Abstract
Background: Marginal mandible resection is required to achieve healing in some cases of medication-related osteonecrosis of the jaws (MRONJ). Despite the sparsity of the literature, computer-aided design/computer-aided manufacturing (CAD/CAM) materials may provide superior outcomes for patients with an increased risk of mandible fracture. The aim of this study was to report a digital workflow for surgical interventions to prevent mandible fracture in MRONJ patients. Methods: We present two cases in which virtual surgical planning (VSP) and CAD/CAM surgical guides and reconstruction plates were used to prevent mandible fractures in elderly MRONJ patients submitted for marginal resection. Two osteoporotic patients, aged 73 and 84 years, presented with stage 3 MRONJ of the right mandibular body with inferior alveolar nerve involvement. The unaffected bone height was 6 mm in both cases, implying a high risk of mandible fracture. After preoperative VSP, surgery was performed through a combined intraoral–transbuccal approach. CAD/CAM-customized cutting guides and reconstruction plates were used for the marginal resection of necrotic bone and internal fixation. Results: Complete healing was achieved and the patients remained asymptomatic up to 1 year post-surgery. Conclusions: VSP and CAD/CAM-customized materials facilitated the complete resection of necrotic bone and rigid fixation in MRONJ patients, allowing a simplified approach with shorter operative times, reduced morbidity, and predictable results.
Highlights
Medication-related osteonecrosis of the jaws (MRONJ) is a serious adverse effect of antiresorptive and antiangiogenic drugs that affects the bone and soft tissue of the maxillofacial region, with significant impacts on quality of life [1]
Recent studies suggest that surgical treatment aiming at the complete resection of necrotic bone can be successful in healing all stages of medication-related osteonecrosis of the jaws (MRONJ) [7,8,9]
The present report describes a digital workflow for necrotic bone resection and the prevention of mandibular fracture secondary to MRONJ surgical intervention through virtual surgical planning and customized computer-aided design/computer-aided manufacturing (CAD/CAM) reconstruction plates where otherwise, to date, few studies are available
Summary
Medication-related osteonecrosis of the jaws (MRONJ) is a serious adverse effect of antiresorptive and antiangiogenic drugs that affects the bone and soft tissue of the maxillofacial region, with significant impacts on quality of life [1]. Recent studies suggest that surgical treatment aiming at the complete resection of necrotic bone can be successful in healing all stages of MRONJ [7,8,9]. Marginal mandible resection is required to achieve healing in some cases of medication-related osteonecrosis of the jaws (MRONJ). Methods: We present two cases in which virtual surgical planning (VSP) and CAD/CAM surgical guides and reconstruction plates were used to prevent mandible fractures in elderly MRONJ patients submitted for marginal resection. CAD/CAM-customized cutting guides and reconstruction plates were used for the marginal resection of necrotic bone and internal fixation. Conclusions: VSP and CAD/CAMcustomized materials facilitated the complete resection of necrotic bone and rigid fixation in MRONJ patients, allowing a simplified approach with shorter operative times, reduced morbidity, and predictable results
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