Analysis of the osseous restorative space after mandibular reconstruction with a bone-driven structural method using the fibula
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A Postoperative Evaluation Guideline for Computer-Assisted Reconstruction of the Mandible
Published on: January 28, 2020
Shifeng Wu1, Yang Yang2, Zhengxue Han3
1Resident, Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, PR China.
Statement Of Problem:
The bone-driven structural technique, which uses the inferior border of the mandible as the reconstruction template, is the mainstream method for fibular mandibular reconstruction. However, this approach may create an unfavorable restorative space for subsequent implant rehabilitation, characterized by height deficiency and malpositioned alveolar ridge relationship. A detailed quantitative characterization of this restorative space remains lacking.
Purpose:
The purpose of this study was to quantify the osseous restorative space following bone-driven fibular reconstruction of mandibular defects and to assess the feasibility of the double-barrel fibula technique for implant-supported prostheses.
Material And Methods:
In this observational study, 19 patients who had undergone mandibular reconstruction were evaluated using postoperative cone beam computed tomography. Key parameters measured included the bone-level vertical height of the target restorative space (B-VTRS) at the central incisor, canine, first molar, and second molar sites, fibular height (FH), and the horizontal relationship of the target restorative space (HTRS) in anterior (horizontal distance) and posterior (angulation) regions. The B-VTRS of anterior and posterior regions were compared using the paired Wilcoxon signed-rank test (α=.05). The remaining vertical height (RH) after simulated double-barrel fibula reconstruction was calculated.
Results:
B-VTRS decreased significantly from the anterior to the posterior (27.57 ±5.72 mm to 16.59 ±3.79 mm, P<.001). The mean FH was 14.49 ±1.81 mm. Calculated RH, accounting for a mandatory 2 mm intersegment gap, was insufficient (<7 mm) for implant prostheses in posterior molar regions. The anterior HTRS was 7.41 ±3.24 mm, suggesting an edge-to-edge restorative target. Posterior HTRS angles were 80.96 ±9.48 degrees (first molar) and 71.01 ±12.82 degrees (second molar), indicating increasing challenge for normal occlusal relationships.
Conclusions:
Bone-driven single fibula reconstruction was found to create a marked vertical deficiency. The double-barrel technique was found to be limited in the posterior region because of insufficient restorative space. Prosthetic planning should prioritize the first molar posteriorly and frequently target an edge-to-edge incisal relationship anteriorly when assessed based solely on the osseous restorative space.
