Abstract
Mandibular reconstruction with fibula flap shows a 3D discrepancy between the fibula and the remnant mandible. Eight patients underwent three-dimensional reconstruction of the fibula flap with iliac crest graft and dental implants through virtual surgical planning (VSP), stereolitographic models (STL) and CAD/CAM titanium mesh. Vertical ridge augmentation and horizontal dimensions of the fibula, peri-implant bone resorption of the iliac crest graft, implant success rate and functional and aesthetic results were evaluated. Vertical reconstruction ranged from 13.4 mm to 10.1 mm, with an average of 12.22 mm. Iliac crest graft and titanium mesh were able to preserve the width of the fibula, which ranged from 8.9 mm to 11.7 mm, with an average of 10.1 mm. A total of 38 implants were placed in the new mandible, with an average of 4.75 ± 0.4 implants per patient and an osseointegration success rate of 94.7%. Two implants were lost during the osseointegration period (5.3%). Bone resorption was measured as peri-implant bone resorption at the mesial and distal level of each implant, with a variation between 0.5 mm and 2.4 mm, and with a mean of 1.43 mm. All patients were rehabilitated with a fixed implant prosthesis with good aesthetic and functional results.
Highlights
Mandibular defects derived from trauma, congenital malformations and tumor resection cause severe bone and soft tissue defects, with their consequent aesthetic and functional sequelae [1]
The purpose of this study was to evaluate the outcomes of the three-dimensional reconstruction of the fibula flap with iliac crest graft and dental implants through virtual surgical planning (VSP), stereolitographic models (STL) models and computer-aided design/computer-aided manufacturing (CAD/CAM) titanium mesh
Three-dimensional reconstruction was performed through VSP, cortico-cancellous iliac crest graft and CAD/CAM titanium mesh
Summary
Mandibular defects derived from trauma, congenital malformations and tumor resection cause severe bone and soft tissue defects, with their consequent aesthetic and functional sequelae [1]. The titanium mesh used as a barrier produces consistent bone augmentation, maintains volume and regenerates high-quality bone for both vertical and horizontal mandibular reconstruction and dental implants. It provides superior space maintenance with predictable and consistent results. The main problem to achieve a correct three-dimensional reconstruction of the bone is the fitting of the titanium mesh over the peroneal flap and the complete filling of the mesh with the iliac crest graft In standard techniques, this is difficult to achieve, resulting in mesh exposure, infection, graft displacement and, bone resorption [9]
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