Designing CAD/CAM Surgical Guides for Maxillary Reconstruction Using an In-house Approach

Abstract

Computer-aided design/computer-assisted manufacturing (CAD/CAM) is now being evaluated as a preparative technique for maxillofacial surgery. Because this technique is expensive and available in only limited areas of the world, we developed a novel CAD/CAM surgical guide using an in-house approach. By using the CAD software, the maxillary resection area and cutting planes and the fibular cutting planes and angles are determined. Once the resection area is decided, the necessary faces are extracted using a Boolean modifier. These superficial faces are united to fit the surface of the bones and thickened to stabilize the solids. Not only the cutting guides for the fibula and maxilla but also the location arrangement of the transferred bone segments is defined by thickening the superficial faces. The CAD design is recorded as .stl files and three-dimensionally (3-D) printed as actual surgical guides. To check the accuracy of the guides, model surgery using 3-D-printed facial and fibular models is performed. These methods may be used to assist surgeons where commercial guides are not available.

Predictability and Effectiveness of Jaws Reconstructive Prosthesis after Tumor Removal: A Systematic Review and Meta-Analysis

“…The group in which the 3d model was used has excellent mandibular symmetry, according to the results of the measured angles. Different authors give remarkably similar findings [20][21][22]. In all operated patients who used 3d model printing, the complete stability of the mandibular connection with the preservation of osseointegration was established during the follow-up examination, performed eight weeks after the surgical operation [23,24].…”

Digital chain for pelvic tumor resection with 3D-printed surgical cutting guides

“…However, there is a lack of description of design digital chains for these guides. Maxillofacial reconstruction seems to be the most prominent field for developing SCG design workflows ( Numajiri et al, 2018 ; Ostas et al, 2021 ), but it remains rare. To the best of our knowledge, such workflows do not exist for pelvic applications in the literature, especially for tumor resection surgeries.…”

“…There is abundant literature on this topic, and the efficiency of these guides seems to be established ( Vidal et al, 2020b ). However, there does not seem to be any set methodology for designing such guides ( Numajiri et al, 2018 ). Recent publications, using pelvic surgical guides, showed a wide variety of designs with no clearly classified or standardized features ( Wang et al, 2017 ; Evrard et al, 2019 ; Siegel et al, 2020 ; Gkagkalis et al, 2021 ) .…”

“…However, the descriptions of SCG design digital chains are insufficient, especially for pelvic tumor resections. Numajiri et al (2018 )published a detailed workflow they have developed for patient-specific cutting and reconstruction guides used in fibula free flap maxillary reconstruction. Popescu (2014 )described an in-house online platform for the design of SCGs, covering various applications.…”

In-House Manufacturing of a Translucent Three-Dimensional Model and Surgical Guide for Marginal Mandibulectomy

“…With these advancements, computer-assisted design (CAD) and computer-aided manufacturing techniques have now become essential for oral and maxillofacial surgeons [2,4]. In addition, the usefulness of in-house manufacturing, in which three-dimensional (3D) printing is performed within its own facility, has been demonstrated in recent years [5][6][7].…”