Accuracy of secondary maxillofacial reconstruction with prefabricated fibula grafts using 3D planning and guided reconstruction. Issue 4 (April 2016)

• Record Type: Journal Article
• Authors: Schepers, Rutger H.; Kraeima, Joep; Vissink, Arjan; Lahoda, Lars U.; Roodenburg, Jan L.N.; Reintsema, Harry; Raghoebar, Gerry M.; Witjes, Max J.
• Is Part Of: Journal of cranio-maxillofacial surgery. Volume 44:Issue 4(2016)
• Page Start: 392
• Page End: 399
• Publication Date: 2016-04
• Subjects: 3D -- Mandible -- Maxilla -- Reconstruction -- Fibula -- Implants; Skull -- Surgery -- Periodicals; Maxilla -- Surgery -- Periodicals; Face -- Surgery -- Periodicals; Surgery, Plastic -- Periodicals; Maxilla -- surgery -- Periodicals; Face -- surgery -- Periodicals; Skull -- surgery -- Periodicals; Oral Surgical Procedures -- Periodicals; Reconstructive Surgical Procedures -- Periodicals; Surgery, Plastic -- Periodicals; Surgery, Oral -- Periodicals; Electronic journals; 617.514
• DOI: 10.1016/j.jcms.2015.12.008
• Languages: English
• ISSNs: 1010-5182

Abstract

Abstract: Background: We compared the pre-operative 3D-surgical plan with the surgical outcome of complex two-stage secondary reconstruction of maxillofacial defects using inserted implants in the prefabricated fibula graft. Methods: Eleven reconstructions of maxillofacial defects with prefabricated fibulas were performed using a 3D virtual planning. Accuracy of placement of the fibula grafts and dental implants was compared to pre-operative 3D virtual plans by superimposing pre-operative and post-operative CT-scans: we first superimposed the CT-scans on the antagonist jaw, to represent the outcome of occlusion, and then superimposed on the planned fibula segments. Results: Superimposing the CT scans on the antagonist jaws revealed a median deviation of the fibula segments and implants of 4.7 mm (IQR:3–6.5 mm) and 5.5 mm (IQR:2.8–7 mm) from the planned position, respectively. Superimposing of the CT scans on the fibula segments revealed a median difference of fibula and implant placement of 0.3 mm (IQR:0–1.6 mm) and 2.2 mm (IQR:1.5–2.9 mm), respectively. Conclusions: The final position of the fibula graft is determined by the occlusion of the denture, which is designed from the 3D plan. From a prosthodontic perspective, the accuracy of 3D-surgical planning of reconstruction of maxillofacial defects with a fibula graft and the implants allows for a favorable functional position of the implants and fibula graft.