3D planning in the reconstruction of maxillofacial defects

Resection of a tumor in the upper- or lower jaw often results in a large defect, because with the tumor resection also an adjacent part of the jaw is resected. The most favorable treatment for large defects is the combination of a bony free vascularized graft to reconstruct the defect with implants to retain prosthetic constructions. The Free vascularized Fibula Flap (FFF) is a versatile flap that commonly is used to reconstruct such bony and soft tissue defects. It is shown that oral rehabilitation with implant-supported dental prostheses after reconstruction of the mandibular or maxillary defects with segmented FFFs results in acceptable function, and good to excellent speech intelligibility and aesthetics. This phd research investigates the best way of virtual planning of the FFF and dental implants. The current developed technique according to Rohner is labor intensive considering the many planning steps and the highly qualified dental technicians that are needed to develop the drilling guides etc. In this phd research this planning technique is simplified and therefore more general applicable. The procedure can now be planned entirely virtual and the drilling guides, reconstruction plates and prosthetics can be produced CAD-CAM. The accuracy of this method is good. A problem that had to be solved in the virtual planning of immediate reconstruction of malignant tumors was the determination of tumor boundaries. To solve this a method is developed using tumor delineation on a magnetic resonance image (MRI), similar to the routinely performed contouring of tumors ((ConeBeam)CT) in the radiotherapy plan.