The use of 3D virtual surgical planning and computer aided design in reconstruction of maxillary surgical defects

Abstract

Purpose of reviewThe present review describes the latest development of 3D virtual surgical planning (VSP) and computer aided design (CAD) for reconstruction of maxillary defects with an aim of fully prosthetic rehabilitation. The purpose is to give an overview of different methods that use CAD in maxillary reconstruction in patients with head and neck cancer.Recent findings 3D VSP enables preoperative planning of resection margins and osteotomies. The current 3D VSP workflow is expanded with multimodal imaging, merging decision supportive information. Development of more personalized implants is possible using CAD, individualized virtual muscle modelling and topology optimization. Meanwhile the translation of the 3D VSP towards surgery is improved by techniques like intraoperative imaging and augmented reality. Recent improvements of preoperative 3D VSP enables surgical reconstruction and/or prosthetic rehabilitation of the surgical defect in one combined procedure. SummaryWith the use of 3D VSP and CAD, ablation surgery, reconstructive surgery, and prosthetic rehabilitation can be planned preoperatively. Many reconstruction possibilities exist and a choice depends on patient characteristics, tumour location and experience of the surgeon. The overall objective in patients with maxillary defects is to follow a prosthetic-driven reconstruction with the aim to restore facial form, oral function, and do so in accordance with the individual needs of the patient.

Virtual Surgical Planning and Customized Subperiosteal Titanium Maxillary Implant (CSTMI) for Three Dimensional Reconstruction and Dental Implants of Maxillary Defects after Oncological Resection: Case Series

“…Dental rehabilitation after oncological surgical treatment is of utmost importance and should be planned from the beginning [ 12 , 13 ]. Generally, endosseous implants can reliably be placed in fibula flap (FFF) primarily (immediately at the time of fibula harvest) or secondarily (delayed by 6–12 months), with comparable safety and outcome profile [ 14 ].…”

“…Another option is zygoma implants, combining autologous soft tissue reconstruction with zygomatic implant-supported rehabilitation. They provide a predictable support for prosthetic rehabilitation of the maxilla and can be placed at the time of ablative surgery [ 12 ]. However, occasionally, zygoma implants cannot be placed due to insufficient bone support, requiring excellent surgical skills.…”

Virtual Surgical Planning in Free Tissue Transfer for Orbito-Maxillary Reconstruction

“…During the planning session, resection margins are carefully planned to account for any situations that may occur intraoperatively as the plan allows limited flexibility during surgery. 30 31…”

Aesthetic reconstruction of onco-surgical maxillary defects using free scapular flap with and without CAD/CAM customized osteotomy guide

“…Resection of neoplasms in the maxilla often results in complex defects encompassing soft tissue, bone and dentition. This results in diminished aesthetics and impaired oral functions and thereby lowers the quality of life [ 1 ].…”