Abstract
BackgroundThe aim of this study was to introduce a complete 3D workflow for immediate implant retained prosthetic rehabilitation following maxillectomy in cancer surgery. The workflow consists of a 3D virtual surgical planning for tumor resection, zygomatic implant placement, and for an implant-retained prosthetic-obturator to fit the planned outcome situation for immediate loading.Materials and methodsIn this study, 3D virtual surgical planning and resection of the maxilla, followed by guided placement of 10 zygomatic implants, using custom cutting and drill/placement-guides, was performed on 5 fresh frozen human cadavers. A preoperatively digitally designed and printed obturator prosthesis was placed and connected to the zygomatic implants. The accuracy of the implant positioning was obtained using 3D deviation analysis by merging the pre- and post-operative CT scan datasets.ResultsThe preoperatively designed and manufactured obturator prostheses matched accurately the per-operative implant positions. All five obturators could be placed and fixated for immediate loading. The mean prosthetic point deviation on the cadavers was 1.03 ± 0.85 mm; the mean entry point deviation was 1.20 ± 0.62 mm; and the 3D angle deviation was 2.97 ± 1.44°.ConclusionsIt is possible to 3D plan and accurately execute the ablative surgery, placement of zygomatic implants, and immediate placement of an implant-retained obturator prosthesis with 3D virtual surgical planning.The next step is to apply the workflow in the operating room in patients planned for maxillectomy.
Highlights
Surgical management and oral rehabilitation of patients diagnosed with a maxillary tumor is challenging
It is possible to Three dimensional (3D) plan and accurately execute the ablative surgery, placement of zygomatic implants, and immediate placement of an implant-retained obturator prosthesis with 3D virtual surgical planning.The step is to apply the workflow in the operating room in patients planned for maxillectomy
Virtual surgical planning To mimic the clinical problem of a maxillary defect, typical examples of maxillary tumor resection surgeries were planned virtually (Fig. 1a, b). 3D virtual surgical plan (VSP) are created that included partial resection of the maxilla, leaving a maxillary defect, based around an assumed tumor volume that would be suitable for obturator prostheses supported by zygoma implants
Summary
Surgical management and oral rehabilitation of patients diagnosed with a maxillary tumor is challenging. Prosthodontic rehabilitation by an obturator prothesis, or surgical rehabilitation by tissue grafting the maxillary defect, can be considered in order to obtain the best functional outcome for the patient [3]. While the functional results of prosthodontic and surgical rehabilitation of small- to medium-sized maxillary defects are somewhat comparable, reconstruction with free flaps seem to provide better speech and swallowing results for extensive or anterior located defects than conventional prosthetic obturation [4]. Supporting the obturator prostheses with implants improves the results of oral function rehabilitation significantly, as well as being a viable technique to improve the functionality of prosthetic rehabilitation in patients who have undergone a maxillectomy [5]. The workflow consists of a 3D virtual surgical planning for tumor resection, zygomatic implant placement, and for an implant-retained prosthetic-obturator to fit the planned outcome situation for immediate loading
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