scholarly journals Mandibular Reconstruction with Bridging Customized Plate after Ablative Surgery for ONJ: A Multi-Centric Case Series

2021 ◽  
Vol 11 (22) ◽  
pp. 11069
Author(s):  
Salvatore Battaglia ◽  
Francesco Ricotta ◽  
Salvatore Crimi ◽  
Rosalia Mineo ◽  
Fabio Michelon ◽  
...  
Keyword(s):  
Maxillofacial Surgery ◽  
Case Series ◽  
Mandibular Reconstruction ◽  
Computer Assisted ◽  
Virtual Planning ◽  
Reconstructive Procedures ◽  
Average Accuracy ◽  
Ablative Surgery ◽  
Cad Cam ◽  
Safe Technique

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.

scholarly journals Use of CAD–CAM Bridging Mandibular Prosthesis in Osteonecrosis of the Jaw: The Experience of Our School

2020 ◽  
Vol 9 (11) ◽  
pp. 3516
Author(s):  
Francesco Ricotta ◽  
Salvatore Battaglia ◽  
Federico Bolognesi ◽  
Francesco Ceccariglia ◽  
Claudio Marchetti ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Secondary Infection ◽  
Case Series ◽  
Osteonecrosis Of The Jaw ◽  
Reconstructive Procedures ◽  
Surrounding Soft Tissue ◽  
Cad Cam ◽  
Safe Technique ◽  
Bone Exposure

Osteonecrosis of the jaw (ONJ) is a disease that affects the jaw. It is mainly related to radiation or bisphosphonates therapy, and the symptoms and signs consist of pain, bone exposure, inflammation of the surrounding soft tissue swelling, and secondary infection or drainage. In the case of advanced disease of the mandibular area, the treatment of choice is mandibular resection and reconstruction. In the present study, we report a case series of patients affected by ONJ and treated with a customised bridging mandibular prosthesis-only technique. From 2016 to 2018, we treated five consecutive patients affected by ONJ: three patients were affected by biphosphonate-related osteonecrosis of the mandible (BRONJ) and two were affected by osteoradionecrosis of the mandible (ORNJ). Three patients needed a soft tissue free flap to permit optimal wound closure, intra- and/or extraorally. All reconstructive procedures were carried out successfully, with no major or minor microvascular complication. The average postoperative follow-up was 24.8 (range 10–41) months. Considering that microvascular bone transfer is a high-risk procedure in BRONJ patients, we can conclude that the positioning of a customised bridging mandibular prosthesis (CBMP), whether or not associated with a microvascular soft tissue transfer, is a safe technique in terms of surgical outcome and feasibility.

scholarly journals Knowledge Acquisition and Construction of a RDF-Ontology for Computer-Assisted Surgery

2021 ◽  
Author(s):  
Niclas Hagen ◽  
Reinald Kühle ◽  
Frederic Weichel ◽  
Urs Eisenmann ◽  
Petra Knaup-Gregori ◽  
...  
Keyword(s):  
Knowledge Acquisition ◽  
Maxillofacial Surgery ◽  
Computer Assisted Surgery ◽  
Mandibular Reconstruction ◽  
University Hospital ◽  
Planning System ◽  
Oral And Maxillofacial Surgery ◽  
Computer Assisted ◽  
Planning Systems ◽  
Virtual Planning

The integration of surgical knowledge into virtual planning systems plays a key role in computer-assisted surgery. The knowledge is often implicitly contained in the implemented algorithms. However, a strict separation would be desirable for reasons of maintainability, reusability and readability. Along with the Department of Oral and Maxillofacial Surgery at Heidelberg University Hospital, we are working on the development of a virtual planning system for mandibular reconstruction. In this work we describe a process for the structured acquisition and representation of surgical knowledge for mandibular reconstruction. Based on the acquired knowledge, an RDF(S) ontology was created. The ontology is connected to the virtual planning system via a SPARQL interface. The described process of knowledge acquisition can be transferred to other surgical use cases. Furthermore, the developed ontology is characterised by a reusable and easily expandable data model.

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

2014 ◽  
Vol 7 (2) ◽  
pp. 158-166 ◽  
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.

scholarly journals Virtual planning and guided surgery in fibular free-flap mandibular reconstruction: A 29-case series

2016 ◽  
Vol 133 (3) ◽  
pp. 175-178 ◽  
Author(s):  
D. Culié ◽  
O. Dassonville ◽  
G. Poissonnet ◽  
J.-C. Riss ◽  
J. Fernandez ◽  
...  
Keyword(s):  
Free Flap ◽  
Case Series ◽  
Mandibular Reconstruction ◽  
Virtual Planning ◽  
Guided Surgery ◽  
Fibular Free Flap

scholarly journals 3D virtual planning in orthognathic surgery and CAD/CAM surgical splints generation in one patient with craniofacial microsomia: a case report

2016 ◽  
Vol 21 (1) ◽  
pp. 89-100 ◽  
Author(s):  
Francisco Vale ◽  
Jessica Scherzberg ◽  
João Cavaleiro ◽  
David Sanz ◽  
Francisco Caramelo ◽  
...  
Keyword(s):  
Case Report ◽  
Computer Aided Design ◽  
Computer Assisted ◽  
Linear Measurements ◽  
Postoperative Results ◽  
Virtual Planning ◽  
Postoperative Changes ◽  
Craniofacial Microsomia ◽  
Computer Aided ◽  
Cad Cam

Objective: In this case report, the feasibility and precision of tridimensional (3D) virtual planning in one patient with craniofacial microsomia is tested using Nemoceph 3D-OS software (Software Nemotec SL, Madrid, Spain) to predict postoperative outcomes on hard tissue and produce CAD/CAM (Computer Aided Design/Computer Aided Manufacturing) surgical splints. Methods: The clinical protocol consists of 3D data acquisition of the craniofacial complex by cone-beam computed tomography (CBCT) and surface scanning of the plaster dental casts. The ''virtual patient'' created underwent virtual surgery and a simulation of postoperative results on hard tissues. Surgical splints were manufactured using CAD/CAM technology in order to transfer the virtual surgical plan to the operating room. Intraoperatively, both CAD/CAM and conventional surgical splints are comparable. A second set of 3D images was obtained after surgery to acquire linear measurements and compare them with measurements obtained when predicting postoperative results virtually. Results: It was found a high similarity between both types of surgical splints with equal fitting on the dental arches. The linear measurements presented some discrepancies between the actual surgical outcomes and the predicted results from the 3D virtual simulation, but caution must be taken in the analysis of these results due to several variables. Conclusions: The reported case confirms the clinical feasibility of the described computer-assisted orthognathic surgical protocol. Further progress in the development of technologies for 3D image acquisition and improvements on software programs to simulate postoperative changes on soft tissue are required.

scholarly journals Deviation Analyses of Computer-Assisted, Template-Guided Mandibular Reconstruction With Combined Osteotomy and Reconstruction Pre-Shaped Plate Position Technology: A Comparative Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Jie Chen ◽  
Ruipu Zhang ◽  
Ye Liang ◽  
Yujie Ma ◽  
Saiwen Song ◽  
...  
Keyword(s):  
Coracoid Process ◽  
Mandibular Reconstruction ◽  
Computer Assisted ◽  
Anatomical Landmarks ◽  
Virtual Planning ◽  
Actual Length ◽  
Deviation Analysis ◽  
Resection Line ◽  
Condylar Head ◽  
Fibular Flap

BackgroundComputer-assisted and template-guided mandibular reconstruction provides higher accuracy and less variation than conventional freehand surgeries. The combined osteotomy and reconstruction pre-shaped plate position (CORPPP) technique is a reliable choice for mandibular reconstruction. This study aimed to evaluate the accuracy of CORPPP-guided fibular flap mandibular reconstruction and analyze the possible causes of the deviations.Patients and MethodsFrom June 2015 to December 2016, 28 patients underwent fibular flap mandibular reconstruction. Virtual planning and personalized CORPPP-guided templates were applied in 15 patients while 13 patients received conventional freehand surgeries. Deviations during mandibulectomy and fibular osteotomy, and overall and triaxial deviation of the corresponding mandibular anatomical landmarks were measured by superimposing the pre- and postoperative virtual models.ResultsThe deviation of the resection line and resection angle was 1.23 ± 0.98 mm and 4.11° ± 2.60°. The actual length of fibula segments was longer than the designed length in 7 cases (mean: 0.35 ± 0.32 mm) and shorter in 22 cases (mean: 1.53 ± 1.19 mm). In patients without ramus reconstruction, deviations of the ipsilateral condylar head point (Co.), gonion point (Go.), and coracoid process point (Cor.) were 6.71 ± 3.42 mm, 5.38 ± 1.71 mm, and 11.05 ± 3.24 mm in the freehand group and 1.73 ± 1.13 mm, 1.86 ± 0.96 mm, and 2.54 ± 0.50 mm in the CORPPP group, respectively, with significant statistical differences (p < 0.05). In patients with ramus reconstruction, deviations of ipsilateral Co. and Go. were 9.79 ± 4.74 mm vs. 3.57 ± 1.62 mm (p < 0.05), and 15.17 ± 6.53 mm vs. 4.36 ± 1.68 mm (p < 0.05) in the freehand group and CORPPP group, respectively.ConclusionMandibular reconstructions employing virtual planning and personalized CORPPP-guided templates show significantly higher predictability, convenience, and accuracy of mandibular reconstruction compared with conventional freehand surgeries. However, more clinical cases were required for further dimensional deviation analysis. The application and exploration of clinical practice would also continuously improve the design of templates.

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

2014 ◽  
Vol 42 (7) ◽  
pp. 1460-1464 ◽  
Author(s):  
Achille Tarsitano ◽  
Simona Mazzoni ◽  
Riccardo Cipriani ◽  
Roberto Scotti ◽  
Claudio Marchetti ◽  
...  
Keyword(s):  
Case Series ◽  
Mandibular Reconstruction ◽  
Cad Cam

scholarly journals Accuracy of Computer-Assisted Template-Based Implant Placement Using Two Different Surgical Templates Designed with or without Metallic Sleeves: A Randomized Controlled Trial

2019 ◽  
Vol 7 (2) ◽  
pp. 41 ◽  
Author(s):  
Marco Tallarico ◽  
Matteo Martinolli ◽  
Yong-Jin Kim ◽  
Fabio Cocchi ◽  
Silvio Mario Meloni ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Test Group ◽  
Computer Assisted ◽  
Virtual Planning ◽  
Implant Placement ◽  
Surgical Template ◽  
Significant Difference ◽  
Cad Cam ◽  
Open Versus ◽  
Surgical Templates

Purpose: To compare virtual planning accuracy of novel computer-assisted, template-based implant placement techniques, which make use of CAD/CAM stereolithographic surgical templates with or without metallic sleeves. Furthermore, to compare open versus closed sleeves for templates without metallic sleeves. Materials and methods: Any partially edentulous patients requiring at least one implant to be placed according to a computer-assisted template-based protocol were enrolled. Patients were randomized according to a parallel group design into two arms: Surgical template with or without metallic sleeves. Three deviation parameters (angular, horizontal, vertical) were defined to evaluate the discrepancy between the planned and placed implant positions. Results: No implants failed, and no complications were experienced. Forty-one implants were placed using surgical templates with metallic sleeves while 49 implants were placed with a surgical template without metallic sleeves. Of these, 16 implants were placed through open sleeves and 33 through closed sleeves. There was a statistically significant difference in angle (p = 0.0212) and in the vertical plan (p = 0.0073) with lower values for implants placed with a surgical template without metallic sleeves. In the test group, close sleeves were more accurate compared with open sleeves in angle (p = 0.0268) and in horizontal plan (p = 0.0477). Conclusion: With the limitations of the present study, surgical templates without metallic sleeves were more accurate in the vertical plan and angle compared to the conventional template with metallic sleeves. Open sleeves should be used with caution in the molar region only in case of reduced interarch space. Further research is needed to confirm these preliminary results.

scholarly journals Mandibular Reconstruction Using ProPlan CMF: A Review

2017 ◽  
Vol 1 (1) ◽  
pp. s-0037-1606835 ◽  
Author(s):  
Ryo Sasaki ◽  
Michael Rasse
Keyword(s):  
Computer Assisted Surgery ◽  
Mandibular Reconstruction ◽  
Patient Specific ◽  
Computer Assisted ◽  
Planning Service ◽  
Virtual Planning ◽  
Surgical Guide ◽  
Surgical Guides ◽  
Computer Aided

ProPlan CMF (Depuy Synthes, Solothurn, Switzerland, and Materialise, Leuven, Belgium) is a computer-aided surgical virtual planning service using an online meeting with professional medical engineers and transfers patient-specific surgical guide to the virtual plan. Moreover, prebent reconstruction plates or patient-specific computer-aided manufacturing-fabricated reconstruction can also be used. This service started in 2011. Currently, it is widely used in Europe. Current status of mandibular reconstruction with ProPlan CMF vertical planning service with the surgical guide was reviewed. The accuracy was excellent in terms of contact of the osteotomized parts and the contact to the remaining skeleton. The authors found that currently, a small number of reports regarding the mandibular reconstruction with virtual planning service and surgical guides are available. These reports also have a small number of cases and short-term follow-up results. In this situation, this review revealed that (1) mainly the resection guides, cutting guides, and patient-specific mandible reconstruction plates were adequately well fitted to the surgical site intraoperatively, (2) the ischemic time might be more reduced than that of the conventional surgery (3) the accuracy of computer-assisted surgery in the mandibular reconstruction was clinically acceptable, and (4) condyle positions after the computer-assisted surgery was mainly normal. The higher additional cost than that of the conventional technique is presently an issue. Large-scale clinical studies and long-term follow-up studies are demanded.

Fast and economical protocol for in-house virtual planning and 3D-printed surgical templates in mandibular reconstruction

2020 ◽  
Vol 4 (2) ◽  
pp. 83-90
Author(s):  
Syahir Hassan ◽  
Md Arad Jelon ◽  
Nur Ikram Hanim Abd Rahim ◽  
Mohammad Adzwin Yahya ◽  
Norhayati Omar
Keyword(s):  
3D Printing ◽  
Fused Deposition Modeling ◽  
Case Series ◽  
Mandibular Reconstruction ◽  
Titanium Plate ◽  
Virtual Planning ◽  
Planning Stage ◽  
Fused Deposition ◽  
3D Printed ◽  
Surgical Templates

In this work, a case series consisting of mandibular reconstruction with free fibula flap in ameloblastic carcinoma, pathological mandibular fracture and recontouring of mandibular angle hyperplasia that were treated successfully using fast and economical in-house virtual planning and 3D-printing protocol has been presented. Pre-operatively, the design of the reconstructed mandibular model and surgical templates were carried out, with the help of two types of free software. As the next step, all designed 3D hardware tools were printed using affordable fused deposition modeling desktop 3D printer. A 3D-printed reconstructed mandibular model was used for titanium plate bending. Our findings have illustrated that it necessitates an average of 5 h 29 min per case from virtual planning stage until the 3D printing of all 3D hardware tools is completed. The average cost for 3D-printed hardware tools and titanium plate per case is only $203.42.

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