Abstract
ObjectivesReconstruction of large mandiblular defects following ablative oncologic surgery could be done by using vascularized bone transfer or, more often, primarily with simultaneous or delayed bone grafting, using load bearing reconstruction plates. Bending of these reconstruction plates is typically directed along the outer contour of the original mandible. Simultaneously or in a second operation vascularized or non-vascularized bone is fixed to the reconstruction plate. However, the prosthodontic-driven backward planning to ease bony reconstruction of the mandible in terms of dental rehabilitation using implant-retained overdentures might be an eligible solution. The purpose of this work was to develop, establish and clinically evaluate a novel 3D planning procedure for mandibular reconstruction.Materials and methodsThree patients with tumors involving the mandible, which included squamous cell carcinoma in the floor of the mouth and keratocystic odontogenic tumor, were treated surgically by hemimandibulectomy.ResultsIn primary alloplastic mandible reconstruction, shape and size of the reconstruction plate could be predefined and prebent prior to surgery.Clinical relevanceThis study provides modern treatment strategies for mandibular reconstruction.
Highlights
Indications for partial and total mandibulectomy include malignancies especially squamous cell carcinomas (SCC), benign tumors such as ameloblastomas and sequelae of radiotherapy such as osteoradionecrosis
Clinical relevance: This study provides modern treatment strategies for mandibular reconstruction
The base of planning is up to now mostly the outer contour of the mandible. This leads to an inappropriate positioning of bone grafts in secondary reconstruction due to the limited dimensions of bone grafts
Summary
Indications for partial and total mandibulectomy include malignancies especially squamous cell carcinomas (SCC), benign tumors such as ameloblastomas and sequelae of radiotherapy such as osteoradionecrosis. Reconstruction of the mandible is mainly done with vascularized bone grafts or alloplastic materials (reconstruction plates). Dimension limitations of bone grafts, especially in height and width, do not match with prosthodontic needs and often result in unavoidable malpositioned dental implants with sequentially lateral crossbite situation. Aim of this study is to implicate the ideal, i.e. prosthodontic driven planning and positioning of bone grafts in the planning procedure respecting the desired implant position: backward planning independent of the reconstructive technique. This requires patient specific pre-bending of the reconstruction plate to guide the bone graft into the desired position. The outer contour of the mandible is not anymore the basis for bending the plate
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