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Multicenter study on the use of patient-specific CAD/CAM reconstruction plates for mandibular reconstruction

  • Frank Wilde
  • Henning Hanken
  • Florian Probst
  • Alexander Schramm
  • Max Heiland
  • Carl-Peter Cornelius
Original Article

Abstract

Purpose

 For the new generation of mandibular reconstruction, patient-specific mandible reconstruction plates (PSMPs) have been developed which are milled from titanium after preoperative computer planning using CAD/CAM procedures. Resection margins and plate position are determined by surgical guides. In addition, length and shape of the plate and the number and angulation of the screw holes can be planned.

Methods

 30 patients received such PSMP. Indication ranged from stabilization osteosynthesis, single alloplastic stand-alone reconstruction to microvascular reconstructions. Time for planning, fit of surgical guides and plates, pre-/postoperative occlusion, radiological position of the temporo mandibular joint and complications were recorded.

Results

 The median time for online planning was 35 min. The results concerning fit and handling of the PSMP and the surgical guides were mainly very positive. In six cases, the plan had to be adapted to the intraoperative clinical needs. The postoperative position of the condyles in the temporo mandibular fossae was regular in 28 cases. The evaluation of the occlusion was not representative due to not clearly identifiable occlusion in 2/3 of the cases. Nevertheless, complications like postoperative extraoral plate exposure, infection, graft and flap necrosis or difficulties to position the guides or the plate during surgery occurred.

Conclusions

 Mandibular reconstruction with PSMP offers a broad range of opportunities and benefits compared with standard procedures and can be recommended for all kind of mandibular reconstructions. It is not yet foreseeable whether PSMP will in future become routine clinical practice for mandibular reconstruction or will be confined to selected isolated cases.

Keywords

Mandibular reconstruction Computer-assisted surgery  Patient-specific mandible reconstruction plates Patient-specific implants Surgical guides CAD/CAM 

Notes

Conflict of interest

The authors H.H. and F.P. declare that they have no conflict of interest. Authors F.W. and C.-P.C. were involved in the development process of the presented PSMPs. Authors A.S. and M.H. did honoraria speaking for DePuy/Synthes\(^{\textregistered }\) at symposia.

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Copyright information

© CARS 2015

Authors and Affiliations

  • Frank Wilde
    • 1
  • Henning Hanken
    • 2
  • Florian Probst
    • 3
  • Alexander Schramm
    • 1
  • Max Heiland
    • 2
  • Carl-Peter Cornelius
    • 3
  1. 1.Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, Military Hospital UlmAcademic Hospital of the University of UlmUlmGermany
  2. 2.Department of Oral and Maxillofacial SurgeryUniversity Medical Center Hamburg-EppendorfHamburgGermany
  3. 3.Department of Oral and Maxillofacial SurgeryLudwig Maximilians University Hospital of MunichMunichGermany

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