Abstract
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 language | English |
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Pages (from-to) | 1265-1274 |
Number of pages | 10 |
Journal | Oral diseases |
Volume | 26 |
Issue number | 6 |
Early online date | 2020 |
DOIs | |
Publication status | Published - 14-Apr-2020 |
Keywords
- CAD-CAM
- finite element analysis
- mandibular reconstruction
- mouth neoplasms
- patient-specific modelling
- prosthesis and implants
- RECONSTRUCTION PLATES
- ACCURACY
- FRACTURE
- RESECTION
- SURGERY
- BEHAVIOR
- IMPLANT
- JOINT