Publication

Abstract :

Background: Even though microvascular surgery has become standard of care for jaw reconstruction, fixation of bone flap in a three dimensionally accurate position to receive dental implants is a difficult proposition. <Objective: To assess and analyse the effectiveness of inverse planning method in an ideal positioning of bone flap for future dental rehabilitation.

Methods: 14 patients who underwent maxillary or mandibular reconstructions following resection of benign pathology between July 2014 and September 2016 were included in study (maxilla, n = 6; mandible n = 8). Choice of reconstruction in all cases was microvascular fibula osteocutaneous flap. Stereolithographic (STL) models of jaws and fibula (wherever indicated) were produced from computed tomography scans. Model surgery was performed to determine most ideal position of fibula. Cutting guides and splints were fabricated, reconstruction and plate was precontoured to ensure accurate translation of planning to the operating table. Maxillary and mandibular reconstruction was performed with guidance of preoperative inverse planning and using fibular osteotomy and reposition guide templates to replicate the inverse planning intraoperatively. Findings: Though the technique involves meticulous lab work, it was effective in reducing operative time required for fibula osteotomy and fixation. Postoperative radiological examination showed excellent positioning of bone that facilitated easier and more accurate placement of dental implants. The prosthetic rehabilitation procedures were significantly simplified and showed better load sharing by implants.

Conclusion: Rapid prototyping technology and inverse planning technique significantly improves functional and rehabilitative outcome in maxillary and mandibular reconstruction with free fibula flaps, followed by dental implants.