Related Experiment Video
Updated: May 13, 2026
Designing CAD/CAM Surgical Guides for Maxillary Reconstruction Using an In-house Approach
Published on: August 24, 2018
In-House In-and-Out Technique for Mandibular Reconstruction Analysis: A 3D Comparison with CAD-CAM Designs for Fibula
Javier Asensio-Salazar1, Alejandro Alarcón Granero1, Alvaro Rivero Calle1
1From the Department of Oral and Maxillofacial Surgery, Hospital Universitario 12 de Octubre.
Background:
Mandibular reconstruction after segmental mandibulectomy presents significant functional and aesthetic challenges. Virtual surgical planning and 3-dimensional printing improve surgical precision but are costly and time-consuming. In-house protocols have emerged as alternatives to reduce costs and accelerate workflows. The in-and-out technique is an innovative in-house method that uses a 3-dimensional printed biomodel to transfer reconstruction plate positioning to cutting guides.
Methods:
This retrospective cohort study compared mandibular reconstruction accuracy using the in-and-out technique versus a computer-aided design and manufacturing protocol of the reconstruction plate. Fourteen patients underwent fibula flap mandibular reconstruction between May of 2022 and February of 2024. There were 7 patients in each group. Postoperative computed tomography scans were compared with preoperative stereolithographic models to evaluate volumetric accuracy using CloudCompare. Intercondylar and intergonial distances were assessed with MeshLab. Nonparametric tests were used for superiority and noninferiority studies.
Results:
Median stereolithographic deviation was 0.21 mm (interquartile range [IQR], 0.15 to 0.26 mm) for the in-and-out group and 0.18 mm (IQR, 0.17 to 0.21 mm) for the control group. The median intercondylar deviation was 2.11 mm (IQR, 1.26 to 2.32 mm) for the in-and-out group versus 1.89 mm (IQR, 0.92 to 3.41 mm) in the control group. Median intergonial deviation was 1.86 mm (IQR, 1.38 to 2.41 mm) for the in-and-out group versus 1.95 mm (IQR, 1.14 to 2.93 mm) for the control group. With the in-and-out technique, costs were reduced by more than 75%, and workaround time was reduced from 2 weeks to 2 days. Time from biopsy to surgery time was reduced in 8 days.
Conclusions:
The in-and-out technique may be a viable alternative to outsourced computer-aided design and manufacturing workflows for mandibular reconstruction at a fraction of the cost, especially for simpler cases and those requiring a shorter workaround time.
