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Updated: Aug 29, 2025
3D Planning and Printing of Patient Specific Implants for Reconstruction of Bony Defects
Published on: August 4, 2020
Outcomes of mandibular reconstruction using three-dimensional custom-made porous titanium prostheses
Fabienne Haroun1, Nadia Benmoussa2, François Bidault3
1Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris Saclay, 114 Rue Edouard Vaillant, Villejuif 94800, France; BioMaps (UMR1281), University Paris Saclay, CNRS, INSERM, CEA, Orsay, France.
Background:
Our aim was to report the long-term outcomes of mandibular reconstruction using CAD-CAM-designed 3D-printed porous titanium implants in patients not amenable to a free vascularized fibula flap reconstruction.
Methods:
The implants were designed with ProPlan CMF® 2.2 software and manufactured with a Selective Laser Melting (SLM) "layer-by-layer" 3D-printing of pure porous titanium powder beds. Primary endpoints were implant exposure and implant removal calculated using Gray's tests. Secondary endpoints were predictive factors of implant exposure and implant removal, and rates of dental rehabilitation.
Results:
Thirty-six patients were operated between 2015 and 2017 and were included in this study. Reconstruction using a porous titanium 3D-printed implant was proposed due to medical contraindication for a fibula free flap (n = 13), due to the failure of a previous fibula free flap reconstruction (n = 7), or due to refusal of a fibula free flap reconstruction by the patient (n = 16). The medical indications for mandibular reconstruction were a primary tumor requiring mandibulectomy in nine patients, mandibular osteoradionecrosis requiring mandibulectomy in nineteen patients, and secondary reconstruction in eight patients. The 2-year rates of implant exposure and implant removal were 69.4% and 52.8%. Reconstruction of the symphysis was a high-risk exposure variable (OR 30; p = 0.0003). Only one patient underwent a successful dental rehabilitation.
Conclusion:
The use of a porous titanium 3D- implant for mandibular reconstruction in head and neck cancer patients resulted in high rates of implant exposure and of implant removal, notably when symphysis involvement.
