Virtual Bending of Titanium Reconstructive Plates for Mandibular Defect Bridging: Review of Three Clinical Cases

Abstract

The reconstruction of acquired mandibular defects due to ablative tumor surgery or traumatic injuries is still challenging. The gold standard in such treatment is application of reconstructive titanium plates, which should be contoured and adapted to the defect as much as possible because of their influence on postoperative functional and esthetic results. Traditionally, plate bending is achieved by trial and error intraoperatively. Use of stereolitography (STL) models potentially could reduce the risk of incorrect contouring as well as operating time. On the other hand, fabrication of STL is time-consuming and costly. However, we found only one experimental study dedicating to virtual plate bending in the literature. The aim of this article was to demonstrate clinical application of a method of virtual bending of reconstructive plate for mandibular defect bridging. No significant complications occurred, and satisfactory functional and esthetic results were achieved in all cases. We found this technique precise and applicable in cases of reconstruction of mandibular defects.

The Application of Virtual Planning and Navigation Devices for Mandible Reconstruction and Immediate Dental Implantation

“…Moreover, the reconstructive titanium plates could be prebent according to virtual bending method prior to surgery with reasonable degree of accuracy, which makes this plate both the element of rigid fixation and the template for the best anatomical shape of neomandible. 6 This technique gives possibility to reduce significantly surgical time and improve postoperative functional and esthetic result, compared with conventional methods. However, minor corrections could always be done during surgery if some planning errors are found.…”

“…On the other hand, MRP technology and usage of stereolithographic models can also be used for preoperative planning of mandibular reconstruction and prosthodontic rehabilitation. 6,[12][13][14] Surgical templates can be prepared for intraoperative plates bending and bone grafts shaping by using this method. In fact, stereolithography models can be sterilized and used as templates.…”

“…Then by using the contour of the lower margin of the mandible, virtual prebending of fixing the flap reconstructive plate was done according to protocol of virtual plate bending. 6 Virtual plate bending. After scanning the straight reconstructive plate (2.7 mm, Conmet, Moscow, Russia), and performing its segmentation according to the holes on the plate, each segment is adapting to the bone surface within healthy and pathological sites-modeling the shape of the plate similar to the shape of the mandibular body before resection.…”

“…Preoperative bending of fixing the flap reconstructive plate was done on virtual model and transferred according to the aforementioned method. 6 After achieving virtual model of the plate, numbering of the segments is done and determined where within segments the plate will bend by performing vertical, horizontal, and axial spindle. All data are imputing to protocol of plate bending and after selecting the standard reconstructive plate with appropriate length and shape (angled or straight), it is bending through segment according to worked out protocol (►Fig 5).…”

Custom software for the 3D printing of patient specific plate bending templates in pelvic fracture repair.

“…3D Printed models are also common in oral and maxi-facial reconstruction. Multiple studies have created virtual, bent plates and compared their accuracy to that of a hand bent plate [25], [26].…”