CAD-CAM vs conventional technique for mandibular reconstruction with free fibula flap: A comparison of outcomes

Comparing the use of conventional and three-dimensional printing (3DP) in mandibular reconstruction

“…Only Yang et al [ 51 ] found no significant difference between the surgical techniques. De Farias et al [ 25 ] ( p < 0.001), Gil et al [ 47 ] ( p < 0.04), Mahendru et al [ 50 ] ( p < 0.0001), Zhang et al [ 46 ] ( p < 0.05) and Tarsitano et al [ 44 ] ( p < 0.041) all found a statistically significant reduction in operative time in the 3D group compared to the control. Additionally, King et al [ 26 ] found the mean operative time was 22.8 ± 2.1 min in the group treated conventionally and only 6.9 ± 0.3 min in the group treated using CAM/CAD technology ( p < 0.0001).…”

“…Gil et al [ 47 ] found statistically significant differences in the frequency of titanium plate exposure ( p = 0.009) and dental malocclusion ( p = 0.03), with less incidence in the 3D group. Mahendru et al [ 50 ] found no flap failures in the CAM/CAD-treated group, with two incidences found in the group treated conventionally. Furthermore, whilst only one patient in the CAM/CAD group required re-exploration, seven patients underwent this additional procedure in the conventional group.…”

“…Modabber et al [ 42 ] found that patient self-assessment for aesthetics was graded higher in the 3D group (3D: avg 88.5 Control: avg 67.9). Mahendru et al [ 50 ] graded aesthetics out of 5 (3D: average = 3.64 versus Control: average = 2.55). De Farias et al [ 25 ] had both medical staff and non-medical associates of the patient grade the aesthetic outcome, in a rank out of 10 (3D: Medical average = 7.7 Non-medical average = 9.2 Control: Medical average = 6.0 Non-medical average = 8.8).…”

“…Tarsitano et al [ 44 ] identified this weakness, stating that it causes potential bias, as findings may result from confounding variables and not the technique used. One example is Mahendru et al [ 50 ], who found that the number of osteotomies required between the two group was significantly different. Although they stated a significant reduction in operative time in the 3D group, this could have simply been because the surgeries were less complex to begin with.…”

“…Five research teams reported on the incidence of postoperative complications [ 41 , 44 , 47 , 50 , 54 ] (Table 4 ). Although not always reported by the researchers included in this review, Chaine et al [ 67 ] analysed the complications following FFF reconstructions, finding common complications to include: flap loss, malocclusion, soft tissue necrosis, fistula growth, donor site morbidity and even facial asymmetry.…”