Patient-Specific Mandibular Reconstruction Plates Increase Accuracy and Long-Term Stability in Immediate Alloplastic Rec
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ORIGINAL ARTICLE
Patient-Specific Mandibular Reconstruction Plates Increase Accuracy and Long-Term Stability in Immediate Alloplastic Reconstruction of Segmental Mandibular Defects A. N. Zeller1 • M. T. Neuhaus1 • L. V. M. Weissbach1 • M. Rana2 A. Dhawan3 • F. M. Eckstein1 • N. C. Gellrich1 • R. M. Zimmerer1
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Received: 7 November 2019 / Accepted: 18 December 2019 Ó The Association of Oral and Maxillofacial Surgeons of India 2020
Abstract Objectives The aim of the current study was to evaluate potential differences in the accuracy of mandibular reconstruction and long-term stability, with respect to different reconstructive procedures. Methods In total, 42 patients who had undergone primary segmental mandibular resection with immediate alloplastic reconstruction, with either manually pre-bent or patientspecific mandibular reconstruction plates (PSMRP), were included in this study. Mandibular dimensions, in terms of six clinically relevant distances (capitulum [most lateral points], capitulum [most medial points], incisura [most caudal points], mandibular foramina, coronoid process [most cranial points], dorsal tip of the mandible closest to the gonion point) determined from tomographic images, were compared prior to, and after surgery. Results Dimensional alterations were significantly more often found when conventionally bent titanium reconstruction plates were used. These occurred in the area of the coronoid process (p = 0.014). Plate fractures were significantly (p = 0.022) more often found within the manually pre-bent group than within the PSMRP group (17%/0%).
A. N. Zeller and M. T. Neuhaus have contributed equally to this work. & A. N. Zeller [email protected] 1
Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
2
Department of Oral and Maxillofacial Surgery, University Hospital Duesseldorf, Du¨sseldorf, Germany
3
Sri Guru Ram Das Institute of Dental Sciences and Research, Amritsar, India
Conclusion The results suggest that the use of PSMRP may prevent rotation of the proximal mandibular segment, thus avoiding functional impairment. In addition, the use of PSMRP may potentially enhance the long-term stability of alloplastic reconstructions. Keywords Ablative surgery Alloplastic reconstruction CAD/CAM Mandibular reconstruction Fracture Osteosynthesis
Introduction Alloplastic reconstruction of the mandible remains as one of the most challenging procedures in craniomaxillofacial surgery. After ablative surgery, the aim of the reconstructive procedure is long-term stability and full oral rehabilitation, as well as the preservation of the facial esthetics of the patient [1–3]. Complex interactions between bony dimensions, joint function, and muscular interactions make accurate reconstruction necessary. In analogy to the aims of orthognathic surgery, some authors have suggested that it is essential to achieve a centric condyle position [4], even though there is no uniform definition of this term, nor sufficient data to support its use. Furthe
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