“Three‐in‐one” patient‐specific surgical guides for simultaneous dental implants in fibula flap jaw reconstruction: A prospective case series

Abstract

Background Conventional freehand immediate placement of dental implants is technically challenging in the jaw reconstructive surgery. Computer‐aided surgery might be the best solution, however, there has not been any standard approach to ensure the accuracy and efficiency of simultaneous dental implants in fibula flap jaw reconstruction. Purpose We aim to evaluate the clinical outcome of simultaneous dental implant in fibula flap using the “three‐in‐one” patient‐specific surgical guide (3‐in‐1‐PSSG) in an open‐label, prospective, single‐arm, and single‐center clinical trial. Materials and Methods A novel computer‐aided designed and three‐dimensional (3D) printed 3‐in‐1‐PSSG, which contains functions of fibula segmentation, surgical plate positioning and implant placement, was used to facilitate the reconstructive surgery and simultaneous dental implant placement. The intraoperative success of dental implant placement, implant survival rate and accuracy of dental implant placement were reported. Results From November 2018 to June 2020, 15 consecutive patients with 48 dental implants were enrolled in this study. Fifteen 3‐in‐1‐PSSGs were fabricated with a mean number of dental implants per guide of 3.2 ± 1.5. The intraoperative success rate of this approach was 14 out of 15. With an average follow‐up period of 40 weeks, the overall implant survival rate was 83.3% (40/48). Eight implants were removed due to two fibula flap failures. The mean deviation at the implant platform and implant apex were 2.8 mm (interquartile range [IQR]: 1.9‐3.4) and 3.2 mm (IQR: 2.0‐4.6), and the angular deviation was 2.5° (IQR: 1.1‐6.8). Conclusions Our preliminary data indicated that the 3D printed 3‐in‐1‐PSSG facilitated simultaneous dental implant in fibula flap jaw reconstruction with a favorable intraoperative success and short‐term clinical outcome. It might be a viable alternative to allow one‐step immediate oral rehabilitation in patients underwent jaw reconstruction with free flaps. Long‐term results with a larger sample size are warranted.

Patient-Specific 3D-Printed Miniplates for Free Flap Fixation at the Mandible: A Feasibility Study

“…Before this patient received the second flap with miniplates, there was a local infection and, consequently, loss of the implant-bearing part of the fibula due to poor soft tissue management over the residual part of the reconstruction plate ( Figure 3B ). Certainly, backward-planning including positioning of dental implants is possible before surgery ( 40 ), but reconstruction plates often impede reliable soft tissue management for dental implants ( 20 ).…”

The Learning Curve of Computer-Assisted Free Flap Jaw Reconstruction Surgery Using 3D-Printed Patient-Specific Plates: A Cumulative Sum Analysis

“…When surgeons felt competent in this surgical procedure, the significantly increased proportions of tumor staging and concomitant surgery suggested that the complexity of surgery after 23 cases was higher than the earlier cases. The concomitant surgery, simultaneous dental implant placement with the aid of a “three-in-one” patient-specific surgical guide ( 35 ), was also a technically challenging procedure. Accordingly, a fluctuation of proficiency was observed at this stage.…”

A Comparative Study on a Novel Fibula Malleolus Cap to Increase the Accuracy of Oncologic Jaw Reconstruction

“…Similar to our published methodology, the actual location of implants inserted was represented as the 3D models built from the postoperative CT scan ( 16 ). Long axes of the actual and the planned dental implants were compared to demonstrate the angle deviation in implant insertion.…”