Comparison between patient-specific implants and hand-bent plates in mandibular reconstruction

Area of Science:

• Oral and Maxillofacial Surgery
• Biomaterials Engineering
• Orthognathic Surgery

Background:

• Alloplastic reconstruction is crucial after segmental mandibular resection (SMR), but hardware-associated complications (HRC), especially fractures, are common.
• Advances in manufacturing, such as patient-specific implants (PSI), aim to improve fracture resistance compared to traditional hand-bent reconstruction plates (RP).
• Clinical evidence is lacking on whether newer manufacturing techniques reduce HRC in real-world settings.

Purpose of the Study:

• To compare the incidence of hardware-related complications (HRC) between patient-specific implants (PSI) and traditional reconstruction plates (RP) following SMR.
• To evaluate if PSI offers advantages beyond fracture resistance and impacts surgical timing.

Main Methods:

• A retrospective cohort study of 210 patients undergoing SMR and alloplastic reconstruction between 2007 and 2019.
• Patients received either hand-bent reconstruction plates (RP, n=113) or patient-specific implants (PSI, n=97).
• Indications for SMR included tumor (n=208) and osteoradionecrosis (n=2).

Main Results:

• Overall HRC occurred in 34.29% of patients, with no significant difference between PSI and RP groups.
• Implant exposure was observed in 22.38% and fractures in 8.57% of cases, with similar rates for both implant types.
• The use of PSI did not delay the time from diagnosis to resection and reconstruction.

Conclusions:

• The manufacturing method of alloplastic materials does not influence the rate of hardware-related complications.
• Patient-specific implants provide benefits beyond enhanced fracture resistance and do not prolong surgical procedures.
• HRC remain a significant challenge impacting patient quality of life, necessitating further research into contributing factors.