Novel finite element-based plate design for bridging mandibular defects: Reducing mechanical failure

Bram B J Merema*, Joep Kraeima, Sebastiaan A H J de Visscher, Baucke van Minnen, Fred K L Spijkervet, Kees-Pieter Schepman, Max J H Witjes

*Corresponding author for this work

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Introduction: When the application of a free vascularised flap is not possible, a segmental mandibular defect is often reconstructed using a conventional reconstruction plate. Mechanical failure of such reconstructions is mostly caused by plate fracture and screw pull-out. This study aims to develop a reliable, mechanically superior, yet slender patient-specific reconstruction plate that reduces failure due to these causes. Patients and Methods: Eight patients were included in the study. Indications were as follows: fractured reconstruction plate (2), loosened screws (1) and primary reconstruction of a mandibular continuity defect (5). Failed conventional reconstructions were studied using finite element analysis (FEA). A 3D virtual surgical plan (3D-VSP) with a novel patient-specific (PS) titanium plate was developed for each patient. Postoperative CBCT scanning was performed to validate reconstruction accuracy. Results: All PS plates were placed accurately according to the 3D-VSP. Mean 3D screw entry point deviation was 1.54 mm (SD: 0.85, R: 0.10–3.19), and mean screw angular deviation was 5.76° (SD: 3.27, R: 1.26–16.62). FEA indicated decreased stress and screw pull-out inducing forces. No mechanical failures appeared (mean follow-up: 16 months, R: 7–29). Conclusion: Reconstructing mandibular continuity defects with bookshelf-reconstruction plates with FEA underpinning the design seems to reduce the risk of screw pull-out and plate fractures.

Original languageEnglish
Pages (from-to)1265-1274
Number of pages10
JournalOral diseases
Issue number6
Early online date2020
Publication statusPublished - 14-Apr-2020


  • finite element analysis
  • mandibular reconstruction
  • mouth neoplasms
  • patient-specific modelling
  • prosthesis and implants

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