Pre-bent Reconstruction Plates Research Articles

The value of prebent reconstruction plates and in-house 3D printing

IntroductionReconstruction plates, prebent on 3D printed models, are a cheap, quick, and safe solution to improve mandibular reconstruction procedures. The European Medical Device Regulation has changed recently and severely affects 3D printing in hospitals. Therefore, its legitimation must be discussed. This retrospective observational Case-Control Study aimed to evaluate the impact of prebent reconstruction plates on the condylar position in the temporomandibular joint after continuity resection of the mandible in oncological cases. Materials and MethodsWe included patients who underwent segmental mandibular resection without exarticulation of the condyle or history of prior surgery. The patients were divided into groups with prebent plates on a stereolithographic model and intraoperatively bent reconstruction plates. The segmental defects were categorized using the Jewer Classification. Computed Tomography (CT) scans before and after surgery were analyzed using a standardized method to measure the metric movement of the condyles, as well as their angulation to reference planes to quantify positional changes (primary outcome measures). The influence of the defect location, according to the Jewer classification, was evaluated as a secondary outcome measure. Results73 patients, including 33 with preformed reconstruction plates, were included. We could show significantly fewer rotational deviations in cases of prefabricated osteosynthesis in the coronal plane (p<0,001) and in the sagittal plane (p<0,027). DiscussionUsing preformed reconstruction plates on 3D printed models improves the correct anatomical position of the condyle after mandibular resection. Especially Jewer-class-L defects seem to benefit from individualized reconstruction plates.

Virtual surgical planning in fibula flap mandibular reconstruction

: Mandibular reconstruction is one of the workhorse in head and neck reconstructive surgery, with the free fibula flap currently considered the gold standard technique. The last two decades have seen considerable developments and a surge in popularity of virtual surgical planning (VSP) and Computer-aided design and manufacturing (CAD-CAM). Starting with virtual performing of the surgery, the possibilities that this technology offers are enormous. Stereolithographic models, customized bone cut guides and pre-bent reconstruction plates are very useful intraoperative tools. In spite of the high costs of this technology, it is helpful to surgeons in the following ways: (I) During ablative oncological surgery, cleaner bone margins are easily obtained due to bone cut accuracy enhancement; and (II) the efficiency of reconstructive surgery is improved by simplifying the otherwise time-consuming reconstructive steps associated with the traditional free-hand technique. The aim of this article is to describe our experience and to share the tips and pitfalls than we have found along these years with this technology which is producing a paradigm shift in bone graft reconstruction. In conclusion, our recommendation is to use a case-by-case evaluation to select those patients for whom VSP and CAD-CAM will help to obtain the best aesthetical and functional outcomes.

Three dimensional accuracy of mandibular reconstruction by pre-bent reconstruction plate using intra oral versus extra oral approaches following mandibular resection in patients with extensive ameloblastoma

Purpose: This prospective study aimed to compare the intraoral placement of the pre-bent reconstruction plate with that inserted via the extraoral approach, to evaluate their impact on the three-dimensional (3D) position of the proximal segment Patients and methods: Patients were divided into two equal groups. In group 1, the mandible was reconstructed with a pre-bent reconstruction plate via an intraoral approach. In group 2, an extraoral approach was used. The primary outcome variables were the need for intraoperative plate readjustment, the time needed for plate insertion, total operation time, difficulties encountered during surgery, and the postoperative stability of the proximal segment. Distances between corresponding anatomical landmarks on the mandibular angle and condyle as well as the intercondylar angle (ICA) and B`XC angle, were measured. The difference between the pre- and postoperative measurements was used to evaluate the reconstruction accuracy. Results: Thirty patients were enrolled in this study. In group 1, four plates required minor readjustment. In group 2, only two cases required re-adaptation. The intraoral insertion of the pre-bent plates revealed a decrease in the linear measurements, resulting in mandibular compression. On contrary, the extraoral approach showed increase in the measurements, resulting in widening of the mandible. However, this width difference was statistically insignificant. Concerning the ICA and B`XC angle, no significant difference could be ascertained between the two groups. Conclusion: Intraoral approach is more conservative procedure, thereby achieving the best esthetic outcomes and resulting in a more accurate 3D mandibular reconstruction.

Outcomes of using pre-bent reconstruction plates in mandibular reconstruction

Outcomes of using pre-bent reconstruction plates in mandibular reconstruction

The lateral-rectus approach combined with preoperative simulation assisted by 3D printing for treatment of acetabular fractures in the elderly

Objective To explore the efficacy of the anterior lateral-rectus approach combined with preoperative simulation assisted by 3D printing for treatment of acetabular fractures in the elderly. Methods A total of 52 elderly patients with acetabular fracture were admitted to Department of Orthopaedics and Trauma, The Third Affiliated Hospital to Southern Medical University from January 2014 to December 2017. They were 36 males and 16 females, with an average age of 71.6 years (from 65 to 88 years). According to the Judet-Letournel classification, there were 5 anterior column fractures, 6 transverse fractures, 18 anterior and posterior hemi-transverse fractures, and 23 both-column fractures. For all cases a preoperative surgical simulation was implemented based on their 3D-printed acetabular models. A pre-bent reconstruction plate or a custom acetabular aliform plate was placed to fixate the fracture after reduction via the anterior lateral-rectus approach. The reduction quality, healing time, function of affected hip and complications were recorded. Results The operation time for this cohort ranged from 85 to 138 min (average, 102 min); the intraoperative bleeding ranged from 280 to 750 mL(average, 520 mL). Perioperatively, implant failure, wound infection or symptomatic lower extremity phlebothrombosis was observed in none of the patients. According to the Matta radiological evaluation, the postoperative reduction was rated as excellent in 40 cases, as good in 7 and as poor in 5 (an excellent and good rate of 90.4%). All cases were followed up for 6 to 18(mean, 10.6 months). All the acetabular fractures united after 8 to 20 weeks (average, 12 weeks). According to the modified Merle d’Aubigne-Postal scoring at the final follow-up, the function of affected hip was categorized as excellent in 29 cases, as good in 12 and as fair in 11 (an excellent and good rate of 78.8%). Walking pain was experienced by 5 patients 6 months after operation, diagnosed by imaging examination as traumatic arthritis of the hip joint. Follow-ups observed no such complications as screw loosening or heterotopic ossification. Conclusion In the treatment of acetabular fractures in the elderly, the anterior lateral-rectus approach combined with preoperative simulation assisted by 3D printing can achieve effective reduction and fixation, decrease intraoperative hemorrhage, shorten operation time and reduce such complications as screw loosening caused by osteoporosis. Key words: Acetabulum; Fractures, bone; 3D-printed technology; Aged; Surgical approach

Mandibular Reconstruction With a Deep Circumflex Iliac Artery Flap Using Computer-Assisted and Intraoral Anastomosis Techniques

This study aimed to evaluate intraoral anastomosis of a deep circumflex iliac artery (DCIA) flap in combination with computer-assisted techniques for mandibular reconstruction. Between December 2015 and March 2018, 4 patients with mandibular discontinuity defects caused by ablative tumor surgery were included in the study. Mandibular reconstruction was performed with a DCIA flap using computer-assisted and intraoral anastomosis techniques. A computer-aided design-computer-aided manufacturing cutting guide, a reconstruction stereomodel, and a prebent reconstruction plate were used for mandibular reconstruction in each patient.Anastomosis was performed on the facial artery and vein using the deep circumflex iliac vessels through an intraoral approach. The resulting error-grade color map was used to evaluate repeatability between the preoperative design and postoperative results. Mandibular reconstruction with a DCIA flap using computer-assisted and intraoral anastomosis techniques was successful in all 4 patients. All flaps survived with no severe complications. Satisfactory cosmetic outcomes and occlusion with sufficient bone height for implants were achieved postoperatively. Repeatability between the virtual plan and postoperative result was 81.1%±8.2% within 1mm, 85.8%±8.1% within 2mm, and 89.6%±6.7% within 3mm. The use of intraoral anastomosis and computer-assisted techniques with DCIA flaps for mandibular reconstruction without additional facial scarring is feasible and advantageous. However, the findings should be interpreted cautiously owing to the relatively short follow-up time and limited number of patients involved in this study.

Primary reconstruction of resected proximal mandibular segments: a novel protocol using patient-specific poly ether-ether ketone (peek) condylar replicas

Purpose: This study aims to evaluate the efficiency of computer-aided design and computer-aided manufacturing(CAD/CAM), mirror-imaged Polyetheretherketone (PEEK) assembly that aimed to duplicate both of the exactanatomic position and the configuration of the resected mandibular condyle, post segmental proximal tumor resection.Methods: Five patients were included in the study; diagnosed for mandibular ramus locally aggressive tumors, involving or markedly jeopardizing the mandibular condyles. All of the patients were subjected to a fully guided reconstructive protocol that implements guided resection, guided alignment of a pre-bent reconstruction plate, secured to a (CAD/CAM) fabricated, mirror-imaged (PEEK), looking forward to duplicating both of the anatomic location and the configuration of the amputated mandibular ramus and condyle.Results: Clinical evaluation revealed acceptable recovery of the maximal mouth opening and limited postoperativemalocclusion and mandibular deviation. The computed radiographic superimposition between the virtual plane and the oneweek postoperative C.T. revealed decreased linear condyle displacement in both the mediolateral and anteroposterior directions versus an increased linear vertical displacement and decreased axial angular rotation versus increased sagittal angular rotation. The replication between the virtually planned condylar location and that surgically duplicated was judged as good to excellent among all the cases.Conclusion: The novel simulation and allocation of the customized (PEEK) assembly represents a simple and efficientmodality to reconstruct both of the lost condylar position and configuration. However, the anterior extension of the resected proximal mandibular segment deemed determinant to the success of the identical surgical execution of the virtual preplanned arrangement.

Three-dimensional accuracy of mandibular reconstruction by patient-specific pre-bent reconstruction plates using an “in-house” 3D-printer

PurposeThe purpose of this study was to compare the three-dimensional accuracy of mandibular reconstruction following mandible continuity resection in patients treated with patient-specific, pre-bent reconstruction plates, using an ‘in-house’ 3D printer, with that in patients treated with conventional, intraoperatively bent plates. Patients and methodsWe retrospectively analyzed 42 alloplastic mandibular reconstructions following continuity resection. 21 patients received patient-specific, pre-bent reconstruction plates using an in-house 3D printer. The control group consisted of 21 patients provided with intraoperatively bent reconstruction plates. Distances between corresponding anatomical landmarks on the mandibular angle and condyle (A–A′, BB′, CC′, BC′), as well as the intercondylar angle (ICA), were measured and compared on the pre- and postoperative CT scans. ResultsMultivariate analysis of variance (MANOVA) showed significant multivariate main effect of group (F(5, 36) = 5.58, p = 0.001; Wilks lambda 0.564; partial η2 = 0.436), indicating more accurate postoperative results for the pre-bent group. Post-hoc comparison revealed significantly larger postoperative deviation in the distances between the mandibular angle and the intercondylar angle (ICA) for the intraoperatively bent group in comparison with the pre-bent group. However, there was no significant effect on the distance between the condyles. ConclusionsMandibular reconstructions employing patient-specific, pre-bent reconstruction plates made using an in-house 3D printer show significantly better three-dimensional accuracy compared with intraoperatively bent plates. The described method prevents rotational error of the mandibular angle and improves restoration of the physiological intercondylar angle in mandible reconstruction after continuity resection.

The fitting accuracy of pre-bend reconstruction plates and their impact on the temporomandibular joint

BackgroundVarious causes for bone defects of the lower jaw have been described. As a result, patients often suffer from compromised aesthetics and a loss of, or reduction in, important physiological functions, such as swallowing, breathing, and speaking. A change in the shape of the lower jaw can impair the natural occlusion and leads to an atypical or modified position of the temporomandibular joint. Titanium reconstruction plates are the standard approach to jaw reconstruction, and are used for temporary bridging of a jaw defect or fixation of a bone graft. Conventionally these plates are intraoperatively adjusted to the mandible by the surgeon. Computer-aided manufacturing, computer-aided design, and rapid prototyping have gained increasing importance in the field of medicine, as they allow the production of individual models of the lower jaw, with the possibility of preoperatively bending the reconstruction plates. In this retrospective study, the accuracy of pre-bent titanium plates and their effect on the temporomandibular joint situation in comparison with intraoperatively curved plates will be discussed. Materials and MethodsPatients who attended our department for lower jaw reconstruction between March 2013 and February 2015 were included in this retrospective study. Within that time 20 patients were treated with pre-bent reconstruction plates (group 1). 20 comparable patients were selected with reconstruction and conventional intraoperative bending (group 2). To evaluate the accuracy of the plates and the condylar position, postoperative cone beam computed tomograms and computed tomograms were used to assess the bone–plate distance at 12 defined points and four angles in axial reconstruction. The results were compared, statistically evaluated, and discussed. ResultsRegarding the maximum bone–plate distances and the sum of distances, there was a significant difference between the accuracy of the pre-bent and the conventionally bent reconstruction plates (p = 0.022, p = 0.048). Regarding the condylar position, there was no significant difference between both methods (p = 0.867). ConclusionThe results of this study show that a better fitting accuracy can be achieved using pre-bent plates. Preparation of the plates proves to be advantageous and meaningful, especially in complex bone defects and deformations of the lower jaw. Nevertheless, concerning the position of the temporomandibular joint, no significant difference could be ascertained between the shown methods, contradicting several studies.

Mandibular Reconstruction Using ProPlan CMF: A Review

ProPlan CMF (Depuy Synthes, Solothurn, Switzerland, and Materialise, Leuven, Belgium) is a computer-aided surgical virtual planning service using an online meeting with professional medical engineers and transfers patient-specific surgical guide to the virtual plan. Moreover, prebent reconstruction plates or patient-specific computer-aided manufacturing-fabricated reconstruction can also be used. This service started in 2011. Currently, it is widely used in Europe. Current status of mandibular reconstruction with ProPlan CMF vertical planning service with the surgical guide was reviewed. The accuracy was excellent in terms of contact of the osteotomized parts and the contact to the remaining skeleton. The authors found that currently, a small number of reports regarding the mandibular reconstruction with virtual planning service and surgical guides are available. These reports also have a small number of cases and short-term follow-up results. In this situation, this review revealed that (1) mainly the resection guides, cutting guides, and patient-specific mandible reconstruction plates were adequately well fitted to the surgical site intraoperatively, (2) the ischemic time might be more reduced than that of the conventional surgery (3) the accuracy of computer-assisted surgery in the mandibular reconstruction was clinically acceptable, and (4) condyle positions after the computer-assisted surgery was mainly normal. The higher additional cost than that of the conventional technique is presently an issue. Large-scale clinical studies and long-term follow-up studies are demanded.

Mandible Reconstruction with 3D Virtual Planning

The fibula free flap has now become the most reliable and frequently used option for mandible reconstruction. Recently, three dimensional images and printing technologies are applied to mandibular reconstruction. We introduce our recent experience of mandibular reconstruction using three dimensionally planned fibula free flap in a patient with gunshot injury. The defect was virtually reconstructed with three-dimensional image. Because bone fragments are dislocated from original position, relocation was necessary. Fragments are virtually relocated to original position using mirror image of unaffected right side of the mandible. A medical rapid prototyping (MRP) model and cutting guide was made with 3D printer. Titanium reconstruction plate was adapted to the MRP model manually. 7 cm-sized fibula bone flap was designed on left lower leg. After dissection, proximal and distal margin of fibula flap was osteotomized by using three dimensional cutting guide. Segmentation was also done as planned. The fibula bone flap was attached to the inner side of the prebent reconstruction plate and fixed with screws. Postoperative evaluation was done by comparison between preoperative planning and surgical outcome. Although dislocated condyle is still not in ideal position, we can see that reconstruction was done as planned.

Segmental Mirroring: Does It Eliminate the Need for Intraoperative Readjustment of the Virtually Pre-Bent Reconstruction Plates and Is It Economically Valuable?

The aim of this study was to compare segmental mirroring with mirroring of the entire unaffected side to determine which method obviates intraoperative readjustment of virtually planned pre-bent plates and to evaluate the effect on costs. Patients eligible for inclusion in this prospective study had unilateral mandibular discontinuity defects. Patients were randomly divided into 2 groups. In group I, models were constructed by mirroring the entire unaffected side of the mandible at the midsagittal plane. In group II, only the resected segments were cut and replaced by the corresponding mirrored healthy segments. The lesions were resected, and their sites were reconstructed using pre-bent reconstruction plates. The need for intraoperative plate readjustment, plate placement time, operation time, and operation costs were reviewed. Fifty patients were enrolled in this study. All but 5 plates in group I required readjustment. In group II, plates were placed without intraoperative handling. Average operating times were 4.20 ± 0.56 hours in group I and 3.186 ± 0.28 hours in group II (P = .00002). Mean times for plate placement were 33.36 ± 8.20 and 21.88 ± 5.73 minutes in groups I and II, respectively. The difference resulted in an average time gain of 11.48 minutes. Average personal costs per minute were US$740.77 for group I and US$560.87 for group II. The difference resulted in an average saving of approximately US$179.90. Segmental mirroring is superior in reflecting the bone anatomy in 3-dimensional models, thus eliminating intraoperative plate readjustment and providing better plate adaptation with better contour. It decreases operating time and costs and thus can be recommended for lesions that do not cross the midline.

Rapid prototyping and patient-specific pre-contoured reconstruction plate for comminuted fractures of the mandible

The clinical use of rapid prototype, 3-dimensional models and pre-bent reconstruction plates is recognised for mandibular reconstruction after resection of cancer. We describe a new approach using similar techniques in the management of complicated mandibular fractures.

Patient-specific reconstruction plates are the missing link in computer-assisted mandibular reconstruction: A showcase for technical description

IntroductionPreoperative planning of mandibular reconstruction has moved from mechanical simulation by dental model casts or stereolithographic models into an almost completely virtual environment. CAD/CAM applications allow a high level of accuracy by providing a custom template-assisted contouring approach for bone flaps. However, the clinical accuracy of CAD reconstruction is limited by the use of prebent reconstruction plates, an analogue step in an otherwise digital workstream. Technical reportIn this paper the integration of computerized, numerically-controlled (CNC) milled, patient-specific mandibular plates (PSMP) within the virtual workflow of computer-assisted mandibular free fibula flap reconstruction is illustrated in a clinical case. Intraoperatively, the bone segments as well as the plate arms showed a very good fit. Postoperative CT imaging demonstrated close approximation of the PSMP and fibular segments, and good alignment of native mandible and fibular segments and intersegmentally. Over a follow-up period of 12 months, there was an uneventful course of healing with good bony consolidation. ConclusionThe virtual design and automated fabrication of patient-specific mandibular reconstruction plates provide the missing link in the virtual workflow of computer-assisted mandibular free fibula flap reconstruction.

Mandibular reconstruction using plates prebent to fit rapid prototyping 3-dimensional printing models ameliorates contour deformity.

BackgroundRecently, medical rapid prototyping (MRP) models, fabricated with computer-aided design and computer-aided manufacture (CAD/CAM) techniques, have been applied to reconstructive surgery in the treatment of head and neck cancers. Here, we tested the use of preoperatively manufactured reconstruction plates, which were produced using MRP models. The clinical efficacy and esthetic outcome of using these products in mandibular reconstruction was evaluated.MethodsA series of 28 patients with malignant oral tumors underwent unilateral segmental resection of the mandible and simultaneous mandibular reconstruction. Twelve patients were treated with prebent reconstruction plates that were molded to MRP mandibular models designed with CAD/CAM techniques and fabricated on a combined powder bed and inkjet head three-dimensional printer. The remaining 16 patients were treated using conventional reconstruction methods. The surgical and esthetic outcomes of the two groups were compared by imaging analysis using post-operative panoramic tomography.ResultsThe mandibular symmetry in patients receiving the MRP-model-based prebent plates was significantly better than that in patients receiving conventional reconstructive surgery.ConclusionsPatients with head and neck cancer undergoing reconstructive surgery using a prebent reconstruction plate fabricated according to an MRP mandibular model showed improved mandibular contour compared to patients undergoing conventional mandibular reconstruction. Thus, use of this new technology for mandibular reconstruction results in an improved esthetic outcome with the potential for improved quality of life for patients.

Costs incurred by applying computer-aided design/computer-aided manufacturing techniques for the reconstruction of maxillofacial defects

This study aims to evaluate the additional costs incurred by using a computer-aided design/computer-aided manufacturing (CAD/CAM) technique for reconstructing maxillofacial defects by analyzing typical cases. The medical charts of 11 consecutive patients who were subjected to the CAD/CAM technique were considered, and invoices from the companies providing the CAD/CAM devices were reviewed for every case. The number of devices used was significantly correlated with cost (r = 0.880; p < 0.001). Significant differences in mean costs were found between cases in which prebent reconstruction plates were used (€3346.00 ± €29.00) and cases in which they were not (€2534.22 ± €264.48; p < 0.001). Significant differences were also obtained between the costs of two, three and four devices, even when ignoring the cost of reconstruction plates. Additional fees provided by statutory health insurance covered a mean of 171.5% ± 25.6% of the cost of the CAD/CAM devices. Since the additional fees provide financial compensation, we believe that the CAD/CAM technique is suited for wide application and not restricted to complex cases. Where additional fees/funds are not available, the CAD/CAM technique might be unprofitable, so the decision whether or not to use it remains a case-to-case decision with respect to cost versus benefit.

Towards Characterizing the “Immunoscore” in the Tumor Microenvironment in Oral, Head and Neck Cancer

rehabilitation. Fibular free flaps were utilized to immediately reconstruct themaxilla andmandible in six patients, facilitating orthognathic jaw position, favorable facial projection, separation of the nose and mouth, and oral competence. The remaining patients were treated without microvascular free tissue transfer, but the virtual planning, pre-bent reconstruction plates, and intraoperative imaging significantly aided accurate reconstruction. Intraoperative CT scans facilitated recognition of minor inaccuracies in orbital plate placement in two patients, the position of which was corrected prior to leaving the operating room. Conclusion: Computer-aided presurgical planning, custom cutting guides and guide stents, and intraoperative imaging have the potential to favorably affect the functional and aesthetic outcomes of patientswith severe facial injuries resulting from gunshot wounds.

Mandible reconstruction with patient-specific pre-bent reconstruction plates: comparison of a transfer key method to the standard method—results of an in vitro study

Patient-specific mandible reconstruction plates may be pre-bent to facilitate the surgical procedure. A method using transfer keys (TK) for repositioning pre-bent plates was compared with the standard method on mandibular models to evaluate its feasibility. Ten mandible models were used to pre-bend reconstruction plates. After plate fixing on the models, TK were fabricated. Plates and TK were removed and segmental resections were performed. The plates were replaced on the models by the standard method of determining the plate position using previous screw holes. Plates were removed and then relocated by use of the TK. To compare the accuracy of both methods, the distances between four corresponding points of the condyles and the mandibular rami were measured. The mean deviation of the absolute values from the initial values for the models between the condyles and the rami was 0.964 mm for the standard method and 0.821 mm for the TK method. To determine whether there was enlargement or shrinkage between the rami or the condyles, we analysed the relative values of the data. For the standard method, the mean deviation from the initial values was +0.178 mm; for the TK method, it was +0.080 mm. In both cases, the differences were not significant. Pre-bent reconstruction plates using patient-specific 3D models can be useful in mandible reconstruction. The TK method was tested in vitro and shown to be as accurate as the standard method. The TK method may shorten the procedure and may be useful for secondary cases and cases where the pathology involves the outer corte of the mandible.

Deep circumflex iliac artery flap combined with a costochondral graft for mandibular reconstruction

Our aim was to use the deep circumflex iliac artery (DCIA) flap together with a costochondral graft as a safe and reliable bone flap for routine reconstruction of the mandibular body and the temporomandibular joint (TMJ). Five patients with benign tumours of the mandible had segmental mandibulectomy including the condyle, and this was reconstructed in one stage using the DCIA combined with a constochondral graft. The rib was inserted into the iliac crest as a whole transplant, and fixed to the proximal stump of the mandible with a prebent reconstruction plate according to a computer-aided design. The grafts healed uneventfully, and dental implants were inserted in 4 cases. During the 2-year follow-up these patients had good mandibular function, including mouth opening, force of bite, and occlusion. The radiographs showed good bony consolidation between the graft and the stump of the mandible and function of the TMJ. A DCIA flap combined with a costochondral graft is a safe and reliable way to provide not only a large bulk of bone to suit the mandible, but also good function of the TMJ in the absence of radiotherapy.

Experience with the Use of Prebent Plates for the Reconstruction of Mandibular Defects

Bending of large titanium plates for mandibular reconstruction is a tedious task. This is usually done by trial and error over an intraoperatively bent template. By means of rapid prototype technology, accurate three-dimensional models can be obtained. Using these models, it is possible to design, obtain, and adapt custom hardware for individual surgical cases. Reductions of operating room time when using this technology have been reported from 17% to 60%, with an average of 20%. This translates to reduction of cost and risks, improving the overall surgical outcome. The purpose of this article is to establish the indications and contraindication for the use three-dimensional models and prebent plates. We present our experience with five cases in which prebent reconstruction plates were used for mandibular reconstruction. No significant complications occurred, and satisfactory results were achieved in all cases. We found that the models required to obtain the hardware are extremely accurate, have multiple reported applications, and represent a valuable surgical tool in the planning and execution of reconstructive surgery.