Poster Board Number: 40: Mandibular Reconstruction With a Non-Vascularized Iliac Crest Bone Graft Utilizing Computer-Aided Design and Computer-Aided Manufacturing for the Fabrication of a Custom Surgical Resection Guide and Reconstruction Plate

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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PEMAKAIAN MEDICAL RAPID PROTOTYPING UNTUK PREKONTUR PLAT REKONSTRUKSI PADA RESEKSI MANDIBULA

ODONTO Dental Journal ◽

10.30659/odj.4.2.149-158 ◽

2017 ◽

Vol 4 (2) ◽

pp. 149

Author(s):

Arya Kusuma Agraha ◽

Masykur Rahmat ◽

Rahardjo .

Keyword(s):

Rapid Prototyping ◽

Computer Aided Design ◽

Mandibular Reconstruction ◽

Reconstruction Plate ◽

Mandibular Bone ◽

Accurate Picture ◽

Computer Aided ◽

Long Time ◽

Cad Cam ◽

Aided Design

Background: In the case of mandibular resection that leaves a large mandibular bone defect, a mandibular reconstruction is required to restore functional and postoperative aesthetic factors. Mandibular reconstruction plate installation on mandibular resection is very important but difcult to achieve maximum results. The formation of reconstruction plates can be preoperative and intraoperative. Preoperative stereolithography (medical rapid prototyping/MRP) can be used to form rapid and accurate plates (precontours). Objective: Report the use of MRP as an alternative tool to precontour mandibular reconstruction plate.Case management: Reported reconstruction of mandibular defects in one case of hemimandibulectomy and two cases of segmental resection with avascular iliac bone grafts using MRP through a computer-aided design and computer aided manufacture procedure (CAD/CAM) to establish preoperative reconstruction plates (precontour) so the surgery doesn’t take long time to reconstruct, by forming a mandibular models under normal circumstances.Result: The formation of a reconstruction plates (precontour) using MRP (medical rapid prototyping) with CAD / CAM procedure gives results in accordance with the original form.Conclusions: The making of MRP through CAD / CAM procedure gives maximal result resembling the form of mandibular model. The MRP models get an accurate picture of the patient’s jaw as a pre contour tools for reconstruction plate. The formation of the reconstruction plates (precontour) with these MRP model is obtained from CAD / CAM and provides a normal jaw image, so that preoperative precontouring will give good and maximum result on the reconstruction plates made under the MRP models.

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