Three-dimensional printed titanium mesh combined with iliac cancellous bone in the reconstruction of mandibular defects secondary to ameloblastoma resection

Abstract

Background The reconstruction of large mandibular defects is a challenge, and free vascularized bone flaps are most commonly used. However, the precision and symmetry of this repair are deficient, and patients have a risk of vascular embolism, flap necrosis, and donor site complications. Therefore, to explore an ideal alternative in mandibular reconstruction with high surgical accuracy and low complications is indispensable. Methods Seven patients with recurrent or large-scope ameloblastoma were enrolled in this study. All patients were provided with a fully digital treatment plan, including the design of osteotomy lines, surgical guides, and three-dimensional printed titanium mesh for implantation. With the assistance of surgical guide, ameloblastomas were resected, and custom 3D printed titanium mesh combined with posterior iliac bone harvest was used in mandibular reconstruction. A comparison was made between the discrepant surgical outcomes and the intended surgical plan, as well as the average three-dimensional deviation of the mandible before and after the surgery. At the same time, the resorption rate of the implanted bone was evaluated. Results All patients completed the fully digital treatment process successfully without severe complications. Image fusion showed that the postoperative contour of the mandible was basically consistent with surgical planning, except for a slight increase in the inferior border of the affected side. The mean three-dimensional deviation of the mandible between the preoperative and postoperative periods was 0.78 ± 0.41 mm. The mean error between the intraoperative bone volume and the digital planning bone volume was 2.44%±2.10%. Furthermore, the bone resorption rates of the harvested graft 6 months later were 32.15%±6.95%. Conclusions The use of digital surgical planning and 3D-printed templates can assist surgeons in performing surgery precisely, and the 3D-printed titanium mesh implant can improve the patient’s facial symmetry. 3D printed titanium mesh combined with posterior iliac cancellous bone graft can be regarded as an ideal alternative in extensive mandibular reconstruction.

In Silico Investigation of Mandibular Reconstruction: Tissue Differentiation Dynamics with Particulate-Cancellous Bone Marrow Grafts under Varied Bite Forces and Implant Elastic Moduli

“…Rigid fixation is required for the grafting to be successful because the graft material has no stiffness. To the best of our knowledge, existing studies regarding this were mostly experimental (Giordano et al, 1980;Kinoshita et al, 1997;Ma et al, 2023;Matsuo et al, 2019Matsuo et al, , 2012Miyamoto et al, 2014;Yamada et al, 2016;Zhao et al, 2023), while it is believed that a computational study is important for practical uses such as implant design and rehabilitation planning as well as to gain better insights especially for the parameters that difficult or impossible to obtain in an experimental study, such as progression of bone graft's elastic modulus and equivalent stiffness, and load transfer between implant and bone. The model in this study was created to replicate the experimental setup in Ma et al (2023).…”

“…Numerous efforts have been made to better understand mandibular reconstruction with PCBM grafts, such as comparing implant materials (Giordano, Brady, Foster, & Adams, 1980), post-operative follow-up (Matsuo, Hamada, Takahashi, & Chikazu, 2019;Miyamoto et al, 2014), comparison between defect sizes and locations (Kinoshita et al, 1997), the effect of growth factors (Matsuo et al, 2012), and evaluation of novel implant features (Ma, Liu, Zhou, & Wang, 2023;Yamada et al, 2016;Zhao, Shen, Li, & et al, 2023). All of the studies were experimental, which requires lots of time and is expensive, and there are desired metrics that are hard or impossible to obtain with this kind of study.…”