Abstract
BackgroundThe reconstruction of a large mandibular defect poses a challenging issue in oral cancer ablation surgery. One popular option for mandibular continuity reconstruction after tumor resection involves the use of a reconstruction plate (R-plate), which maintains space and contour without bone harvesting. An R-plate, however, cannot provide final functional loading rehabilitation with implants or dentures.MethodsWe suggest a new method of functional mandibular reconstruction using retentive posts and an upper prosthesis. The finite element method (FEM) was used to optimize the design. Surgery was needed to adapt the retentive posts. Prosthodontic procedures were required for the upper prosthesis.ResultsEight patients were treated with retentive posts and prostheses. All patients underwent wide resections of the mandible, and reconstruction with an R-plate and microvascular soft tissue transfer. We adapted the retentive posts on an R-plate and fabricated the upper prostheses with a flexible denture or a fixed resin prosthesis. Finally, the patients had functional rehabilitation, which restored proper mastication.ConclusionsThe retentive posts of the R-plate and upper prosthesis allow functional dental rehabilitation without the need for a bone graft. Virtual simulation using FEM will help to design and optimize the retentive posts. Two or three regular size posts are suitable for the quadrant jaw. This first preliminary step will allow improved patient-specific retentive post designs in the near future.
Highlights
The reconstruction of a large mandibular defect poses a challenging issue in oral cancer ablation surgery
Fabrication of retentive posts for the reconstruction plate A Leibinger® mandibular R-plate (2.8 mm height) and 2.7 mm locking screws were used for the primary mandibular reconstruction
Stress was concentrated at a connection point between the mandible and R-plate
Summary
The reconstruction of a large mandibular defect poses a challenging issue in oral cancer ablation surgery. One popular option for mandibular continuity reconstruction after tumor resection involves the use of a reconstruction plate (R-plate), which maintains space and contour without bone harvesting. Reconstruction of a large mandibular defect poses a challenging issue in oral and maxillofacial surgery. The use of a reconstruction plate (R-plate) to maintain space and contour without requiring bone harvesting has been a popular option to reconstruct the mandible. Some surgeons prefer a staged protocol for dental rehabilitation after an en bloc resection [3]. These surgeons performed an R-plate reconstruction with a secondary bone graft from the iliac crest bone. There was no way to reconstruct the dental functional rehabilitation including chewing, normal swallowing, and acceptable pronunciations for patients who could not tolerate an additional major surgery
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