Computer-aided Design and Computer-aided Manufacturing Guided Surgical Management of Alveolar Verrucous Growths: An...

Alveolar verrucous growths present diagnostic and therapeutic challenges due to variable histopathology and diverse risk factors, including tobacco use. Precision in surgical margins is critical to optimize treatment outcomes and reduce recurrence. This study was done to assess the diagnostic accuracy and clinical efficacy of computer-aided design and computer-aided manufacturing (CAD-CAM) guided surgical excision in managing alveolar verrucous lesions, and to analyze the impact of lesion size, tobacco use, systemic conditions, and biopsy type on recurrence and healing.

A prospective interdisciplinary study involving young to middle-aged adults with verrucous alveolar lesions was conducted on 46 participants. Clinical diagnoses were correlated with histopathological findings. CAD-CAM guided excisions with margins ranging from 1 to 3 mm were employed. Data on lesion size, tobacco habits, systemic comorbidities, biopsy type, recurrence, and delayed healing were analyzed.

Histopathological concordance ranged from 66.6% to 100%, highest in verrucous carcinoma (VC) cases. Tumor-free margins improved with wider CAD-CAM guided excision: 73% at 1 mm, 91% at 2 mm, and 100% at 3 mm. Tobacco chewing significantly increased the odds of verrucous hyperplasia (odds ratio [OR] 4.1), and lesions >4 cm correlated with higher VC risk (OR 5.3). Excisional biopsies with margins ≥2 mm markedly reduced recurrence and delayed healing, even in patients with diabetes and hypertension.

CAD-CAM guided margin planning enhances surgical precision and oncologic safety in alveolar verrucous lesions. Integration of lesion characteristics, tobacco exposure, and systemic health factors informs individualized treatment, minimizing recurrence, and promoting optimal healing.