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Computer-guided Versus Conventional Modified Cortical Shell Technique for the Rehabilitation of Posterior Mandibular

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    Computer-guided bone grafting offers superior horizontal bone gain compared to free-hand techniques in mandibular reconstruction. Both methods show similar neurosensory recovery, highlighting the precision of guided workflows.

    Keywords:
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    Area of Science:

    • Oral and Maxillofacial Surgery
    • Biomaterials Engineering
    • Digital Dentistry

    Background:

    • The cortical shell technique is crucial for mandibular reconstruction but lacks precise anatomical guidance.
    • Free-hand harvesting and grafting present challenges in accuracy and predictability.

    Purpose of the Study:

    • To compare horizontal bone gain and neurosensory function between modified free-hand and computer-guided cortical shell grafts.
    • To assess the accuracy of a computer-guided workflow for mandibular bone augmentation.

    Main Methods:

    • Eighteen patients with atrophic mandibles were divided into free-hand (control) and computer-guided (test) groups.
    • The guided group utilized cutting and positional guides for graft harvest and fixation.
    • Radiographic horizontal bone gain and neurosensory function were evaluated post-operatively.

    Main Results:

    • The computer-guided group achieved a statistically significant greater mean horizontal bone gain (4.93 mm) compared to the free-hand group (4.46 mm).
    • Neurosensory function recovery was similar and favorable in both groups (S4 grade after two months).
    • Superimposed scans confirmed high accuracy of the guided workflow, with minimal deviation from the surgical plan.

    Conclusions:

    • Computer-guided workflow enhances precision in cortical shell graft harvest, positioning, and fixation.
    • This digital approach leads to superior horizontal bone gain compared to the free-hand technique.
    • The guided method provides predictable outcomes with comparable neurosensory results to free-hand procedures.