Does an In-House Computer-Aided Design/Computer-Aided Manufacturing Approach Contribute to Accuracy and Time Shortening in Mandibular Reconstruction?

Abstract

Mandibular reconstruction using computer-aided design and computer-assisted manufacturing (CAD/CAM) techniques has received recent attention. This technique has theoretical advantages, although this approach can be commercially used in the limited area of the world. The aim is to describe our experience using in-house CAD/CAM guides and the situations in which CAD/CAM may present benefit in the region where commercial guides are unavailable. The authors developed our In-house CAD/CAM approach for mandibular reconstructions with a free fibular flap. Patients were divided into 2 group; CAD/CAM and conventional groups. In the CAD/CAM group, reconstructions were planned virtually using CAD/CAM; these CAD/CAM guides were used in the surgery. In the conventional group, free-hand cutting and fitting of the fibular segments were performed as reconstructions. Later, the bone computed tomographic image was compared with the plan. The averaged deviations and the percentages of the points within 1 mm, 2 mm, and 3 mm deviations were recorded. Total and ischemic time were also recorded. Reconstruction points within 1 mm deviation were 59% of CAD/CAM group (n = 9) and 42% of conventional group (n = 10, P = 0.04), within 2 mm 82% and 69% (P = 0.03). Total time were 1012 and 911 minutes, while flap ischemic time were 147 and 175 minutes (P = 0.03), respectively. In-house CAD/CAM mandibular reconstruction also supported accuracy and shorter flap ischemic time. For a detailed accurate reconstruction, CAD/CAM showed superiority than conventional method. Use of the In-house CAD/CAM guides might be an option where commercial guides are not available.

In-House, Open-Source 3D-Software-Based, CAD/CAM-Planned Mandibular Reconstructions in 20 Consecutive Free Fibula Flap Cases: An Explorative Cross-Sectional Study With Three-Dimensional Performance Analysis

“…Our slightly higher costs can be explained by two factors: we created and printed repositioning aids for each osteotomy site, and the neomandibula segment was also printed in order to bend the miniplates preoperatively. The total lead time (planning, designing, printing, postprocessing, final preparation with drill sleeves, and sterilization) is two to three days, which agrees very well with the times reported in the literature (13,14) and can be expedited further with growing experience and optimization of the processes. Another essential aspect raised by Numajiri et al is that this form of costeffective planning is done in the surgeon's time and is not outsourced to the osteosynthesis manufacturers and their clinical engineers as is usually the case (28).…”

“…The reason is again the heterogeneity of parameters. The majority of studies compared the preoperative virtual plan to the postoperative situation by measuring the fibula segment lengths (21,(29)(30)(31), point-to-point distances and angles (3,13,14), intercondylar distance (32), or intercoronoid distance (21) or by comparing interfragmentary gap distances (33). Numajiri et al analyzed an algorithm for the production of low-cost cutting guides designed and printed inhouse (28).…”

“…For this laboratory setting under ideal conditions, an error deviation of 2.4 mm seems to be quite high. Four years later, Numajiri et al published a clinical study comparing freehand and in-house-planned CAD/CAM FFF cases (14). Based on a point-to-point analysis, they describe their in-house Blender-based solution as accurate.…”

“…In addition, the dependence on the industry reduces flexibility of planning timing and, depending on the complexity of the case, requires a lead time of at least seven to ten working days, during which one to three web meetings are held to discuss the planning and its implementation. In this context, two developments can be observed in the daily routine and more recent literature: first, the establishment of low-cost solutions for the in-house production of cutting guides using open-source software and in-house printers (11)(12)(13)(14) and, second, the use of partially adjustable resection aids such as the ReconGuide (KLS Martin Group; Gebrüder Martin GmbH & Co. KG; Tuttlingen, Germany) and the MUC-Jig (15,16).…”

Use of Dental Impression Silicone to Fabricate Simple Surgical Guides in Mandibular Reconstruction∗

“…For example, CAD/CAM surgery usually requires a starting investment of thousands of dollars for the initial purchase cost of 3D printers. 6,7 Operators who are not familiar with computer use and who lack experienced engineer support may require time to learn virtual planning and design, hampering accurate virtual planning or reproduction on a 3D printer. In addition, image storage and processing formats for CT data differ among hospitals and CT data formats do not always meet the requirements of the free planning software.…”