Bone Graft Surgery Research Articles

Comparison of pedicle screw fixation via paraspinal approach and traditional open approach for treatment of thoracolumbar fracture and dislocation

Objective To compare the clinical efficacy of posterior pedicle screw fixation through Wiltse paraspinal approach and posterior traditional open approach in the treatment of thoracolumbar fracture and dislocation. Methods A retrospective case control study was performed based on the clinical data of 40 patients with thoracolumbar fracture and dislocation admitted between January 2013 and January 2016. All the surgeries were performed through posterior midline incision, and they were divided into two groups according to different approaches. Patients in Group A received pedicle screw fixation through Wiltse paraspinal approach while Group B received fixed pedicle screw through open surgery. Group A was composed of 12 males and 8 females, aged 21-60 years [(41.5±9.6)years]. Group B was composed of 13 males and 7 females, aged 18-58 years [(39.1±13.1)years]. The same surgical procedures were adopted in spinal decompression, reduction, and the spinal vertebral interbody bone graft and fusion surgery in the two groups. Operation duration, intraoperative blood loss, postoperative drainage volume, visual analogue scale (VAS), spinal canal patency at the last follow-up, percentage of postoperative injury of vertebral height recovery, and Cobb angle were compared. CT and MRI were used to evaluate postoperative paravertebral muscle atrophy, and American spinal injury association (ASIA) impairment scale was used to evaluate neurological function assessment. Results All patients were followed up for 9-33 months, with (19.3± 5.6)months for Group A and (22.5±4.9)months for Group B (P>0.05). The operation duration was (240.5±38.3)min in Group A and (258.5±43.7)min in Group B (P>0.05). The intraoperative blood loss was (525.0±168.2)ml in Group A, less than (770.0±269.2)ml in Group B (P 0.05). In terms of MRI evaluation score of postoperative paravertebral muscle atrophy, Group A reported better results than Group B [(2.1±0.6)points vs. (1.2±0.6)points] (P 0.05). Within the same group, significant difference was observed between the preoperative data and that at the last follow-up in terms of postoperative VAS score, spinal canal patency, percentage of injury of vertebral height, Cobb angle, and ASIA impairment scale (P<0.05). Conclusion For thoracolumbar fracture and dislocation, compared with traditional open approach, posterior pedicle screw fixation through Wiltse paraspinal approach can effectively restore the vertebral body height and spinal canal patency and can reduce the intraoperative bleeding, postoperative drainage, postoperative back pain, and paravertebral lesion. Key words: Spinal injuries; Thoracic vertebrae; Lumbar vertebrae; Fracture fixation

Non-union of Scapular Spine Fracture Case-Report: a Cause of Classical Subacromial Impingement Syndrome

Fractures of the scapular spine are relatively uncommon and in most cases healing of the fracture is achieved following conservative treatment. We report a case of a 36 year old male who developed a painful atrophic non-union scapular spine fracture producing secondarily subacromial impingement symptoms and his sustained recovery 9 years after treatment by open reduction, internal fixation and bone grafting.

Ideal Versus Late Secondary Alveolar Bone Graft Surgery: A Bone-Thickness Cone-Beam Computed Tomographic Assessment.

To compare the bone morphology after secondary alveolar bone graft surgery (SABG) performed before and after permanent canine eruption. Cross-sectional study. Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil. 25 cone-beam computed tomography (CBCT) scans of complete unilateral cleft lip and palate (CLP) individuals who underwent SABG before or after eruption of the permanent canine taken 2 and 6 months (T1 and T2) after SAGB, resulting in 50 CBCT scans. Two groups were assessed, Ideal Group (IG; n = 10) and Late Group (LG; n = 15), according to the time of the SABG. SABG buccal-palatal thicknesses were measured in 3 different root levels: cement-enamel junction (cervical slice), middle point of the root (intermediate slice), and apex of the central incisor (apical slice). Thickness measurements were assessed in the mesial, distal, and intermediate aspects of the alveolar bone graft. Clinical long-term follow-up was also done. The IG showed significantly greater bone thickness, especially in the intermediate and apical slices, when compared to LG, in T1 and T2. Bone thickness was maintained over time. Clinically, all the IG individuals completed orthodontics, and no major complications were observed. In contrast, 27% of the LG individuals had failures, and rehabilitation was achieved through prosthesis. Ideal SABG presents with better results compared with late ABG. When it is not possible to perform SABG at the ideal time, acceptable outcomes still can be expected for late bone grafting.

GreenBone – plant-derived nanoparticles with osteogenic and anti-inflammatory properties

With the exception of blood, bone is the most widely transplanted material and it is estimated that more than 2.2 million bone graft operations are performed annually. Autologous bone grafting is often associated with clinical drawbacks. As a consequence, alternative biomaterials including synthetic graft materials are used.

Open Cancellous Bone Grafting for Recalcitrant Palatal Fistula: Repurposing the Papineau Technique.

Summary:Cleft palate fistula is defined as a breakdown in the primary surgical repair of the palate resulting in oronasal communication, which can create symptomatic regurgitation for fluids/solids and affect speech, manifested by airflow escape during phonation. With the reported postoperative occurrence rate of 33–37% postfistula repair, it remains a challenging problem. The primary aim of this study was to describe our experience in the management of 7 consecutive cases of recalcitrant palatal fistula, all secondary to primary cleft palate repair. Pure cancellous bone graft was harvested in a standard fashion in sufficient quantity based on size of fistula from the iliac crest and was morselized and was kept mixed with the patient’s blood. After flap turnover for nasal closure, the graft was packed over the raw surface on the oral aspect and was secured by placing an oxidized regenerated cellulose sheet fixed to the surrounding mucosa. As per the Papineau technique, no oral closure was performed. Six-month follow-up showed complete epithelization of the oral raw surface in 6 of the 7 patients. In the diverse spectra of cleft surgeries, management of recalcitrant cleft palate fistula remains a surgical challenge. Repurposing Papineau’s concept of open cancellous bone grafting in cleft palate fistula is a novel attempt with a sound scientific basis. In our experience, this technique has proved to be very effective in managing recalcitrant palatal fistulae.

Effects of Bisphosphonate Administration on Cleft Bone Graft in a Rat Model.

Bone grafts in patients with cleft lip and palate can undergo a significant amount of resorption. The aim of this study was to investigate the effects of bisphosphonates (BPs) on the success of bone grafts in rats. Thirty-five female 15-week-old Fischer F344 Inbred rats were divided into the following experimental groups, each receiving bone grafts to repair an intraoral CSD: (1) Graft/saline: systemic administration of saline and (2) systemic administration of zoledronic acid immediately following surgery (graft/BP/T0), (3) 1 week postoperatively (graft/BP/T1), and (4) 3 weeks postoperatively (graft/BP/T2). As an additional control, the defect was left empty without bone graft. Microcomputed tomography and histologic analyses were performed in addition to evaluation of osteoclasts through tartrate-resistant acid phosphatase staining. Bone volume fraction (bone volume/tissue volume) for the delayed BP treatment groups (graft/BP/T1 = 45.4% ± 8.8%; graft/BP/T2 = 46.1% ± 12.4%) were significantly greater than that for the graft/saline group (31.0% ± 7.9%) and the graft/BP/T0 (27.6% ± 5.9%) 6 weeks postoperatively (P < .05). Hematoxylin and eosin staining confirmed an evident increase in bone volume and fusion of defect margins with existing palatal bone in the graft/BP/T1 and graft/BP/T2 groups. The graft/BP/T0 group showed the lowest bone volume with signs of acute inflammation. Delayed BP administration following cleft bone graft surgery led to significant increase in bone volume and integration compared with saline controls. However, BP injection immediately after the surgery did not enhance bone volume, and rather, may negatively affect bone graft incorporation.

An unusual foreign object mimicking an odontoma in a patient with cleft alveolus: a case report

BackgroundThe habit of inserting foreign objects into body cavities is seen in children and in adults with intellectual disability. Usually, the foreign objects cause chronic inflammation and local tissue destruction, which give rise to symptoms. Diagnosis at an asymptomatic stage is uncommon when the history is not suggestive. We describe a rare case where a foreign object was misdiagnosed as an odontoma in a patient with an alveolar cleft.Case presentationA radiopaque round mass was noted on the radiograph of a 12-year-old Sinhalese boy who was awaiting an alveolar bone graft. Apart from problems related to the alveolar cleft and mild halitosis, he was otherwise healthy. This was suspected to be an odontoma in the cleft region. During alveolar bone graft surgery, a button battery was recovered that was later confirmed as having been self-inserted by the child. Alveolar bone graft surgery was delayed because of local chronic inflammation due to the foreign object. Three months later, complete healing of the site was noted when reexplored for alveolar bone grafting.ConclusionsIt is important to include foreign objects in the radiological differential diagnosis in asymptomatic children. Furthermore, cone beam computed tomography should be considered in suspected cases. Early removal with thorough debridement causes minimal tissue destruction.

Papineau technique combined with vacuum-assisted closure for open tibial fractures: clinical outcomes at five years.

Treatment of open tibial fractures with soft tissue and segmental bone defects is difficult. This study reports our results for treating these injuries with a combination of Papineau open bone grafting and vacuum-assisted wound closure (VAC). The records of 19 patients with open tibial fractures with soft tissue and segmental bone defects treated with bone grafting and VAC from 2004 to 2010 were retrospectively reviewed. Outcomes included: time to complete granulation tissue coverage, wound healing, and bone union; length of hospitalization; frequency of debridement; number of deep tissue infections. Initial surgery was performed within 48 hours of injury. Ten fractures were Orthopaedic Trauma Association classification 41-A3, one was 41-C3, seven were 43-A3, and one was 43-C3. No surgical complications occurred, and the mean length of hospitalization was 11.0±3.0weeks (range, 7-18weeks). The mean follow-up time was 59.35±8.76months. The mean time for complete wound healing was 7.76±1.52weeks (range, 6-11weeks). Bone union was achieved in all patients at a mean of 33.88±8.37weeks (range, 23-53weeks). Only one patient developed a deep tissue infection, which was treated with antibiotics and debridements, and complete bone union wound healing was achieved. Based on Paley grade, five outcomes were excellent, eight were good, and four were fair. The combination of VAC and open bone grafting results in good outcome for patients with open tibial fractures and severe bone and soft-tissue defects.

Scaphoid nonunion: does open reduction, bone grafting and Herbert screw fixation justify the treatment?

Conventional bone grafting and Herbert screw fixation give satisfactory results for scaphoid nonunion; however, vascularized bone grafting has superior results, especially in the case of avascular necrosis of proximal fragment. Vascularized bone grafting is technically more demanding with small error of margin, problems of getting the appropriate graft, fixation and incorporation, and requires longer duration for wrist immobilization. Forty-five patients of scaphoid nonunion were treated by cancellous bone grafting, cortex containing graft if required and Herbert screw fixation. Functional outcomes were assessed at the latest follow up after surgery (minimum oneyear after surgery). The average pre-operative and post-operative scapho-lunate angle, grip strength, flexion-extension movement, radio-ulnar movement, scaphoid index and modified mayo score were improved from 49.60±6.40° (37-66) to 36.26±4.73° (range 28-46), 20.66±3.17kg (15-27) to 31.11±3.29kg (range 25-40), 78.57±14.22° (45-110) to 132.86±13.90° (100-165), 30.06±6.06° (20-44) to 44.95±6.37°(range 35-59), 0.66±0.076 (0.55-0.79) to 0.60±0.065 (range 0.49-0.73) and 58.66±5.24 (50-70) to 84.37±5.01 (range 75-95), respectively, with P value <0.001. Based on modified mayo score, 21 (46.7%) patients had excellent results, 19 (42.2%) had good results, 4 (8.9%) had fair results and one patient (2.2%) had poor results. Bone grafting and Herbert screw fixation provides a good option for treatment of scaphoid nonunion, especially in the absence of avascular necrosis of proximal fragment. More importantly, vascularized bone grafting in all scaphoid nonunion may not be necessary and could otherwise have been united uneventfully by this technique. However, avascular necrosis of proximal fragment must be ruled out pre-operatively as well as intra-operatively.

The Use of Three Dimensional Printed Hydroxyapatite Granules in Alveolar Ridge Preservation

In this study, an alveolar ridge preservation using novel hydroxyapatite granules which was fabricated by three dimensional printing technique in post-extraction socket was carried out and evaluated. Clinical, radiographic and histology were assessed prior to dental implant placement. Five volunteered patients who needed an extraction of anterior tooth and scheduled for implant replacement were enrolled in this pilot study. No sign of infection or local of systemic immune reaction to the three dimensional printed hydroxyapatite granules in all patients was noted. At 8 weeks post-surgery, the grafted area was observed to be completely filled with woven bone and the formation of new vessels was seen. In addition, the bone quality and quantity of the grafted site when placing the implant showed efficient implant stability (ISQ values ∼ 65) without the need of additional bone graft surgery. Overall results indicated that three dimensional printed hydroxyapatite granules could be potentially employed as bone grafting material for alveolar ridge preservation.

Pulp Vitality of Maxillary Canines After Alveolar Cleft Bone Grafting: Pulse Oximetry Versus Electric Pulp Test Versus Cold Test.

Assessment of pulp vitality is necessary prior to any dental treatment. The purpose of this study was to assess pulp vitality of bilateral canines in unilateral cleft patients following alveolar bone graft surgery using pulse oximetry, electrical pulp test, and cold test. This analytical, cross-sectional study was conducted on canines of 20 unilateral cleft patients who had alveolar bone graft surgery. Pulp vitality of canines was evaluated postoperatively by pulse oximetry, electrical pulp test, and cold test. Data were analyzed using t test, Mann-Whitney test, and χ2 test. P ≤0.05 was considered statistically significant. The mean pulp SpO2 was significantly lower in canines at the cleft side compared with the normal side (85.04 ± 4.65 versus 87.78 ± 4.01, P = 0.05). The response to cold test was not significantly different (P = 0.056). The mean response to electrical pulp was not significantly different between the 2 sides either (P = 0.62). The mean SpO2 of canines was lower at the cleft side than normal side but both sides had adequate blood supply and were vital.

Canine Eruption After Secondary Alveolar Bone Graft in Unilateral Cleft Lip and Palate Patients.

The aim of this article is to analyze dental abnormalities in unilateral cleft lip and palate patients by focusing on the role of the secondary alveolar bone graft (SABG) surgery and its outcomes on canine eruption/inclusion. A sample of 24 patients with unilateral cleft lip and palate were selected.Dental anomalies, canine eruption based on the existence of supernumeraries, agenesis elements, inclination of the major canine axis before and after surgery, distance from the occlusal plane before and after surgery, and sector classification were analyzed. Out of the 24 patients, 87.5% presented a canine spontaneously erupted in the dental arch while 12.5% needed surgical-orthodontic traction.There is also no proof that inclination of the canine significantly influenced the eruption before (P = 0.5889) and after (P = 0.4029) surgery. Also, there is no any correlation between the 2 sides (P = 0.1257).The SABG surgery showed a significant correlation with canine eruption (P = 0.009242); moreover, SABG shows a positive relationship with the radicular development of the canine (P = 0.005163).Lateral incisive (P = 0.8493) and second premolar agenesis (P = 1) are not statistically correlated with the eruption of the canine. This does not happen with supernumerary elements that are correlated with the surgical-orthodontic traction (P = 0.0004464). Agenesis does not play any role in the process of canine eruption while supernumeraries do. There is no relationship between the inclination and eruption of the canine.The SABG surgery has a key role because it contributes to create an appropriate support for the erupting canine, the nasal base and the anterior maxilla.

Heterotopic ossification related to the use of recombinant human BMP-2 in osteonecrosis of femoral head.

Despite the wide use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in bone defect, its application in treating osteonecrosis of femoral head (ONFH) is yet to be elucidated. The heterotopic ossification (HO) after rhBMP-2 usage in some orthopedic surgeries has been reported previously; however, only a few studies describe this complication in the treatment of ONFH.The present study investigated whether the rhBMP-2 application would increase the risk of HO formation in selected ONFH patients with nonvascularized bone grafting surgery and enhance the surgical results of nonvascularized bone grafting as compared to patients who did not receive intraoperative rhBMP-2.A retrospective analysis was performed on 94 patients (141 hips) who, with Association Research Circulation Osseous (ARCO) stages IIb, IIc, and IIIa ONFH, underwent nonvascularized bone grafting surgery. The first 46 patients (66 hips) received intraoperative rhBMP-2. The postoperative radiographic results (X-ray and CT scan) and Harris hip score (HHS) were reviewed in each patient to record the incidence of HO formation and evaluate the clinical efficacy of rhBMP-2, respectively.HO formation frequently occurred in patients receiving intraoperative rhBMP-2 (8/66 hips) than those not receiving the protein (1/75 hips) (P = .02). HHS improved from preoperatively at the final follow-up (P < .01) in the BMP-positive group, with a survival rate of 83.3%. In the BMP-negative group, the HHS improved from preoperatively at the end of the follow-up (P < .01), and the survival rate was 72.0%.rhBMP-2 has osteoinductive property and might serve as an adjuvant therapy in the surgical treatment of ONFH. However, the incidence of HO formation might increase when used in high doses.

Coracoid bone block transfer procedure: Correlation between subscapularis volume below the bone graft and shoulder stability

IntroductionCoracoid bone graft transfer has become the gold standard in patients with recurrent anterior shoulder instability associated with bony defect. Several studies have shown that the main stabilizing component of this procedure is the sling effect by the conjoint tendon and the lower portion of subscapularis (SS). The purpose of this study was to determine whether a larger SS volume below the bone block was correlated to greater postoperative shoulder stability. Materials and methodsThis prospective study included a cohort of patients who underwent open coracoid bone graft transfer for post-traumatic recurrent anterior shoulder instability. Forty patients were reviewed at 2 years with a clinical and CT scan evaluation. A correlation analysis assessed the relation between the SS volume index (ratio of SS volume below the bone block to volume over the bone block) and Rowe and Walch-Duplay instability scores. ResultsThere exists a positive and significant correlation between SS volume index and postoperative Rowe score, r=0.37 (P=0.03). The same trend was observed for Walch-Duplay score without statistical significance. A larger inferior SS volume did not result in a limitation of external rotation, greater fatty infiltration, or malposition of the coracoid graft. ConclusionA larger SS volume below the bone block is related to greater postoperative shoulder stability. We recommend performing the split in the middle of the SS or higher instead of the junction of the superior two-thirds and inferior one-third as usually reported. Level of evidenceIII, prospective study.

Combined negative pressure wound therapy with open bone graft for infected wounds with bone defects: An experimental study.

Background:Bone and soft-tissue defects in infected wound have been an intractable problem to many surgical consultations. Infected wounds with bone defects are physical and financial burden to society. Nowadays, infected wounds with compound defect of bone and soft tissues are common in orthopedics department. Currently, no simple and efficient treatment has been found to solve this problem. This study investigates the effects of combining negative pressure wound therapy (NPWT) with open bone graft on this focus.Materials and Methods:Twenty four rabbits with bone and soft tissue defects accompanied infected wounds were randomized into experimental (combined NPWT with open bone graft) and contrast group (only open bone graft). Treatment efficacy was assessed by the wound condition; wound healing time, bacterial bioburden, and bony callus were evaluated by X-ray. Furthermore, samples of granulation tissue from wounds on the 3rd, 7th, and 14th days of healing were evaluated for blood vessels and expression of vascular endothelial growth factor.Results:Wounds in the experimental group tended to have shorter healing time, healthier wound conditions, lower bacterial bioburden, better bony callus, and more blood supply than those in the controlled group.Conclusions:In conclusion, NPWT combined open bone graft can act as a feasible and valuable method to treat combined infected bone and soft-tissue defects.

Injection of Unicameral Bone Cysts with Bone Marrow Aspirate and Demineralized Bone Matrix Avoids Open Curettage and Bone Grafting in a Retrospective Cohort.

Background:Many treatment options exist for unicameral bone cysts (UBC), without clear evidence of superiority. Meta-analyses have been limited by small numbers of patients in specific anatomic and treatment subgroups. The purpose of this study was to report the outcomes of injecting bone marrow aspirate and demineralized bone matrix (BMA/DBM) for the treatment of proximal humerus UBC.Methods:Fifty-one patients with proximal humerus lesions treated by BMA/DBM injection were retrospectively reviewed from a single academic medical center.Results:The mean number of injections performed per patient was 2.14 (range 1-5). Eleven patients underwent only one injection (22%), an additional 19 patients completed treatment after two injections (37%), four patients healed after three injections (8%), and one patient healed after four injections (2%). The cumulative success rate of serial BMA/DBM injections was 22% (11/51), 58% (30/51), 67% (34/51), and 69% (35/51). Eleven patients (22%) ultimately underwent open curettage and bone grafting, and five patients (10%) were treated with injection of calcium phosphate bone substitute.Conclusion:A BMA/DBM injection strategy avoided an open procedure in 78% of patients with a proximal humerus UBC. The majority of patients underwent at least 2 injection treatments.Level of Evidence:Level IV retrospective cohort study.

Influence of Standardized Orientation on Patient Perception of Perioperative Care Following Alveolar Cleft Repair: A Survey Based Study of Patients Treated in a Large Academic Medical Center.

This study aims to better understand patient-reported outcomes for iliac bone grafting surgery for alveolar cleft repair and to determine how standardizing perioperative patient instruction affects patient-reported outcomes. Retrospective survey-based assessment of patients undergoing iliac bone grafting with and without hospital-based systems standardization. Academic tertiary care hospital. Of the 195 identified patients, 127 participated. Survey on pain and satisfaction regarding iliac bone grafting surgery. Survey answers measured patient opinions about the surgery. Answers of the pre- and poststandardization patients were compared to determine the effect of standardizing patient instructions. Patients rated their satisfaction with the surgery and recovery a 4.5 and 4.4 out of 5, respectively. They rated their overall pain in the hospital a 5.5 out of 10 (4.9 in the mouth, 5.7 in the hip). Patients were discharged an average of 1.2 days after surgery and could return to normal daily activity in 6.1 days. Poststandardization patients were more likely to adhere to instructions regarding use of an antibacterial mouthrinse and a protective oral splint. Patients were highly satisfied with the iliac bone grafting procedure and the recovery and reported only moderate levels of postoperative pain. Implementing standardized patient instructions may not affect patient satisfaction or pain severity, but it significantly increased patient adherence to physician instructions.

High incidence of partially anatomic tunnel placement in primary single-bundle ACL reconstruction.

The purpose of this study was to evaluate tunnel position and width in failed primary single-bundle (SB) anterior cruciate ligament (ACL) reconstructions. It was hypothesized that both femoral and tibial bone tunnels are frequently malplaced in terms of a partially anatomic position in the setting of failed SB ACL reconstruction. Patients with recurrent instability following isolated SB ACL reconstruction using hamstring tendon autografts, undergoing revision ACL surgery, were retrospectively included. Further inclusion criteria were age >18years and availability of preoperative computed tomography (CT) scans and radiographs of the affected knee. Patients with multiligamentous instabilities as well as incomplete or poor radiographs were excluded. Tunnel position was evaluated according to the method described by Harner et al. and Stäubli and Rauschning. Tunnel width was determined on CT scans perpendicular to the bone tunnel axis at three different heights of each bone tunnel. Eighty-two patients met the inclusion criteria and were considered for radiological analysis. Femoral tunnels were graded as anatomic in 60% (49 of 82) of all cases. In the remaining 40% (33/82), 27% of the tunnels were placed partially anatomic and 13% were graded as non-anatomic. Tibial tunnel placement was found to be anatomic in 54% (44/82) of all cases, partially anatomic in 45% and non-anatomic in 1% of the cases. No statistically significant difference between anatomic or partially anatomic tunnel position and tunnel diameter, neither for the femoral nor for the tibial side, was observed (n.s.). The present study demonstrates that there is a high incidence of partially anatomic placed tunnels in failed SB ACL reconstruction. Tunnel width was not associated with tunnel position. Clinically, partially anatomic bone tunnels frequently require a staged procedure with bone grafting and subsequent ACL revision surgery. Thus, surgeons should carefully analyse tunnel position and width preoperatively to properly plan ACL revision surgery.

Stopping Anticoagulation Therapy Before Implant and Bone Grafting Surgery May Not Be Necessary to Prevent Bleeding Events

Management of anticoagulated patients in implant therapy: a clinical comparative study. Clemm R, Neukam FW, Rusche B, Bauersachs A, Musazada S, Schmitt CM. Clin Oral Implants Res 2016;27(10):1274-82. Information not available TYPE OF STUDY/DESIGN: Cohort study.

Reconstruction of Mandible: A Fully Digital Workflow From Visualized Iliac Bone Grafting to Implant Restoration

Although digital aids can help surgeons compensate for the shortcomings of traditional mandibular reconstruction techniques to perform surgery more precisely and effectively, the use of these digital techniques has often been fragmented, divided, and incomplete. This article describes the workflow of a fully digital mandibular reconstruction to explore the proper indications and discusses innovations based on the accuracy and effectiveness of digital techniques. A restoration-oriented mandibular reconstruction was performed by applying different digital techniques. Preoperative virtual surgery and rapid prototyping were used to aid the vascularized iliac bone graft surgery, which offered a solid basis for the ensuing treatment. Subsequently, implant rehabilitation was accomplished with the assistance of computer-assisted design and manufacture, laser treatment, and selective laser melting techniques. The workflow of the fully digital mandibular reconstruction successfully achieved a restoration-oriented treatment. These predictable, accurate, and effective digital techniques improved the consistency of pretreatment design and follow-up treatment. The treatment sequence achieved high predictability and reproducibility owing to the use of digital techniques. This study shows that a digital workflow can be predictable, accurate, and effective, which suggests that it could be a valid digital protocol for developing a treatment sequence for patients with jaw defects caused by trauma, congenital anomalies, or mandibular tumor resection.