Industrial Plasticine-Assisted Physical-Model Reconstruction Versus Virtual Surgical Planning for Comminuted Le Fort...

Reconstruction of comminuted Le Fort I fractures is difficult when the tooth-bearing maxilla is divided into multiple fragments and stable skeletal landmarks are limited. The authors describe a hybrid physical-digital planning strategy that uses industrial plasticine as a reversible provisional stabilizer during assembly of 3-dimensionally printed fracture fragments. The dentate fragments are first oriented according to dental arch form, intercuspation, fracture-line morphology, and residual stable anatomy. Small amounts of plasticine are then applied only to the printed models, permitting repeated translation and rotation until the occlusal and skeletal relationships are satisfactory. The reconstructed dentition is digitized to design an occlusal splint that transfers the plan to surgery. The material never contacts the patient, sterile instruments, or the intraoperative splint. In an initial series of 15 patients, the method was feasible for preoperative planning; no infection or nonunion was recorded, although 2 patients had residual occlusal disorder at 6 months. This strategy provides tactile, reversible 3-dimensional planning without claiming the precision of a fully guided, patient-specific reconstruction.