Evaluation of iliac and fibula graft reconstructions compared to healthy mandibles: A finite element analysis study.

Biomechanical loading test on reconstructed mandibles with fibular, iliac crest or scapula graft: a comparative study

Biomechanical behavior of mandibles reconstructed with fibular grafts at different vertical positions using finite element method

Background:High-quality mandibular reconstruction using vascularized free fibular graft is necessary to provide an osseointegrated dental implant and fixed denture. An appropriate crown–implant ratio is needed, and a good match between bones is extremely important. There are no articles describing the analysis and evaluation of both the fibula and mandible in the same patients.Methods:Computed tomography images of both mandible and fibula of 80 patients were selected in a random manner. We measured bone height of the fibula and mandible at specified points and evaluated the difference of bone height between the fibula and mandible using fibular single or double-barrel grafts.Results:The percentage of patients who had a “good” result for a fibular single graft was only 13.8%. There was no significant difference in bone heights when analyzed by gender. Whether patients were dentulous or not had a large influence on the difference between fibular and mandibular bone heights. Most young patients, but only half of older patients, needed fibular double-barrel grafts. Overweight patients with a high body mass index more often needed fibular double-barrel grafts.Conclusions:For mandibular reconstruction using a fibular graft, preoperative analysis of the patient’s profile and proper use of a fibular single or double-barrel graft contribute to minimizing the difference between the height of the grafted fibula and native mandible and are keys to an ideal reconstruction with good cosmetics and function.

The main goal of the present study was to compare the biomechanical stability of locking plates and conventional miniplate combinations in human mandibles reconstructed with fibular grafts. A specially developed and well-proven testing device reproduced the in vivo loading conditions on the mandible. Cadaveric human mandibles (n = 12) reconstructed with harvested human fibular bone grafts were divided into two groups, and different osteosynthesis systems were applied using two lines of plates per osteotomy. On the test apparatus, the specimens were stressed to failure, and interfragmentary movement was monitored and quantified with a contact-free optical measurement system. The relevant interfragmentary movement results from a Euclidean summary calculation which considered all three spatial angles around the axes. Using values up to a maximum load of 300 N, the conventional six-hole miniplates (profile 1.0) had an average value of 7.45° ± 1.46°, and the locking six-hole plates (profile 1.3) had an average value of 12.16° ± 2.37° for rotational interfragmentary movement. The miniplate system exhibited a significantly superior performance in fixation compared to the fixed-angle system (p < 0.05). According to these biomechanical experiments, both osteosynthesis devices provided sufficient stabilization at loads of up to 300 N. The six-hole miniplate system provided better stabilization of the osteotomy gap for mandibles reconstructed with fibular grafts. The osteosynthesis system is essential for primary stability and the avoidance of pseudarthrosis formation. This study demonstrates that the miniplates provide sufficient stabilization and offers a method to improve fixation in reconstructed mandibles.

Mandibular bone loss represents an acquired bone destruction leading to a permanent continuity solution of the mandible. Mandibular reconstruction with fibular grafting is an effective alternative to restore bone continuity and ensure the aesthetic and functional functions of the patient. Two cases of successful mandibular reconstruction with the fibular graft were presented at the Department of Stomatology and Maxillofacial Surgery of the Yalgado Ouédraogo University Hospital (CHUYO). The first case concerns a 34-year-old female patient who underwent an interrupted mandibular resection for an ossifying fibroma. The second patient was a 38-year-old man with an ameloblastoma of the horizontal branch of the mandible who underwent hemi-mandibulectomy. A splint was placed for both patients. Mandibular reconstruction with a fibular bone graft taken from the left leg was performed in a second stage. The postoperative course was simple. Surgical follow-up noted good integration of the graft into the recipient site. The results obtained were satisfactory for each patient in terms of function (mastication, swallowing, phonation) and aesthetics. A study of the morphological data of the mandible would be of great help in producing a cutting guide that takes into account the realities of our populations.

Comparative study of Vascularized Iliac Crest Graft vs Titanium Mesh Tray with Particulate Cancellous Bone and Marrow Method in Mandibular Reconstruction

Autologous double barrel vascularized fibular bone graft for reconstruction after hemi resection of mandible due to ameloblastoma: Surgical case report

Vascularized bone grafts are considered as the gold standard for mandibular reconstruction. However, there are certain limitations of them, such as they are contraindicated in patients with circulatory disturbances. Therefore, Non-vascular bone grafts become the viable option for reconstruction. Our study aims to prospectively compare the long-term viability of avascular iliac and fibula bone grafts in the reconstruction of mandibular defects. Objectives were to evaluate the difficulty in swallowing, mastication, speech problems, infection, wound dehiscence, restricted limb movement, and altered gait among the iliac and fibula group. A total of 14 patients, planned for the reconstruction of mandibular defects from 2016 to 2018 were randomly allocated into two groups; nonvascular iliac and fibula graft groups. Clinical assessment for improvement in function, esthetics, wound healing, pain, and donor site morbidity was done and was followed up for one year. Digital orthopantomogram was taken for radiographic evaluation for up to one year. Difficulty in swallowing, mastication, speech, infection, restricted limb movement, and altered gait was statistically significant and was seen more in the fibula group. Wound dehiscence with graft exposure was found in one subject. The overall success rate was 100% in the iliac group and 85.7% in the fibula group. Considering the long-term complications and success rate, the nonvascular iliac graft was found to be superior and can be used as an alternative to a nonvascular fibula graft for a defect length up to 7cm.

Topological optimization of 3D printed bone analog with PEKK for surgical mandibular reconstruction

Long-Term Evaluation After Mandibular Reconstruction With Fibular Grafts Versus Microsurgical Fibular Flaps

There are several challenges in terms of mandibular reconstruction. The defect size, graft materials, and plate combinations should be taken into consideration in surgical planning. The aim of this study was to evaluate the effect of different reconstruction variations on the stress distribution of segmental resected mandibles with two different defect sizes using finite element analysis (FEA). Computerized tomography images of a human mandible, fibula, and iliac crest were used as references to build three-dimensional (3D) models on a PC. The virtual plates and screws were used to simulate reconstruction of the mandibular defects. The models were divided into two groups based on the longitudinal defect size. Different osteosynthesis variations and autogenous graft material combinations were used to reconstruct the mandibles. In all models, higher von Mises stress values occurred on the mandibles reconstructed with the fibula than those with the iliac crest. Fixation of the bone grafts with a reconstruction plate for the 10-mm defects and using a mini-plate in addition to the reconstruction plate for the 30-mm defects decreased stresses on the grafted bones. Mandibular reconstruction with the iliac grafts is biomechanically superior to that with the fibular grafts. In addition, osteosynthesis methods and the defect size affect the stress distribution.

Editorial Comment

Combination of biomechanical evaluation and accurate placement of dental implants: a new concept of virtual surgery in maxillary and mandibular functional reconstruction.

BackgroundOver the past few decades, fibular grafts have been widely utilized across 86 countries and regions globally for surgical reconstruction of various anatomical sites, including the mandible, upper extremities, lower extremities, spine, and in phalloplasty procedures. The present study aims to systematically investigate the developmental trajectory of fibular graft and identify research priorities for surgeons.MethodsA bibliometric analysis was conducted by searching the Web of Science Core Collection on April 12, 2024, for articles published between 2004 and 2023 on fibular grafting, using the query TS = (“graft” OR “transfer” OR “flap”) AND TS = (“fibular”). We included full-text English articles and reviews, and exclude documents that were not related to fibular grafting or were non-research-oriented publications. GraphPad Prism, CiteSpace, and VOSviewer analyzed publication trends and co-citation networks, providing insights into fibular grafting research.ResultsA total of 2,884 fibular graft publications were analyzed. Out of 86 countries/regions, the United States and China stood out as the main contributors in terms of publication volume, while England had the highest citation rate per publication. The journals with the most publications and citations were The Journal of Craniofacial Surgery and Plastic and Reconstructive Surgery, respectively. Mark K. Wax had the most publications, while Hidalgo DA had the highest co-citation count. The most frequently occurring keywords were “reconstruction” and “mandibular reconstruction.” Co-citation reference clustering revealed a growing preference for vascularized fibular grafts over non-vascularized alternatives. The top 10 co-cited references were exclusively focused on mandibular reconstruction. Keyword bursts analysis showed that over the initial 20-year period, identified keywords fall into three main themes: graft design (e.g., osteoseptocutaneous flap, perforator flap), reconstruction areas (e.g., maxilla, extremity, ankle, spine and phalloplasty), and defect causes (e.g., pseudarthrosis, sarcoma, bone tumor). In particular, fibular grafts in phalloplasty represent an emerging trend among various anatomical reconstruction sites. In the last 5 years, there has been a notable rise in interest in 3D planning, virtual surgical planning, augmented reality, and reconstruction accuracy.ConclusionThe findings offer an in-depth overview of the landscape of fibular graft research, highlighting key contributors and emerging trends.

The vascularized fibular flap for mandibular reconstruction