Accuracy of fibula reconstruction using patient-specific CAD/CAM reconstruction plates and dental implants: A new modality for functional reconstruction of mandibular defects

Background: The purpose of this study was to analyze the accuracy of mandibular reconstruction using patient-specific computer-aided designed and computer-aided manufactured (CAD/CAM) reconstruction plates as a guide to place fibula grafts and dental implants in a one-stage procedure using pre-operative 3D virtual planning. Methods: Seven consecutive patients were analyzed retrospectively, the 3D accuracy of placement of the fibula grafts and dental implants was compared to the virtual plan. Results: Six out of seven flaps survived for an average follow-up time of 9.4 months. The outcome was compared to the virtual plan, superimposed on the mandible. For the fibula segments, the mean deviation (SD) was 3.0 (1.8) min and the mean angulation (SD) was 4.2 degrees (3.2 degrees). For the implants, the mean deviation (SD) was 3.3 (13) mm and the mean angulation (SD) was 13.0 degrees (6.7 degrees). The mean (SD) mandibular resection plane deviation was 1.8 (0.9) mm. Conclusions: A patient-specific reconstruction plate is a valuable tool in the reconstruction of mandibular defects with fibula grafts and dental implants. Implant angulation showed a greater deviation from the virtual plans in patients with a sharp ventral fibula rim, where the guide is removed after pilot drilling of the implants. (C) 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.