Individualized Titanium Mesh Research Articles

Assessment of the application of a novel three-dimension printing individualized titanium mesh in alveolar bone augmentation: A retrospective study.

To assess the clinical and radiographic outcomes of alveolar ridge augmentation using a novel three-dimensional printed individualized titanium mesh (3D-PITM) for guided bone regeneration (GBR). Preoperative cone-beam computed tomography (CBCT) was used to evaluate alveolar ridge defects, followed by augmentation with high-porosity 3D-PITM featuring circular and spindle-shaped pores. Postoperative CBCT scans were taken immediately and after 6 months of healing. These scans were compared with preoperative scans to calculate changes in bone volume, height, and width, along with the corresponding resorption rates. A statistical analysis of the results was then conducted. A total of 21 patients participated in the study, involving alveolar ridge augmentation at 38 implant sites. After 6 months of healing, the average bone augmentation volume of 21 patients remained at 489.71 ± 252.53 mm3, with a resorption rate of 16.05% ± 8.07%. For 38 implant sites, the average vertical bone increment was 3.63 ± 2.29 mm, with a resorption rate of 17.55% ± 15.10%. The horizontal bone increment at the designed implant platform was 4.43 ± 1.85 mm, with a resorption rate of 25.26% ± 15.73%. The horizontal bone increment 2 mm below the platform was 5.50 ± 2.48 mm, with a resorption rate of 16.03% ± 9.57%. The main complication was exposure to 3D-PITM, which occurred at a rate of 15.79%. The novel 3D-PITM used in GBR resulted in predictable bone augmentation. Moderate over-augmentation in the design, proper soft tissue management, and rigorous follow-ups are beneficial for reducing the graft resorption and the incidence of exposure.

Modified individualized titanium mesh in orbital floor reconstruction for preventing exposure.

To describe a novel method of medial fixation of titanium mesh with a right-angled screwdriver for orbital floor and maxillary reconstruction and to compare the reconstruction outcome of orbital floor reconstruction with modified and traditional methods. The data of 23 patients who underwent maxillectomy and orbital floor defect reconstruction by individualized titanium mesh in Peking University School and Hospital of Stomatology between 2018 and 2021 were retrospectively reviewed. While eight patients received modified orbital floor reconstruction with titanium mesh and angled screwdriver (group A), 15 patients received traditional orbital floor reconstruction (group B). The contact area with buccal flap for titanium mesh in groups A and B was calculated. Titanium mesh deformation, fracture or exposure was recorded. Postoperative ophthalmic function and success of esthetic restoration were assessed. Mean follow-up was for 15.7 months (range, 9-22 months). The contact area with buccal flap for the modified titanium mesh in group A (13.11 ± 1.41 cm2) was significantly less than that of the traditional titanium mesh in group B (21.83 ± 1.23 cm2; p < .05). The exposure of titanium mesh occurred in two patients in group B. The self-evaluation of facial symmetry for 23 patients showed no significant difference between group A (7.75 ± 0.71) and group B (6.68 ± 1.30; p > .05). No specific complications were reported. We propose a novel method of zygomatic medial fixation of titanium mesh with a right-angled screwdriver for orbital floor and maxillary reconstruction, which has the potential to prevent the postoperative exposure of titanium mesh. Level III (Retrospective comparative study).

Vertical bone augmentation with customized CAD/CAM titanium mesh for severe alveolar ridge defect in the posterior mandible: A case report.

Case Letter.

Reconstruction of orbital wall fractures with superior orbital fissure syndrome using individualized preformed titanium mesh: a pilot study

The aim was to preliminarily evaluate the effect of individualized preformed titanium mesh in the treatment of orbital wall fractures with superior orbital fissure syndrome (SOFS). This study consisted of 10 patients of orbital wall fracture and SOFS who were treated at the Affiliated Stomatology Hospital of Southwest Medical University. On the basis of preoperative computed tomography data, individualized titanium mesh was produced by mirror engineering and rapid prototyping, and it was implanted into defects in the orbital walls to restore the normal anatomy. Early orbital wall reconstruction was performed to improve the SOFS. Postoperatively, the ocular and facial appearance and eye function were evaluated. The orbital structure, volume, and size of the SOF were restored in the 10 patients using the individualized titanium mesh. The symptoms of SOFS completely disappeared in all patients with no severe postoperative complications. Significant recovery of ocular and facial appearance and eye function was reported. This pilot study demonstrated that individualized preformed titanium mesh can accurately restore the orbital walls and the structure and size of the SOF, and it is useful in the treatment of SOFS without intraorbital bone fragment displacement.

The Ti-Mesh Technique: Guided Bone Regeneration for Three-Dimensional Augmentations. Clinical Aspects: A Case Series.

This article presents the surgical aspects of, and evaluates bone dimensional changes following, the application of the guided bone regeneration (GBR) technique using individualized titanium mesh on atrophied alveolar ridges to achieve an optimal crest volume for implant placement. Six patients were included and evaluated clinically and radiologically for at least 3 years. Every patient presented bone resorption affecting implant placement in a proper prosthetic position. During the regenerative procedure, customized titanium mesh was used to secure the contour of the augmented site and the stability of xenograft particles deposited on the atrophied crest. After 6 months of healing, the mesh was removed, and implants were placed in planned, prosthetic positions. CBCT scans were taken before the regenerative procedures and after 6 months, before the second-stage surgeries. This allowed for assessment of the postaugmentation vertical and horizontal bone tissue gain. The average volumetric gain of the augmented sites was 5.2 mm horizontally and 2.75 mm vertically. In 50% of cases, minor soft tissue perforation was observed after a few weeks. This complication did not influence the implant placement procedure and was treated during the second-stage procedure with the GBR technique, using a resorbable membrane and xenograft particles to compensate the localized bone defect. No implant failed during the control period. Panoramic radiographs were taken 1 to 3 years after completion of definitive prosthetic treatment to assess potential bone resorption around implants. No crestal bone resorption was observed within this period. It can be concluded that the use of customized titanium mesh is a predictable technique for bone regeneration in advanced, three-dimensional defects.

Microsurgical reconstruction of maxillary defects after limited resections for malignant tumors

Introduction. Partial maxillectomy involves resection of 1 or 2 walls of the upper jaw, usually medial and anterior ones. The main purposes of reconstruction include the formation of an adequate support for the eyeball; isolation of the orbit from the nasal cavity, nasopharynx, and anterior skull base; normal symmetry; good aesthetic result.Materials and methods. Between 2014 and 2020, we followed up 13 patients. Nine of them (69 %) had combined defects involving the inferior orbital, anterior, and medial walls of the maxilla (class V according to according to the Brown–Shaw classification, 2010), as well as skin on the buccal and zygomatic areas; 1 patient also had lower eyelid affected. Four individuals (31 %) had isolated defects involving the inferior orbital, anterior, and medial walls of the maxilla (class V according to according to the Brown–Shaw classification, 2010). Twelve patients have undergone preoperative 3D-computer simulation. We divided patients into 2 groups according to the size of their defects and resection areas in the anterior wall of the maxillary sinus. Group 1 included 5 patients with partial maxillary defects (involving 25–40 % of the total area), whereas Group 2 comprised 7 patients with limited maxillary defects (involving 25–40 % of the total area).Five patients have undergone reconstructive surgeries with fasciocutaneous flaps, including anterolateral thigh flaps used in 4 individuals (31 %) and thoracodorsal flap used in 1 individual (8 %). Eight patients had their defects repaired using radial fasciocutaneous flaps. The inferior orbital wall was reconstructed using an individual titanium mesh implant.Results. All patients from Group 1 after defect repair with anterolateral thigh flaps and thoracodorsal flaps (4 individuals) had satisfactory aesthetic result. One patient had an unsatisfactory aesthetic result after reconstruction with a radial fasciocutaneous flap due to mesh implant protrusion and formation of an opening in the nasal cavity. The assessment of the eyeball position demonstrated that symmetry was achieved in 4 patients (80 %) after reconstruction using anterolateral thigh flaps (3 patients) and thoracodorsal flap (1 patient). Five patients from Group 2 (72 %) had excellent results, while 2 patients (28 %) had satisfactory results. The assessment of the eyeball position demonstrated that symmetry was achieved in 5 patients (70 %); two participants (28 %) had lower eyelid ectropion.Conclusion. Patients with large maxillary defects (involving 41–60 % of the total area of the anterior wall of the maxillary sinus and the alveolar process of the maxilla) should undergo reconstructive surgeries with fasciocutaneous anterolateral thigh flaps. In case of relatively small defects (involving 25–40 % of the total area of the anterior wall of the maxillary sinus and the alveolar process of the maxilla) the best option is defect repair with radial fasciocutaneous flaps. Such strategy ensures excellent aesthetic and functional results in 75 % of patients.

Long-term Effect of Individualized Titanium Mesh in Orbital Floor Reconstruction After Maxillectomy.

The aim of this study was to determine the clinical outcomes and long-term stability of individualized titanium mesh combined with free flap for orbital floor reconstruction after maxillectomy and to identify the risk factors for titanium mesh exposure. The data of 66 patients who underwent maxillectomy and orbital floor defect reconstruction by individualized titanium mesh in Peking University School and Hospital of Stomatology between 2011 and 2019 were retrospectively reviewed. Postoperative ophthalmic function and success of aesthetic restoration were assessed. Titanium mesh exposure was recorded and the risk factors were identified. Mean follow-up was for 24.8 months (range, 6-92 months). Ophthalmic function was successfully restored in 63/66 patients. Aesthetic restoration was not considered satisfactory by 10 patients. Titanium mesh exposure occurred in six patients (exposure rate, 9.1%). Preoperative radiotherapy was identified as an independent risk factor for mesh exposure (OR=28.8, P=0.006). Previous surgery, postoperative radiotherapy, pathological type of the primary lesion, the type of tissue flap applied, and the use of intraoperative navigation were not significant risk factors. Six patients with titanium mesh exposure underwent second surgery, but mesh exposure recurred in two patients due to insufficient soft tissue coverage. Individualized titanium mesh with free flap can effectively restore maxilla-orbital defects. Preoperative radiotherapy is an independent predictor of postoperative titanium mesh exposure. Adequate soft tissue coverage of the mesh may reduce the risk of mesh exposure. 4 (case-control study) Laryngoscope, 131:2231-2237, 2021.

Research on the dimensional accuracy of customized bone augmentation combined with 3D-printing individualized titanium mesh: A retrospective case series study.

Few studies have focused on the dimensional accuracy of customized bone grafting by means of guided bone regeneration (GBR) with 3D-Printed Individual Titanium Mesh (3D-PITM). Digital technologies were applied to evaluate the dimensional accuracy of customized bone augmentation with 3D-PITM with a two-stage technique. Sixteen patients were included in this study. The CBCT data of post-GBR (immediate post-GBR) and post-implantation (immediate post-implant placement) were 3D reconstructed and compared with the pre-surgical planned bone augmentation. The dimensional differences were evaluated by superimposition using the Materialize 3-matic software. The superimposition analysis showed that the maximum deviations of contour between were 3.4 mm, and the average differences of the augmentation contour were 0.5 ± 0.4 and 0.6 ± 0.5 mm respectively. The planned volume of bone regeneration was approximately equal to the amount of regenerated bone present 6 to 9 months after the surgical procedure. On average, the vertical gain in bone height was about 0.5 mm less than planned. And, the horizontal bone gain on the straight buccal of the dental implants and 2 to 4 mm apical of the platform fell also about a 0.5 mm short on average. Statistically significant differences were observed between the augmented volume of virtual and post-GBR, and the horizontal bone gain of post-implantation on the level of 4 mm apical to the implant platform (P < .05). The dimensional accuracy of customized bone augmentation with the 3D-PITM approach needs further improvement and compared to other surgical approaches of bone augmentation.

Assessment of the clinical effect regarding three-dimensional printing individualized titanium mesh for bone augmentation in the esthetic area

Objective: To evaluate the clinical effect of three-dimensional (3D) printing individualized titanium mesh for ridge augmentation in the esthetic zone. Methods: Forty-three patients were treated with personalized titanium mesh bone augmentation from Department of Oral Implantology, Stomatological Hospital of Chongqing Medical University from January, 2018 to June, 2020. According to the preoperative cone-beam CT (CBCT) data, the 43 patients [male: 21, female: 22, aged (30.1±5.8) years] were divided into three groups according to the Seibert classification as horizontal, vertical and horizontal-vertical classes (sample size: 14, 15, 14). Then, comprehensively the bone mass and esthetic requirements were taken into account to design and accordingly fabricate the 3D printing individualized titanium mesh. During the surgical process, autologous bone and xenogeneic bone substitutes were mixed at a 1∶1 ratio, combined with injectable platelet-rich fibrin (i-PRF) and individualized titanium mesh for ridge augmentation. All patients were recalled at 1, 3, and 6 months post-operation to observe the mesh exposure; the clinical effect of ridge augmentation was evaluated 6 months post-operation. After the implant placement and final restoration, the pink esthetic score (PES)/white esthetic score (WES) were evaluated. Results: Only one patient experienced early mesh exposure, and no obvious infection was observed. The bone gain regarding three types of bone defects was significantly higher immediately post-operation compared to pre-operation (horizontal, vertical and horizontal-vertical bone defect measured as (3.27±0.13), (17.41±0.46), (3.76±0.24), (14.37±0.89) mm pre-operation, respectively; and (5.25±0.15), (26.10±0.55), (6.35±0.29), (22.52±0.90) mm immediately post-operation, P<0.01). There was no obvious bone resorption 6 months post-operation [outcomes for horizontal, vertical and horizontal-vertical bone defect measured as (5.14±0.14), (25.67±0.52), (6.13±0.26), (22.35±0.89) mm, P>0.05]. The PES/WES scores of all patients were interpreted as "excellent". Conclusions: The 3D printing individualized titanium mesh is effective in repairing bone defects in the esthetic zone, and produces credible esthetic outcomes after implantation and final restoration.

Bone flap resorption after complications of in elective neurosurgery (case study)

Сraniotomy is an integral part of modern elective neurosurgery which involves cutting a free bone flap to provide access to pathological intracranial structures with its reimplantation at the end of surgery.Bone flap grafting in the trepanation window with various fixation methods in the end of elective neurosurgery in the absence of severe cerebral edema or cancer-induced bone destruction is a standard procedure that restores the skull shape, cerebrospinal fluid dynamics and cerebral perfusion.According to the literature, the incidence of aseptic inflammation with subsequent resorption of the bone flap after craniotomy in elective neurosurgery is not clearly defined.An analysis of medical publications in the PUBMED database showed few reports of bone flap resorption after elective craniotomy, and no reports were found after the search in the eLibrary database.Thus, the number of reports on the bone flap resorption after craniotomy in elective neurosurgery is limited, and the pathophysiology of this process remains unclear.However, the described complication of craniotomy can lead to the dislocation of a bone flap, the development of a local pain syndrome, a cosmetic defect, and disturbances in cerebrospinal fluid dynamics.The article describes an example of partial resorption of a bone flap after craniotomy for the removal of meningioma in the middle third of the superior sagittal sinus, which required a number of repeated neurosurgical interventions. The treatment was finished with the removal of a partially resorbed bone flap and implantation of an individual titanium mesh implant.

RECONSTRUCTION OF THE ORBITAL SKELETON USING COMPUTER- AIDED INDIVIDUALIZED TITANIUM MESH COMPARED TO CONVENTIONAL TITANIUM MESH

Introduction: Orbital reconstruction is one of the most challenging tasks for the surgeon who treats craniofacial trauma. Suboptimal outcomes may lead to debilitating morbidity with significant emotional, functional, and occupational deficits Objectives: This study was designed to compare the efficacy of the computer-aided fabricated individual titanium mesh and conventional titanium mesh in orbital skeleton reconstruction in cases of infraorbital dysesthesia. Materials and methods: The study population included 20 patients with orbital skeleton fractures. The sample was selected conveniently to fulfill a list of inclusion criteria. The selected participants were randomly allocated into two equal groups, each group included 10 patients. In the course of a surgical treatment, individually designed titanium mesh were manufactured by application of computer- aided design in combination with rapid prototyping technologies (CAD/RP). Preoperative analysis and postoperative monitoring were conducted to evaluate their success based on restoration of infraorbital nerve function that was evaluated by pin prick test and electrical pulp testing. Results:Regarding postoperative clinical evaluation, group 1(study group) was superior to that of group 2 (control group) in restoring the function of infraorbital nerve Conclusions: computer aided titanium mesh was an accurate option in reconstructions of traumatic orbital wall fractures.

Preliminary application assessment of individualized three-dimensional printing titanium mesh combined with guided bone regeneration for repairing alveolar bone defects

Objective: To preliminarily evaluate the clinical effect of the three-dimensional (3D) printing individualized titanium mesh combined with guided bone regeneration technology for repairing alveolar bone defects. Methods: Six patients with alveolar bone defects (4 males and 2 females, aged 18-27 years, mean 23.3 years) were selected from the Department of Oral Implantology, Stomatological Hospital of Chongqing Medical University from January to June 2018. The patients' cone-beam CT (CBCT) data was imported into the digital design software, and the individualized titanium meshes were designed based on the ideal bone mass around the implant, alveolar bone morphology and soft tissue condition. Then, the ".stl" files were output and the meshes were fabricated by 3D printing technology. The individualized titanium meshes combined with the mixture of autogenous bone and bone substitute materials were used to augmentation during operation. All patients were reviewed at 1, 3 and 6 months after surgery to observe the complications and evaluate the effect of bone augmentation. After taking out the titanium mesh, the CBCT was compared with the preoperative CBCT. The increased bone height and bone width were measured and the bone incremental volume was calculated. Results: Titanium mesh exposure occurred in 2 patients with no obvious infection, and no early removal. In 6 patients, the bone width increased by 1.75-7.54 mm (mean 3.58 mm), the bone height increased by 0.91-11.80 mm (mean 3.37 mm), and bone incremental volume increased by 247-676 mm(3) (mean 503 mm(3)). All of the cases showed sufficiently grafted volume for implant placement. Conclusions: The individualized 3D printing titanium meshes combined with guided bone regeneration could repair alveolar bone defects with excellent clinical effect, but a better design needed to be explored in the future to solve or delay the exposure of titanium mesh.

Application of Three-Dimensional Printing Technology in the Orbital Blowout Fracture Reconstruction.

The aim of this study was to investigate the clinical outcomes of orbital blowout fracture repair by using the three-dimensional (3D) printing-assisted fabrication of individual titanium mesh. Clinical and radiologic data were analyzed for 12 patients with orbital floor and/or medial wall fractures. Lower eyelid incision was used to expose the fractures. Preoperative computed tomographic data were input into an imaging software to rebuild a 3D orbit and mirror the unaffected side into the affected side to replace the demolished orbit. A resin model of the reshaped orbit was generated and used to develop an individual titanium mesh for repairing the fractured orbital. The surgical results were assessed by value of enophthalmos and a comparison of preoperative and postoperative orbital volume difference. All patients had a successful treatment outcome without any complications. Clinical significant enophthalmos were not observed after treatment, and diplopia were solved within 2 weeks postoperative. No extraocular muscle limitation was observed. Postoperative computed tomography scans demonstrated appropriate positioning of titanium mesh and there was no implant displacement. The postoperative orbital volume and enophthalmos difference between the 2 eyes decreased significantly than preoperative (P < 0.001). Three-dimensional printing-assisted fabrication of individual titanium mesh is appropriate for use in orbital blowout fracture.

Orbital floor symmetry after maxillectomy and orbital floor reconstruction with individual titanium mesh using computer-assisted navigation

The present study aimed to evaluate the symmetry of the orbital floor after maxillectomy and orbital floor reconstruction with individual titanium mesh using a computer-assisted navigation system. Nineteen patients who underwent orbital floor reconstruction with individual titanium mesh were included in this study. Postoperative computed tomography scans recorded after three-dimensional (3D) reconstruction were used to evaluate the symmetry of the orbital floor, including orbital floor height, orbital floor eminence, globe projection, orbital volume, and surface deviation. The average orbital floor height of the reconstructed and the unaffected side was 37.7 ± 2.3 and 37.8 ± 2.7 mm, respectively (P=.47). The average orbital floor eminence of the reconstructed and the unaffected side was 40.1 ± 5.5 and 39.6 ± 5.3 mm, respectively (P=.17). The average globe projection of the reconstructed and the unaffected side was 15.5 ± 3.2 and 15.3 ± 3.0 mm, respectively (P=.27). The average orbital volume of the reconstructed and the unaffected side was 25.9 ± 4.4 and 26.3 ± 4.4cm3, respectively (P=.29). Repeatability between the reconstructed and the unaffected side was 88.3%±2.6% at within 1 mm and 98.6%±0.9% at within 2 mm. The average of maximum deviation was 2.4 ± 0.2 mm. Individual titanium mesh is one of the best techniques for orbital floor reconstruction, as it can be placed precisely and helps achieve desirable esthetic outcomes through virtual surgical planning and using a computer-assisted navigation system.

Mechanical Characterization of 3D-Printed Individualized Ti-Mesh (Membrane) for Alveolar Bone Defects.

Individualized titanium mesh holds many advantages over conventional mesh. There are few reports in the literature about the effect of mesh pore size and mesh thickness on the mechanical properties of titanium mesh. This study is designed to develop an individualized titanium mesh using computer-assisted design and additive manufacturing technology. This study will also explore the effect of different thicknesses and pore sizes of titanium mesh on its mechanical properties through 3D FEA. According to this study, the mechanical properties of titanium mesh increased when the thickness decreased (0.5 mm to 0.3 mm). With an increase in mesh diameter (3 mm to 5 mm), the mechanical properties of mesh decreased. The diameter of titanium mesh has less influence on its mechanical properties than does the thickness of the mesh. Titanium mesh with a thickness of 0.4 mm is strong enough and causes less stimulation to mucosa; therefore, it is more suitable for clinical use. In addition, parameters of titanium mesh should be decided clinically according to bone defect size, defect location, and force situation.

Individualized Titanium Mesh Combined With Platelet-Rich Fibrin and Deproteinized Bovine Bone: A New Approach for Challenging Augmentation.

Autologous bone transfer is regarded as the gold standard for ridge augmentation before dental implantation, especially in severe bony defects caused by tumor resection or atrophy. In addition to the advantages of autologous bone, transplantation has several disadvantages, such as secondary operation, increased morbidity and pain. The present study reports, for the first time, a combination of a xenogeneic bone substitute (BO) with platelet-rich fibrin (PRF), which is a fully autologous blood concentrate derived from the patient's own peripheral blood by centrifugation. Solid A-PRF+ and liquid i-PRF together with an individualized 3-D planned titanium mesh were used for reconstruction of a severe tumor-related bony defect within the mandible of a former head and neck cancer patient. The BO enriched with regenerative components from PRF allowed the reconstruction of the mandibular resective defect under the 3-D mesh without autologous bone transplantation. Complete rehabilitation and restoration of the patient's oral function were achieved. Histological analysis of extracted bone biopsies confirmed that the new bone within the augmented region originated from the residual bone. Within the limitations of the presented case, the applied concept appears to be a promising approach to increase the regenerative capacity of a bone substitute material, as well as decrease the demand for autologous bone transplantation, even in cases in which autologous bone is considered the golden standard. PRF can be considered a reliable source for increasing the biological capacities of bone substitute materials.

Reconstruction of Maxillary and Orbital Floor Defect With Free Fibula Flap and Whole Individualized Titanium Mesh Assisted by Computer Techniques

We sought to investigate the clinical application of free fibula flap and individualized titanium mesh through the use of a virtual planning and guiding template to assist the reconstruction of maxilla and orbital floor defects. Between 2015 and 2016, a total of 6 adult patients with maxillary and orbital floor defects were enrolled in this study. Preoperative virtual planning, including virtual maxillary resection and fibular reconstruction, was performed in all cases according to 3-dimensional radiographic and clinical findings. A 3-dimensionally printed resin model and prebent templates were used to guide the harvesting and positioning of the fibula flap during surgery.Then, an individualized titanium mesh was used to support the orbital floor and restore the maxillary contour. The results were confirmed by postoperative computed tomography scans and clinical follow-up. Preoperative virtual planning and prebent templates can be used to guide the harvesting and positioning of the fibula flap, as well as the forming and positioning of the individualized titanium mesh, with satisfactory results. All flaps survived, and symmetrical facial contours were achieved with normal lower jaw movement and proper vertical distance for dental implants in all patients. Computer-aided techniques such as virtual planning, 3-dimensionally printed models, and prebent guide templates can be used to harvest and position a free fibula flap, form personalized titanium mesh, and ultimately improve the clinical efficacy of maxillary and orbital floor reconstruction.

Application of fabricated individual titanium mesh for reconstruction of orbital floor after maxillectomy

Background: Orbital floor defect resulted from maxillectomy can cause severe enophthalmos and diplopia. Computer-assisted individually fabricated titanium mesh is a promising method for rehabilitation of orbital floor.

Outcomes of Orbital Floor Reconstruction After Extensive Maxillectomy Using the Computer-Assisted Fabricated Individual Titanium Mesh Technique

Orbital floor defects after extensive maxillectomy can cause severe esthetic and functional deformities. Orbital floor reconstruction using the computer-assisted fabricated individual titanium mesh technique is a promising method. This study evaluated the application and clinical outcomes of this technique. This retrospective study included 10 patients with orbital floor defects after maxillectomy performed from 2012 through 2014. A 3-dimensional individual stereo model based on mirror images of the unaffected orbit was obtained to fabricate an anatomically adapted titanium mesh using computer-assisted design and manufacturing. The titanium mesh was inserted into the defect using computer navigation. The postoperative globe projection and orbital volume were measured and the incidence of postoperative complications was evaluated. The average postoperative globe projection was 15.91 ± 1.80 mm on the affected side and 16.24 ± 2.24 mm on the unaffected side (P = .505), and the average postoperative orbital volume was 26.01 ± 1.28 and 25.57 ± 1.89 mL, respectively (P = .312). The mean mesh depth was 25.11 ± 2.13 mm. The mean follow-up period was 23.4 ± 7.7 months (12 to 34 months). Of the 10 patients, 9 did not develop diplopia or a decrease in visual acuity and ocular motility. Titanium mesh exposure was not observed in any patient. All patients were satisfied with their postoperative facial symmetry. Orbital floor reconstruction after extensive maxillectomy with an individual titanium mesh fabricated using computer-assisted techniques can preserve globe projection and orbital volume, resulting in successful clinical outcomes.

Reconstruction of a maxillary defect with a fibula graft and titanium mesh using CAD/CAM techniques.

We present a case of maxillary and orbital floor reconstruction with a microvascular fibula graft and an individualized titanium mesh. Both were planned virtually; templates were made by rapid prototyping. The postoperative computertomography scans showed that the planned positions were achieved correctly. This case report illustrates maxillary reconstruction performed with a special template technique and demonstrates the possibilities of computer aided design/computer aided manufacturing (CAD/CAM) applications in reconstructive surgery.