Virtual Reality Planning for Mandible Reconstruction: A Case Report

Mandibular reconstruction with a free fibula flap is considered the gold standard for implant-based prosthodontic rehabilitation. Doing so with presurgical virtual planning has become commonplace, resulting in procedure-specific osteotomy guides and fixation plates, but is limited by a cumbersome user experience. A new virtual reality (VR)-based mandible reconstruction application, ImmersiveRecon, could address these shortcomings. This case report discusses a free fibula-based mandible reconstruction and osseointegrated dental implant placement surgery planned in VR. A 17-year-old man with a history of left hemimandibulectomy for ameloblastoma and prior failed free fibula reconstruction presented for surgical evaluation. The patient's preoperative computed tomography scans were imported into ImmersiveRecon, where planning was completed by the surgeon. Procedure-specific osteotomy guides, position templates, and splints were three-dimensionally printed for use during surgery. The VR planning method was analyzed by comparing preoperative, planned, and postoperative computed tomography scan measurements. VR planning was completed directly by the surgeon without engineer assistance, with a total planning time of 5 minutes. The surgery was completed without difficulty. The patient demonstrated excellent functional and aesthetic outcomes without complications, and prosthodontic rehabilitation was completed with the provision of a final implant-retained prosthesis. Comparison of measurements from the three-dimensionally planned models and postoperative models showed high fidelity and met the standards of the surgeon. VR surgical planning is feasible and provides several advantages over traditional surgical planning approaches, such as improved scan visualization, simplified user interface, and shorter planning sessions.