Mandibular resection may be an essential part of treatment for benign or malignant conditions such as trauma, osteomyelitis or osteoradionecrosis, keratocystic tumors or oral cancer. Once mandibular continuity is lost, the large defects can be challenging to reconstruct, and this is due to both functional and aesthetic reasons (Essig et al. 2011, Modabber et al. 2012). Several options are available for reconstruction, including vascularized bone grafts combined with load-bearing reconstruction plates (Rana et al. 2012).
Well-established osseous donor sites providing sufficient bone length include fibula, iliac crest and scapula flaps (Sullivan et al. 1989, Urken et al. 1998). The vascularized free fibula flap is often the first choice for mandibular reconstruction (Wang et al. 2011). The shape and quality of the cortico-cancellous bone is suitable for contouring, by osteotomies, and allows placement of dental implants, for complete reconstruction and rehabilitation. The reconstruction of the mandible and the required contouring of the osseous fibula flap, are dependent on mini- or reconstruction plates that need to be adjusted intraoperatively based on the outer contour of the original mandible.
With the development of patient-specific functionalized implants (PSFI), another possibility to achieve a true-to-origin contour of resected bone has been established (Roser et al. 2010). The accuracy of reconstruction plates created by computer-aided design/computer-aided manufacturing (CAD/CAM) or selective laser melting (SLM) is superior to the manually bent reconstruction plates. CAD/CAM or SLE plates are also superior in terms of strength and intraoperative positioning, when compared to manually bent plates, which are important parameters for a tailored reconstruction (Wilde et al. 2012, Wilde et al. 2015). In the last few years computer-assisted surgery had a positive impact on the outcome of reconstructions in oral and maxillofacial surgery and the scope of the technique has been increasing (Eckardt et al. 2005). Although this approach can be readily available, most reconstructive units do not use it, due to limitations in terms of costs, time and lack of experience.
Another advantage of the planning session, is that certain complex aspects of surgery could be anticipated and a personalized treatment plan could be drafted due to the recent developments in virtual planning and PSFI. However, PSFIs are still not integrated into clinical routine because of several disadvantages: (1) The current workflow requires a web-based platform for web meeting with engineers, which is often time-consuming and expensive while the functional considerations of the plate are limited, (2) surgical guides for both resecting and flap harvesting are necessary in order to accurately execute the treatment plan. The introduction of the new selective laser melting procedure into CMF reconstruction might be a reasonable solution (Rana, Chui et al. 2015).
Based on our results, the use of PSFIs in the reconstruction of mandibular segmental defects may contribute to a better clinical outcome. Further work will be required in order to evaluate their mechanical properties in detail.