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Patient Specific Alloplastic Implant Reconstruction of Mandibular Defects–Safe Practice Recommendations and Guidelines

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Abstract

Mandibular continuity defects are commonly seen after tumor resection, osteomyelitis or maxillofacial trauma. Three-dimensional reconstruction of these mandibular segmental defects is critical for proper mandibular functioning and esthetics. Various methods used to reconstruct such defects include bridging reconstruction plates, modular endoprosthesis, non-vascularized and vascularized bone grafting with stock reconstruction plate or patient specific implants (PSI) and tissue engineering bone transfer. But in the recent years, literature documents use of PSI only alloplastic reconstruction as an alternate to microvascular bone flap reconstruction. Representative cases enumerate current practice of ‘patient specific implant only’ mandibular reconstruction and its pitfalls. This article discusses current status of literature on PSI’s, choice of indications for ‘PSI only’ mandibular reconstruction and also proposes guidelines for safe practice of patient specific implant reconstruction of mandible.

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References

  1. Wong RCW, Tideman H, Kin L, Merkx MAW (2010) Biomechanics of mandibular reconstruction: a review. Int J Oral Maxillofac Surg 39(4):313–319. https://doi.org/10.1016/j.ijom.2009.11.003

    Article  CAS  PubMed  Google Scholar 

  2. Darwich K, Ismail MB, Al-Mozaiek MYAS, Alhelwani A (2021) Reconstruction of mandible using a computer-designed 3D-printed patient-specific titanium implant: a case report. Oral Maxillofac Surg 25(1):103–111. https://doi.org/10.1007/s10006-020-00889-w

    Article  PubMed  Google Scholar 

  3. Suska F et al (2016) Electron beam melting manufacturing technology for individually manufactured jaw prosthesis: a case report. J Oral Maxillofac Surg 74(8):1706.e1-1706.e15. https://doi.org/10.1016/j.joms.2016.03.046

    Article  PubMed  Google Scholar 

  4. Goodson AMC, Kittur MA, Evans PL, Mark Williams E (2019) Patient-specific, printed titanium implants for reconstruction of mandibular continuity defects: a systematic review of the evidence. J Cranio Maxillofac Surg 47(6):968–976. https://doi.org/10.1016/j.jcms.2019.02.010

    Article  Google Scholar 

  5. Bak M, Jacobson AS, Buchbinder D, Urken ML (2010) Contemporary reconstruction of the mandible. Oral Oncol 46(2):71–76. https://doi.org/10.1016/j.oraloncology.2009.11.006

    Article  PubMed  Google Scholar 

  6. Okura M, Isomura ET, Iida S, Kogo M (2005) Long-term outcome and factors influencing bridging plates for mandibular reconstruction. Oral Oncol 41(8):791–798. https://doi.org/10.1016/j.oraloncology.2005.03.006

    Article  PubMed  Google Scholar 

  7. Ritschl LM et al (2021) Retrospective analysis of complications in 190 mandibular resections and simultaneous reconstructions with free fibula flap, iliac crest flap or reconstruction plate: a comparative single centre study. Clin Oral Investig 25(5):2905–2914. https://doi.org/10.1007/s00784-020-03607-8

    Article  PubMed  Google Scholar 

  8. Mariani PB, Kowalski LP, Magrin J (2006) Reconstruction of large defects postmandibulectomy for oral cancer using plates and myocutaneous flaps: a long-term follow-up. Int J Oral Maxillofac Surg 35(5):427–432. https://doi.org/10.1016/j.ijom.2005.10.008

    Article  CAS  PubMed  Google Scholar 

  9. Gallegos-Hernández JF, Martínez-Miramón A, Reyes-Vivanco A (2019) Seguimiento a largo plazo del colgajo libre de peroné en la reconstrucción mandibular. Cirugía y Cirujanos. https://doi.org/10.24875/CIRU.18000407

    Article  PubMed  Google Scholar 

  10. Cordeiro PG, Disa JJ, Hidalgo DA, Hu QY (1999) Reconstruction of the mandible with osseous free flaps: a 10-year experience with 150 consecutive patients. Plast Reconstr Surg 104(5):1314–20

    Article  CAS  PubMed  Google Scholar 

  11. Bowe C, Butler D, Dhanda J, Gulati A, Norris P, Bisase B (2021) Lateral segmental mandibulectomy reconstruction with bridging reconstruction plate and anterolateral thigh free flap: a case series of 30 consecutive patients. Br J Oral Maxillofac Surg 59(1):91–96. https://doi.org/10.1016/j.bjoms.2020.08.054

    Article  CAS  PubMed  Google Scholar 

  12. van Gemert JTM, Abbink JH, van Es RJJ, Rosenberg AJWP, Koole R, van Cann EM (2018) Early and late complications in the reconstructed mandible with free fibula flaps. J Surg Oncol 117(4):773–780. https://doi.org/10.1002/jso.24976

    Article  PubMed  PubMed Central  Google Scholar 

  13. Markiewicz MR et al (2015) Survival of microvascular free flaps in mandibular reconstruction: a systematic review and meta-analysis. Microsurgery 35(7):576–587. https://doi.org/10.1002/micr.22471

    Article  PubMed  Google Scholar 

  14. Hidalgo DA, Pusic AL (2002) Free-flap mandibular reconstruction: a 10-year follow-up study. Plast Reconstr Surg 110(2):438–449. https://doi.org/10.1097/00006534-200208000-00010

    Article  PubMed  Google Scholar 

  15. Athota SS, Gadipelly S, Batchu PK, Vuyyuru VD (2018) Titanium reconstruction plate exposure following mandibular reconstruction in malignancy—a case report and review of literature. Indian J Dental Adv. https://doi.org/10.5866/2018.10.10126

    Article  Google Scholar 

  16. Qin M et al (2015) Design and optimization of the fixing plate for customized mandible implants. J Cranio Maxillofac Surg 43(7):1296–1302. https://doi.org/10.1016/j.jcms.2015.06.003

    Article  Google Scholar 

  17. Narra N et al (2014) Finite element analysis of customized reconstruction plates for mandibular continuity defect therapy. J Biomech 47(1):264–268. https://doi.org/10.1016/j.jbiomech.2013.11.016

    Article  PubMed  Google Scholar 

  18. Huo J, Dérand P, Rännar LE, Hirsch JM, Gamstedt EK (2015) Failure location prediction by finite element analysis for an additive manufactured mandible implant. Med Eng Phys 37(9):862–869. https://doi.org/10.1016/j.medengphy.2015.06.001

    Article  PubMed  Google Scholar 

  19. Jewer DD, Brian Boyd J, Manktelow RT, Zuker RM, Rosen IB, Gullane PJ, Rotstein LE, Freeman J (1989) Orofacial and mandibular reconstruction with the iliac crest free flap: a review of 60 cases and a new method of classification. Plast Reconstr Surg 84(3):391–403. https://doi.org/10.1097/00006534-198909000-00001

    Article  CAS  PubMed  Google Scholar 

  20. Yi Z et al (1999) Reconstruction plates to bridge mandibular defects: a clinical and experimental investigation in biomechanical aspects. Int or Oral Maxillofac Surg 28:445–450

    Article  CAS  PubMed  Google Scholar 

  21. Marx RE, Cillo JE, Broumand V, Ulloa JJ (2008) Outcome analysis of mandibular condylar replacements in tumor and trauma reconstruction: a prospective analysis of 131 cases with long-term follow-up. J Oral Maxillofac Surg 66(12):2515–2523. https://doi.org/10.1016/j.joms.2007.12.005

    Article  PubMed  Google Scholar 

  22. Westermark A, Koppel D, Leiggener C (2006) Condylar replacement alone is not sufficient for prosthetic reconstruction of the temporomandibular joint. Int J Oral Maxillofac Surg 35(6):488–492. https://doi.org/10.1016/j.ijom.2006.01.022

    Article  CAS  PubMed  Google Scholar 

  23. Lin T-S, Chiu T-F, Hsu J-T, Chen C-C, Chang L-R, Huang H-L (2022) Biomechanical evaluation and factorial analysis of the 3-dimensional printing self-designed metallic reconstruction plate for mandibular segmental defect. J Oral Maxillofac Surg 80(4):775–783. https://doi.org/10.1016/j.joms.2021.11.022

    Article  PubMed  Google Scholar 

  24. Bedogni A, Bettini G, Ferronato G, Fusetti S, Saia G (2014) Replacement of fractured reconstruction plate with customized mandible implant: a novel technique. Laryngoscope 124(2):401–404. https://doi.org/10.1002/lary.24230

    Article  PubMed  Google Scholar 

  25. Fernandes N, van den Heever J, Hoek K, Booysen G (2016) Customized reconstruction of an extensive mandibular defect: a clinical report. J Prosthet Dent 116(6):928–931. https://doi.org/10.1016/j.prosdent.2016.04.012

    Article  PubMed  Google Scholar 

  26. Rachmiel A, Shilo D, Blanc O, Emodi O (2017) Reconstruction of complex mandibular defects using integrated dental custom-made titanium implants. Br J Oral Maxillofac Surg 55(4):425–427. https://doi.org/10.1016/j.bjoms.2017.01.006

    Article  CAS  PubMed  Google Scholar 

  27. Qassemyar Q, Assouly N, Temam S, Kolb F (2017) Use of a three-dimensional custom-made porous titanium prosthesis for mandibular body reconstruction. Int J Oral Maxillofac Surg 46(10):1248–1251. https://doi.org/10.1016/j.ijom.2017.06.001

    Article  CAS  PubMed  Google Scholar 

  28. Tarsitano A, Battaglia S, Sandi A, Marchetti C (2017) Design of a customised bridging mandibular prosthesis for complex reconstruction: a pilot study. Acta Otorhinolaryngol Ital 37(3):195–200. https://doi.org/10.14639/0392-100X-1250

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Vignesh U, Mehrotra D, Howlader D, Singh PK, Gupta S (2019) Patient specific three-dimensional implant for reconstruction of complex mandibular defect. J Craniofac Surg 30(4):E308–E311. https://doi.org/10.1097/SCS.0000000000005228

    Article  Google Scholar 

  30. Öhman D, Schaefer C, Nannmark U, Kjeller G, Malmström J (2019) Mandible reconstruction with patient-specific implants: case report of five consecutive patients. Int J Oral Maxillofac Implants 34(1):e7–e11. https://doi.org/10.11607/jomi.6913

    Article  PubMed  Google Scholar 

  31. Jehn P et al (2020) Patient-specific implant modification for alloplastic bridging of mandibular segmental defects in head and neck surgery. J Cranio Maxillofac Surg 48(3):315–322. https://doi.org/10.1016/j.jcms.2020.01.018

    Article  Google Scholar 

  32. Murlidhar Patil S, Bhola N, Ghavat C, Agarwal A (2021) Reconstruction of surgical defect in mandible using patient specific implant - a case report. Acta Sci Dent Sci 5(7):57–61. https://actascientific.com/ASDS/pdf/ASDS-05-1147.pdf

    Article  Google Scholar 

  33. Lim HK, Choi YJ, Choi WC, Song IS, Lee UL (2022) Reconstruction of maxillofacial bone defects using patient-specific long-lasting titanium implants. Sci Rep 12:7538. https://doi.org/10.1038/s41598-022-11200-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

Figure 4 courtesy Dr Abhay Kamath

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Authors and Affiliations

  1. Department of Cleft and Craniomaxillofacial Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, 41, India

    Pramod Subash, Shibani A. Nerurkar, Arjun Krishnadas & Vinanthi Vinay

  2. Department of Head and Neck Surgery, Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, 41, India

    Subramania Iyer

  3. Department of Prosthodontics and Implantology, Amrita Institute of Medical Sciences, Kochi, Kerala, 41, India

    V. Manju

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  1. Pramod Subash
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Subash, P., Nerurkar, S.A., Krishnadas, A. et al. Patient Specific Alloplastic Implant Reconstruction of Mandibular Defects–Safe Practice Recommendations and Guidelines. J. Maxillofac. Oral Surg. 22 (Suppl 1), 28–36 (2023). https://doi.org/10.1007/s12663-023-01881-z

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