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Patient-specific Implants for Treating Atrophic Mandibles.

Dekel Shilo1,2, Tal Capucha1, Ori Blanc1

  • 1Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel.

Plastic and Reconstructive Surgery. Global Open
|June 10, 2022
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Summary

This study presents a novel single-stage method for reconstructing severely atrophic mandibles using patient-specific crib-shaped implants and bone grafts. This technique successfully restored mandibular bone, enabling dental implant placement and preventing fractures.

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Area of Science:

  • Oral and Maxillofacial Surgery
  • Craniofacial Reconstruction
  • Biomaterials Engineering

Background:

  • Extremely atrophic mandibles pose significant treatment challenges, often leading to complications like spontaneous fractures.
  • Current treatment options for severe mandibular atrophy are limited and associated with high failure rates.
  • Removable dentures are a common but often unsatisfactory solution for patients with extreme mandibular atrophy.

Purpose of the Study:

  • To introduce a novel single-stage surgical technique for mandibular reconstruction in cases of extreme atrophy.
  • To evaluate the efficacy of patient-specific crib-shaped implants (PSI) combined with autogenous bone grafts for vertical and horizontal mandibular augmentation.
  • To achieve sufficient bone volume for stable dental implant rehabilitation and prevent further pathological fractures.

Main Methods:

  • Utilized three-dimensional (3D) segmentation and virtual planning software for PSI design.
  • Designed PSI with a mesh-like structure and large holes to facilitate blood supply and bone integration.
  • Performed single-stage surgery involving PSI placement, iliac-crest bone grafting (onlay), and mandibular fragment repositioning guided by PSI.

Main Results:

  • Achieved perfect PSI fit and stable fixation, promoting optimal incorporation of the autogenous bone graft.
  • Successfully restored bony continuity, leading to enhanced mandibular stability and cessation of spontaneous fractures.
  • Enabled effortless placement of dental implants in the regenerated bone six months post-surgery, with no need for further augmentation.

Conclusions:

  • The described single-stage method using PSI and autogenous bone grafts is a promising approach for treating extremely atrophic mandibles.
  • This technique provides a stable and adequate bone base for dental rehabilitation, addressing a significant challenge in craniofacial reconstruction.
  • The PSI acts as a crucial element for rigid fixation and accurate positioning, improving outcomes in complex mandibular reconstructions.