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Efficacy of personalized 3D-printed osteotomy guide in maximizing fibular utilization and minimizing graft length for reconstruction of large mandibular defect

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Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objective

The study addresses the long-standing challenge of insufficient length in vascularized fibular flaps when reconstructing large mandibular defects that require dual-barrel grafts. Employing personalized 3D-printed osteotomy guides, the study aims to optimize fibular utilization and minimize the required graft length.

Material and methods

Two reconstruction methods for distal bone defects were compared: a fold-down (FD) group that employed a specialized osteotomy guide for folding down a triangular bone segment, and a traditional double-barrel (DB) group. Metrics for comparison included defect and graft lengths, as well as the graft-to-defect length ratio. Postoperative quality of life was assessed using the University of Washington Quality of Life questionnaire (UW-QoL).

Result

Both FD and DB groups achieved successful mandibular reconstruction. Despite larger defects in the FD group (117 ± 31.35 mm vs 84 ± 35.34 mm, p = 0.028), the used fibula length was not statistically longer in the FD group. The median ratio of graft-to-defect length was also lower in the FD group (1.327 vs 1.629, p = 0.024), suggesting that FD required only 82.47% of the graft length needed in the DB approach. Quality of life scores post-surgery were comparable between the groups.

Conclusion

Personalized 3D-printed osteotomy guides enhance fibula graft efficacy for reconstructing larger mandibular defects, necessitating shorter graft lengths while preserving postoperative quality of life.

Clinical relevance

This study confirms the utility of 3D printing technology as an effective and precise tool in orthopedic surgery, particularly for complex reconstructions like large mandibular defects. It suggests a viable alternative that could potentially revolutionize current practices in bone grafting.

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Funding

This study was supported by grants from the Health Commission of Hubei Province scientific research project (No. WJ2021M179 to Tianfu Wu and No. WJ2021M175 to Bing Liu and No. WJ2023M122 to Lin Dai) and Translational Medicine and Interdisciplinary Research Joint Fund of Zhongnan Hospital of Wuhan University (ZNJC202242) to Bo Cheng.

Author information

Authors and Affiliations

  1. State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, People’s Republic of China

    Lei Jiang, Hao Lin, Zhe Shao, Bing Liu & Tianfu Wu

  2. Department of Stomatology, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China

    Lei Jiang & Bo Cheng

  3. Department of Oral and Maxillofacial-Head and Neck Oncology, School and Hospital of Stomatology, Wuhan University, Wuhan, People’s Republic of China

    Zhe Shao, Bing Liu & Tianfu Wu

  4. Hubei Joye 3D High-Tech Co., Ltd, Wuhan, People’s Republic of China

    Zhixiang Ge

  5. Department of Stomatology, Wuhan No.1 Hospital, Wuhan, People’s Republic of China

    Lin Dai

Authors
  1. Lei Jiang
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  2. Hao Lin
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  3. Zhe Shao
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  4. Bing Liu
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  5. Zhixiang Ge
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  6. Lin Dai
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  7. Bo Cheng
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  8. Tianfu Wu
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Contributions

Lei Jiang and Hao Lin drafted the manuscript and data analysis. Zhixiang Ge, Zhe Shao prepared the guide and 3D-printed osteotomy guides.  Dai Lin, Tianfu Wu, Bo Cheng and Bing Liu performed all the surgeries and provided constructive suggestions to the manuscipt.

Corresponding authors

Correspondence to Bo Cheng or Tianfu Wu.

Ethics declarations

Ethics approval and consent to participate

This study was approved by the Regional Ethical Review Board of the School & Hospital of Stomatology of Wuhan University and followed the Declaration of Helsinki [2018]/B(29). Written informed consent was obtained from all patients before surgery.

Competing interests

The authors declare no competing interests.

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Lei Jiang and Hao Lin contribute equally to this work.

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Jiang, L., Lin, H., Shao, Z. et al. Efficacy of personalized 3D-printed osteotomy guide in maximizing fibular utilization and minimizing graft length for reconstruction of large mandibular defect. Clin Oral Invest 28, 125 (2024). https://doi.org/10.1007/s00784-024-05519-3

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  • DOI: https://doi.org/10.1007/s00784-024-05519-3

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