The CAD–CAM technique for mandibular reconstruction: An 18 patients oncological case-series

Purpose: Computer-aided methods for mandibular reconstruction have improved both functional and morphological results in patients who underwent segmental mandibular resection. The purpose of this study is to evaluate the overlaying of virtual planning in terms of measures of the Computer Assisted Design/Computer Assisted Manufacturing CAD/CAM plate for mandibular reconstruction in patients who are ineligible for the insertion of reconstructing the titanium plate supported by fibular free flap, due to their poor health status, or in the presence of specific contraindications to autologous bone flap harvest. Materials and methods: The retrospective study performed analyzed the results of nine patients. The patients were treated at the Maxillofacial Surgery Unit of Policlinico S. Orsola of Bologna, Italy, and Policlinico San Marco, Catania, Italy, from April 2016 to June 2021. Superimposition between planning and post operative Computed Tomography CT scan was performed to assess the accuracy. Results: All reconstructive procedures were carried out successfully. No microsurgery-related complications occurred. In two cases, we had plate misplacement, and in one case, plate exposure that led to plate removal. The average accuracy of the series assessed after CT superimposition, as previously described, was 0.95 mm. Conclusions: Considering that microvascular bone transfer is a high-risk procedure in BRONJ patients, we can conclude that the positioning of a customized bridging mandibular prosthesis (CBMP), whether or not it is associated with a microvascular soft tissue transfer, is a safe technique in terms of surgical outcome and feasibility.

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Implant-Supported CAD/CAM Full-Arch Zirconia Bridges for Maxillary Edentulous Patients: A Case Series at Six Years of Function

Global Journal of Oral Science ◽

10.30576/2414-2050.2020.06.7 ◽

2020 ◽

Vol 6 (1) ◽

pp. 39-42

Author(s):

Dilek Pinar Senyilmaz ◽

Keyword(s):

Case Series ◽

Cad Cam ◽

Edentulous Patients

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Malocclusion Management Following Mandibular Reconstruction With Free Fibula Flaps

Craniomaxillofacial Trauma & Reconstruction ◽

10.1177/1943387520980246 ◽

2020 ◽

pp. 194338752098024

Author(s):

Jorge Ernesto Cantini Ardila ◽

Carlos Eduardo Torres Fuentes ◽

Giovanni Montealegre Gomez ◽

Susana Correa ◽

Erika Paola Gutierrez ◽

...

Keyword(s):

Orthognathic Surgery ◽

Case Series ◽

Mandibular Reconstruction ◽

Free Fibula Flap ◽

Occlusal Splints ◽

Fibula Flap ◽

Case Series Study ◽

Free Fibula ◽

Cutting Guides ◽

Series Study

Study Design: Free fibula flaps are nowadays the gold standard for the surgical reconstruction on large mandibular defects. Malocclusion is an important complication of this type of reconstruction and many of these patients end up requiring subsequent orthognathic corrective surgery. This is a descriptive retrospective case series study. Objective: To describe the demographic data, operative techniques, corrective methods and postoperative results in the management of malocclusion following mandibular reconstruction with free fibula flap. Methods: This case series study included patients who underwent free fibula flap mandibular reconstructions and who that subsequently developed malocclusion requiring orthognathic corrective surgery, from June 2010 to December 2019. Panoramic X-rays, cephalometries and/or 3-D facial reconstruction CT scans were used for surgical planning to create surgical cutting guides, templates and occlusal splints in all the patients that underwent corrective orthognathic surgery. Results: There were 46 patients who underwent a free fibula flap mandibular and maxillary reconstruction at San Jose Hospital between June 2010 and December 2019 of these, 5 patients (10.9%) developed postoperative malocclusion. One case from another institution was added to this study for a total of 6 patients with malocclusion following mandibular reconstruction surgery with a fibula free flap. During the orthognathic surgery, vertical osteotomies were performed in 3 patients and bilateral sagittal split osteotomies were necessary in 2 patients and L-shape in 1 patient. Osteogenic distraction was performed in 3 patients as part of their orthognathic treatment. The fixation methods were based in miniplates for 3 of the patients and lag screws for the remaining 3 patients. With this approach, all patients had an adequate occlusion correction with a 100% consolidation at their 6-month follow up. Conclusion: Malocclusion is a significant complication following mandibular reconstruction surgery that must be identified and managed. In severe cases, it requires corrective orthognathic surgery in severe cases. We have developed a protocol to avoid pitfalls during the primary reconstruction and in case an orthognathic surgery is required for malocclusion correction, preoperative planning with cutting guides and occlusal splints should be assessed, to guarantee favorable results through a reproducible technique.

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A Retrospective, Multicenter, Cross-Sectional Case Series Study Evaluating Outcomes of CAD/CAM Abutments on Implants from Four Manufacturers: 4-Year Mean Follow-up

The International Journal of Oral & Maxillofacial Implants ◽

10.11607/jomi.8840 ◽

2021 ◽

Vol 36 (5) ◽

pp. 966-976

Author(s):

Christopher Barwacz ◽

Kumar Shah ◽

Nurit Bittner ◽

William Parker ◽

Toni Neumeier ◽

...

Keyword(s):

Case Series ◽

Cross Sectional ◽

Case Series Study ◽

Cad Cam ◽

Series Study

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Minimally Invasive Treatment of Edentulous Maxillae with Overdenture Fully Supported by a Cad/Cam Titanium Bar with a Low-Profile Attachment Screwed on Four or Six Implants: A Case Series

Prosthesis ◽

10.3390/prosthesis2020006 ◽

2020 ◽

Vol 2 (2) ◽

pp. 53-64 ◽

Cited By ~ 5

Author(s):

Marco Tallarico ◽

Gabriele Cervino ◽

Roberto Scrascia ◽

Umberto Uccioli ◽

Aurea Lumbau ◽

...

Keyword(s):

Minimally Invasive ◽

Treatment Option ◽

Soft Tissues ◽

Case Series ◽

Optimal Number ◽

Invasive Treatment ◽

Low Profile ◽

Atrophic Maxilla ◽

Cad Cam ◽

Implant Overdenture

Rehabilitation of atrophic maxilla still remains a challenge. Fixed implant-supported restorations have become more predictable in the last years; nevertheless, technical and biological complications still occur. Removable overdenture fully supported by a CAD/CAM titanium bar seems to be a viable treatment option for the rehabilitation of completely edentulous patients with a high degree of bone resorption. In these clinical cases, the soft tissues of the lower third of the face need to be respected, and a fixed-removable solution is the only option to have good hygiene control. Nevertheless, there is no consensus about the optimal number and position of the implants. A total of six adult patients were recruited and treated with an overdenture fully supported by a CAD/CAM titanium bar and low-profile attachment, screwed on four or six implants. A detailed step-by-step description of the procedures was presented. Overall, all the patients were successful treated with no relevant complications. With the limitations of this case series, maxillary implant overdenture fully supported by four or six implants seems to be a safer treatment option for the minimally invasive rehabilitation of atrophic maxillae, regardless of the number of implants.

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Biomechanical In Vitro Study on the Stability of Patient-Specific CAD/CAM Mandibular Reconstruction Plates: A Comparison Between Selective Laser Melted, Milled, and Hand-Bent Plates

Craniomaxillofacial Trauma & Reconstruction ◽

10.1177/1943387520952684 ◽

2020 ◽

pp. 194338752095268

Author(s):

Robin Kasper ◽

Karsten Winter ◽

Sebastian Pietzka ◽

Alexander Schramm ◽

Frank Wilde

Keyword(s):

In Vitro Study ◽

Mandibular Reconstruction ◽

Patient Specific ◽

Plate Fracture ◽

Computer Aided ◽

Cad Cam ◽

Number Of Cycles ◽

Bent Plates ◽

Cam Systems

Study Design: An experimental in vitro study. Objective: Plate fractures are a recurrent problem in alloplastic mandibular reconstruction. Hypothetically it can be assumed that computer-aided design (CAD)/computer-aided manufacturing (CAM) reconstruction plates have a higher stability than conventional hand-bent plates. The aim of the study was to compare additive and subtractive fabricated CAD/CAM mandibular reconstruction plates as well as conventional plates with regard to their biomechanical properties. Methods: In a chewing simulator, plates of 2 conventional locking plate systems and 2 CAD/CAM-fabricated plate systems were compared. The plates were loaded in a fatigue test. The maximum number of cycles until plate fracture and the plate stiffness were compared. Results: While all conventional plates fractured at a maximum load between 150 and 210 N (Newton) after a number of cycles between 40 000 and 643 000, none of the CAD/CAM plates broke despite a nearly doubled load of 330 N and 2 million cycles. Both CAD/CAM systems proved to be significantly superior to the hand-bent plates. There was no difference between the 2 CAD/CAM systems. Conclusions: Concerning the risk of plate fracture, patient-specific CAD/CAM reconstruction plates appear to have a significant advantage over conventional hand-bent plates in alloplastic mandibular reconstruction.

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Biomechanical comparison of titanium miniplates versus a variety of CAD/CAM plates in mandibular reconstruction

Journal of the Mechanical Behavior of Biomedical Materials ◽

10.1016/j.jmbbm.2020.104007 ◽

2020 ◽

Vol 111 ◽

pp. 104007

Author(s):

Claudius Steffen ◽

Kay Sellenschloh ◽

Matthias Vollmer ◽

Michael M. Morlock ◽

Max Heiland ◽

...

Keyword(s):

Mandibular Reconstruction ◽

Cad Cam ◽

Biomechanical Comparison

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Computer-Assisted Mandibular Reconstruction using a Patient-Specific Reconstruction Plate Fabricated with Computer-Aided Design and Manufacturing Techniques

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0034-1371356 ◽

2014 ◽

Vol 7 (2) ◽

pp. 158-166 ◽

Cited By ~ 45

Author(s):

Frank Wilde ◽

Carl-Peter Cornelius ◽

Alexander Schramm

Keyword(s):

Computer Aided Design ◽

Mandibular Reconstruction ◽

Patient Specific ◽

Computer Assisted ◽

Reconstruction Plate ◽

Fibula Flap ◽

Computer Aided ◽

Cad Cam ◽

Aided Design ◽

Five Axis

We investigated the workflow of computer-assisted mandibular reconstruction that was performed with a patient-specific mandibular reconstruction plate fabricated with computer-aided design and computer-aided manufacturing (CAD/CAM) techniques and a fibula flap. We assessed the feasibility of this technique from virtual planning to the completion of surgery. Computed tomography (CT) scans of a cadaveric skull and fibula were obtained for the virtual simulation of mandibular resection and reconstruction using ProPlan CMF software (Materialise®/DePuy Synthes®). The virtual model of the reconstructed mandible provided the basis for the computer-aided design of a patient-specific reconstruction plate that was milled from titanium using a five-axis milling machine and CAM techniques. CAD/CAM techniques were used for producing resection guides for mandibular resection and cutting guides for harvesting a fibula flap. Mandibular reconstruction was simulated in a cadaveric wet laboratory. No problems were encountered during the procedure. The plate was fixed accurately to the residual bone without difficulty. The fibula segments were attached to the plate rapidly and reliably. The fusion of preoperative and postoperative CT datasets demonstrated high reconstruction precision. Computer-assisted mandibular reconstruction with CAD/CAM-fabricated patient-specific reconstruction plates appears to be a promising approach for mandibular reconstruction. Clinical trials are required to determine whether these promising results can be translated into successful practice and what further developments are needed.

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