours had a better clinic result in the CAS group. The length, width, height and gonial angle of the reconstructive mandible were more similar to the original one. The Wilcoxon rank sum test analysis suggested significant differences in the measurements. The chromatographic analysis also visually showed superiority over the traditional group. Conclusions The computer assisted surgical navigation method used in mandibular reconstruction is feasible and precise for clinical application. The contour of the reconstructed mandible and facial symmetry are improved with computer techniques.
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Affiliation(s)
- Jin-Wei Huang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Haidian District 100081 Beijing, China
| | - Xiao-Feng Shan
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Haidian District 100081 Beijing, China
| | - Xu-Guang Lu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Haidian District 100081 Beijing, China
| | - Zhi-Gang Cai
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22# Zhongguancun South Avenue, Haidian District 100081 Beijing, China
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Ferreira JJ, Zagalo CM, Oliveira ML, Correia AM, Reis AR. Mandible reconstruction: History, state of the art and persistent problems. Prosthet Orthot Int 2015; 39:182-9. [PMID: 24570020 DOI: 10.1177/0309364613520032] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 12/19/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND Mandibular reconstruction has been experiencing an amazing evolution. Several different approaches are used to reconstruct this bone and therefore have a fundamental role in the recovery of oral functions. OBJECTIVES This review aims to highlight the persistent problems associated with the approaches identified, whether bone grafts or prosthetic devices are used. A brief summary of the historical evolution of the surgical procedures is presented, as well as an insight into possible future pathways. STUDY DESIGN A literature review was conducted from September to December 2012 using the PubMed database. The keyword used was "mandible reconstruction." Articles published in the last three years were included as well as the relevant references from those articles and the "historical articles" were referred. This research resulted in a monograph that this article aims to summarize. RESULTS Titanium plates, bone grafts, pediculate flaps, free osteomyocutaneous flaps, rapid prototyping, and tissue engineering strategies are some of the identified possibilities. The classical approaches present considerable associated morbidity donor-site-related problems. CONCLUSION Research that results in the development of new prosthetics devices is needed. A new prosthetic approach could minimize the identified problems and offer the patients more predictable, affordable, and comfortable solutions. CLINICAL RELEVANCE This review, while affirming the evolution and the good results found with the actual approaches, emphasizes the negative aspects that still subsist. Thus, it shows that mandible reconstruction is not a closed issue. On the contrary, it remains as a research field where new findings could have a direct positive impact on patients' life quality. The identification of the persistent problems reveals the characteristics to be considered in a new prosthetic device. This could overcome the current difficulties and result in more comfortable solutions. Medical teams have the responsibility to keep patients informed about the predictable problems related with each elected approach, even understanding that a perfect reconstruction is a secondary goal when compared with maintenance of life.
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Schouman T, Khonsari R, Goudot P. Shaping the fibula without fumbling: the SynpliciTi customised guide-plate. Br J Oral Maxillofac Surg 2015; 53:472-3. [DOI: 10.1016/j.bjoms.2015.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 02/10/2015] [Indexed: 11/29/2022]
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Patient-specific reconstruction plates are the missing link in computer-assisted mandibular reconstruction: A showcase for technical description. J Craniomaxillofac Surg 2015; 43:624-9. [PMID: 25934440 DOI: 10.1016/j.jcms.2015.02.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 02/12/2015] [Accepted: 02/19/2015] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Preoperative planning of mandibular reconstruction has moved from mechanical simulation by dental model casts or stereolithographic models into an almost completely virtual environment. CAD/CAM applications allow a high level of accuracy by providing a custom template-assisted contouring approach for bone flaps. However, the clinical accuracy of CAD reconstruction is limited by the use of prebent reconstruction plates, an analogue step in an otherwise digital workstream. TECHNICAL REPORT In this paper the integration of computerized, numerically-controlled (CNC) milled, patient-specific mandibular plates (PSMP) within the virtual workflow of computer-assisted mandibular free fibula flap reconstruction is illustrated in a clinical case. Intraoperatively, the bone segments as well as the plate arms showed a very good fit. Postoperative CT imaging demonstrated close approximation of the PSMP and fibular segments, and good alignment of native mandible and fibular segments and intersegmentally. Over a follow-up period of 12 months, there was an uneventful course of healing with good bony consolidation. CONCLUSION The virtual design and automated fabrication of patient-specific mandibular reconstruction plates provide the missing link in the virtual workflow of computer-assisted mandibular free fibula flap reconstruction.
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Three-Dimensional Virtual Surgery Accuracy for Free Fibula Mandibular Reconstruction: Planned Versus Actual Results. J Oral Maxillofac Surg 2014; 72:2601-12. [DOI: 10.1016/j.joms.2014.07.024] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 07/18/2014] [Accepted: 07/21/2014] [Indexed: 11/20/2022]
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Azuma M, Yanagawa T, Ishibashi-Kanno N, Uchida F, Ito T, Yamagata K, Hasegawa S, Sasaki K, Adachi K, Tabuchi K, Sekido M, Bukawa H. Mandibular reconstruction using plates prebent to fit rapid prototyping 3-dimensional printing models ameliorates contour deformity. Head Face Med 2014; 10:45. [PMID: 25338640 PMCID: PMC4213462 DOI: 10.1186/1746-160x-10-45] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 10/14/2014] [Indexed: 11/10/2022] Open
Abstract
Background Recently, medical rapid prototyping (MRP) models, fabricated with computer-aided design and computer-aided manufacture (CAD/CAM) techniques, have been applied to reconstructive surgery in the treatment of head and neck cancers. Here, we tested the use of preoperatively manufactured reconstruction plates, which were produced using MRP models. The clinical efficacy and esthetic outcome of using these products in mandibular reconstruction was evaluated. Methods A series of 28 patients with malignant oral tumors underwent unilateral segmental resection of the mandible and simultaneous mandibular reconstruction. Twelve patients were treated with prebent reconstruction plates that were molded to MRP mandibular models designed with CAD/CAM techniques and fabricated on a combined powder bed and inkjet head three-dimensional printer. The remaining 16 patients were treated using conventional reconstruction methods. The surgical and esthetic outcomes of the two groups were compared by imaging analysis using post-operative panoramic tomography. Results The mandibular symmetry in patients receiving the MRP-model-based prebent plates was significantly better than that in patients receiving conventional reconstructive surgery. Conclusions Patients with head and neck cancer undergoing reconstructive surgery using a prebent reconstruction plate fabricated according to an MRP mandibular model showed improved mandibular contour compared to patients undergoing conventional mandibular reconstruction. Thus, use of this new technology for mandibular reconstruction results in an improved esthetic outcome with the potential for improved quality of life for patients.
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Affiliation(s)
| | - Toru Yanagawa
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
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