Accelerated workflow for primary jaw reconstruction with microvascular fibula graft

Goetze, Elisabeth; Gielisch, Matthias; Moergel, Maximilian

doi:10.1186/s41205-017-0010-7

Cited by 16 publications

(6 citation statements)

References 25 publications

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“…The computeraided design/computer-aided manufacturing workflow for modeling allows the preoperative definition of cutting paths and angles at the resection site and of the graft, as well as the shape of the osteosynthesis material. 185,186 This process can either be done via commercial platforms or the clinic itself, depending on the available resources. On the one hand, this increases accuracy and reduces operation times.…”

Section: Microva Scul Ar Recons Truc Tionmentioning

confidence: 99%

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Bone reconstruction of extensive maxillomandibular defects in adults

Kämmerer,

Al‐Nawas

2023

Periodontology 2000

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Reconstruction of significant maxillomandibular defects is a challenge that has been much discussed over the last few decades. Fundamental principles were developed decades ago (bone bed viability, graft immobilization). Clinical decision‐making criteria are highly relevant, including local/systemic factors and incision designs, the choice of material, grafting technique, and donor site morbidity. Stabilizing particulated grafts for defined defects—that is, via meshes or shells—might allow significant horizontal and vertical augmentation; the alternatives are onlay and inlay techniques. More significant defects might require extra orally harvested autologous bone blocks. The anterior iliac crest is often used for nonvascularized augmentation, whereas more extensive defects often require microvascular reconstruction. In those cases, the free fibula flap has become the standard of care. The development of alternatives is still ongoing (i.e., alloplastic reconstruction, zygomatic implants, obturators, distraction osteogenesis). Especially for these complex procedures, three‐dimensional planning tools enable facilitated planning and a surgical workflow.

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Section: Microva Scul Ar Recons Truc Tionmentioning

confidence: 99%

“…On the one hand, this increases accuracy and reduces operation times. 186 On the other hand, intraoperative alterations of the surgical plan might be complex, and computer-aided surgery adds high additional costs. 187,188 7 | ALTERNATIVE S…”

Section: Microva Scul Ar Recons Truc Tionmentioning

confidence: 99%

Bone reconstruction of extensive maxillomandibular defects in adults

Kämmerer,

Al‐Nawas

2023

Periodontology 2000

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“…The devices generated may be divided into three main categories: (i) Pre-surgical tools, (ii) intrasurgical tools, and (iii) implants[ 1 ]. At present, some of the possible applications include individualized joint prosthesis, spine stabilization, individual osteosynthesis, and reconstructions or surgical accessories such as drilling or cutting guides[ 2 - 10 ]. Even the combination of a printed surgical guide and a printed dental implant with a modified surface could be possible[ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Steam-sterilized and degradable fused filament fabrication-printed polylactide/ polyhydroxyalkanoate surgical guides for dental implants: Are they accurate enough for static navigation?

Gielisch¹,

Heimes²,

Thiem³

et al. 2022

IJB

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Three-dimensional (3D) printing is a rapidly evolving field and has gained increasing importance in the medical sector. However, the increasing usage of printing materials is accompanied by more wastages. With a rising awareness of the environmental impact of the medical sector, the development of highly accurate and biodegradable materials is of great interest. This study aims to compare the accuracy of polylactide/polyhydroxyalkanoate (PLA/PHA) surgical guides printed by fused filament fabrication and material jetted guides of MED610 in fully guided dental implant placement before and after steam sterilization. Five guides were tested in this study and each was either printed with PLA/PHA or MED610 and either steam-sterilized or not. After implant insertion in a 3D-printed upper jaw model, the divergence between planned and achieved implant position was calculated by digital superimposition. Angular deviation and 3D deviation at the base and the apex were determined. Non-sterilized PLA/PHA guides showed an angle deviation of 0.38 ± 0.53° compared to 2.88 ± 0.75° in sterile guides (P > 0.001), an offset of 0.49 ± 0.21 mm and 0.94 ± 0.23 mm (P < 0.05), and an offset at the apex of 0.50 ± 0.23 mm before and 1.04 ± 0.19 mm after steam sterilization (P < 0.025). No statistically significant difference could be shown for angle deviation or 3D offset at both locations for guides printed with MED610. PLA/PHA printing material showed significant deviations in angle and 3D accuracy after sterilization. However, the reached accuracy level is comparable to levels reached with materials already used in clinical routine and therefore, PLA/PHA surgical guide is a convenient and green alternative.

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“…In secondary mandibular defect reconstruction, preoperative CT angiography of the neck is also considered necessary for surgeons to be better prepared for the difficulties they will encounter. Goetze et al [ 25 ] refer the loss of two fibula free flap in seven patients and other researchers stress that most complications for this kind of flap involve vascular compromise [ 3 , 26 ]. Preoperative angiography or 3D CT images of the neck are mandatory to select the most suitable recipient vessels according to its location and diameter [ 3 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

The Value of Three-Dimensional Modeling on Repositioning and Soft Tissue Filling in Microsurgical Reconstruction of Secondary Mandibular Defects: A Retrospective Study

Tilaveridis¹,

Pantazi²,

Venetis³

et al. 2022

Cureus

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Secondary mandibular defect reconstruction is a challenging operation. It is performed rather rarely, as in most of the cases a primary reconstruction is preferable. Restoration of function and symmetry, in secondary reconstruction of mandibular defects, requires accurate repositioning of segments and appropriate soft tissue filling. The purpose of this study is to estimate the value of three-dimensional (3D) digital modeling to meet the above requirements, in secondary microsurgical reconstruction of mandibular defects. MethodsFive cases of mandibular defects, with various degrees of asymmetry and dysfunction, were restored secondarily, with fibula flaps, after virtual reconstruction on a 3D model derived from their computed tomography, with the utilization of CAD-CAM software. Software reproduced symmetrical 3D models by mirroring the healthy side. Occlusion was restored by fine adjustments on 3D models and finally a reconstruction plate was pre-bent on them, prior to its sterilization for use in surgery. Three out of the five cases received an osteo-cutaneous flap, while in the other two patients, an osseous flap was used. Lower face symmetry, mouth opening, and main patient's complaints were evaluated pre-and postoperatively to assess the value of the 3D modeling. ResultsAll flaps survived. Hematoma occurred in two patients and was resolved after evacuation. In two patients, a fistula observed, was attributed to screw loosening, and treated after a surgical debridement and screw replacement. Intraoral exposure in the posterior part of the fibula flap was recorded in one patient, possibly from wound dehiscence due to tension of the intraoral tissue, and successfully covered with an ipsilateral nasolabial flap. The resulting symmetry and function were satisfactory in all the patients. ConclusionSecondary mandibular defects are often related with cosmetic disfigurement, misalignment of mandibular segments, and mandibular malfunction. For the correction of mandibular continuity, symmetry, and restoration of function, preoperative 3D modeling may be an important tool, according to our results.

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Accelerated workflow for primary jaw reconstruction with microvascular fibula graft

Cited by 16 publications

References 25 publications

Bone reconstruction of extensive maxillomandibular defects in adults

Bone reconstruction of extensive maxillomandibular defects in adults

Steam-sterilized and degradable fused filament fabrication-printed polylactide/ polyhydroxyalkanoate surgical guides for dental implants: Are they accurate enough for static navigation?

The Value of Three-Dimensional Modeling on Repositioning and Soft Tissue Filling in Microsurgical Reconstruction of Secondary Mandibular Defects: A Retrospective Study

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