Virtual planning for mandible resection and reconstruction

Abstract

In mandibular reconstruction, computer-assisted procedures, including virtual surgical planning (VSP) and additive manufacturing (AM), have become an integral part of routine clinical practice. Especially complex cases with extensive defects after ablative tumor surgery benefit from a computer-assisted approach. Various CAD/CAM-manufactured tools such as surgical guides (guides for osteotomy, resection and predrilling) support the transition from virtual planning to surgery. Patient-specific implants (PSIs) are of particular value as they facilitate both osteosynthesis and the positioning of bone elements. Computer-based approaches may be associated with higher accuracy, efficiency, and superior patient outcomes. However, certain limitations should be considered, such as additional costs or restricted availability. In the future, automation of the planning process and augmented reality techniques, as well as MRI as a non-ionizing imaging modality, have the potential to further improve the digital workflow.

Exceptional Cases Demand Exceptional Personalized Solutions: The Next Level in Dental Rehabilitation

“…Traditionally, reconstruction protocols following maxillary, midfacial, and mandibular ablation aim to replace missing tissues: soft tissue through soft tissue transfer and bony tissue through bone transfer [ 7 ].…”

“…Another traditional rule for maxillary and mandibular reconstruction is to plan and re-establish the vascularized bone where dental implants shall be positioned [ 12 , 13 , 14 ]. In addition to the vector limitations of a straight dental implant—although individualized abutments are used—towards prosthodontic needs to compensate significant skeletal mismatches, the presented method describes a reliable reconstruction protocol, where there is literally no limitation neither for the vector nor for the biomechanical loading [ 6 , 7 ]. This is guaranteed by a rigidly fixated one-piece implant carrying the required number of four posts for complete dental rehabilitation of an edentulous jaw.…”

The impact of digital imaging and computer-assisted surgery in oral surgery: A narrative review

“…Figure 2,3 Surgeons can use virtual surgical planning to design patient-specific osteotomies, grafts, or implants tailored to the individual's anatomy. CAS facilitates the fabrication of custom-made surgical guides or templates to aid in the accurate transfer of the preoperative plan to the surgical field By optimizing surgical precision and minimizing surgical time, CAS contributes to the restoration of form and function in patients undergoing maxillofacial reconstruction [23,24,25] Figure 2 Steps in computer-assisted surgery. [23] Figure 3 CAD-process in mandibular reconstruction [23]…”

“…CAS is increasingly utilized in temporomandibular joint (TMJ) surgery to address various pathologies, including degenerative joint disease, ankylosis, or trauma. Virtual surgical planning allows for precise assessment of TMJ anatomy and biomechanics, facilitating the selection of appropriate surgical interventions [23]. CAS enables surgeons to simulate osteotomies, condylar repositioning, or joint replacement procedures, ensuring optimal functional outcomes and patient satisfaction [33].…”

“…Moreover, staying updated with rapidly evolving digital technologies poses ongoing challenges. [23,24] Data Security and Privacy: The digitalization of patient records and imaging data raises concerns about data security and privacy. Practices must implement robust cybersecurity measures to protect sensitive patient information from unauthorized access, breaches, or cyberattacks.…”