Computer-aided design/computer-aided manufacturing (CAD/CAM) technology has improved the functional and morphological results of mandibular reconstructive surgery. The purpose of this study was to ...objectively assess this technology and factors affecting its accuracy. Fibula free flap mandibular reconstruction was performed in 26 cases using CAD/CAM technology at the Maxillofacial Unit of Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, between June 2014 and February 2018. We evaluated the technology’s accuracy by comparing the virtual surgical planning STL file (planned-target mesh) with the STL file from an early postoperative CT scan (postoperative-achievement mesh) in each case. The STL files were imported into Geomagic Studio 2016 (Geomagic GmbH). According to the position of the reconstruction plate (fixed reference point), we assessed deviations at the right condyle, right gonion, gnathion, left gonion and left condyle, calculating mean, minimum and maximum error values. Mean error values ranged from 0.6 to 2.2 mm; they were ≥ 2 mm in only 2 (7.7%) cases. The midline area (symphysis-gnathion) showed the least variation (1.05 ± 0.92 mm), and the gonion area showed the greatest variation (right and left means of 1.6 and 1.46 mm, respectively). Among all possible factors that could affect CAD\CAM accuracy, nothing showed significant influence, including the timing of reconstruction, site and size of the defect and malignancy status. CAD/CAM technology has a high degree of accuracy and reproducibility for microvascular reconstruction of mandibular defects using fibula free flaps, regardless of the defect site and length, use of a single- or double-barrel graft or timing of reconstruction.
The success of implant-supported fixed complete dental prostheses (ISFCDPs) depends on multiple factors: some are related to the fixtures, such as fixture material, surface characteristics, ...positioning, and type of connection to prosthetic components; others are related to the prostheses, such as design and materials used. Zirconia is a material widely used in fixed prosthodontics, whether on natural teeth or on implants, with excellent results over time. Regarding the use of zirconia for ISFCDPs, the 2018 ITI Consensus Report stated that "implant-supported monolithic zirconia prostheses may be a future option with more supporting evidence". Since CAD/CAM technology and zirconia are being continuously innovated to achieve better results and performances over time, a narrative review of the literature seems necessary to focus research efforts towards effective and durable solutions for implant-supported, full-arch rehabilitations. The objective of the present narrative review was to search the literature for studies regarding the clinical performance of zirconia-based ISFCDPs. According to the results of this review, the use of zirconia for ISFCDPs showed good clinical outcomes, with high survival rates ranging from 88% to 100% and prosthetic complications that were restorable by the clinicians in most cases.
The fibula free flap (FFF) is regarded as the gold standard in mandibular reconstruction. Dental rehabilitation is important to improve the health-related quality of life of patients undergoing ...mandibular reconstruction. FFF provides adequate cortical bone osseous tissue for use in dental implantation. The application of “axial split osteotomy” via a double-barrel fibula graft may enable discrepancies between the native mandible and FFF to be avoided, thereby improving the likelihood of early and successful dental rehabilitation.
Background
Oral rehabilitation of patients after maxillofacial reconstructive surgery represents a challenge and stable prosthetic retention can be achieved with the use of dental implants.
Purpose
...This retrospective report aimed to evaluate implant‐based oral rehabilitation following maxillofacial reconstruction with free fibula flaps.
Materials and Methods
A total of 14 patients who had reconstruction with fibula flaps either by CAD/CAM or conventional surgery were included in this study. A total of 56 implants (40 in flaps, 16 in native bone) were evaluated. Follow‐up after reconstructive surgery ranged between 3.25 and 6.3 years. Follow‐up after implant surgery ranged between 1.5 and 3.8 years.
Results
Overall survival rate was 85.7% in free fibula flaps and 85.6% in dental implants. Eight implants were lost in three patients and all of these failures were in dental implants inserted in free flaps. According to the results on patient basis, the implant survival was not influenced by any variable.
Conclusions
The maxillofacial reconstruction with free fibula flap and oral rehabilitation with implant‐supported prostheses after ablative surgery can be considered as an effective and safe procedure with successful aesthetic and functional outcomes.
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CMK, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
The cost of computer-aided design and computer-aided manufacturing (CAD-CAM) technology has created obstacles for its widespread use despite its several advantages. This study compared the cost of ...CAD-CAM technology with that of the conventional freehand technique in fibula reshaping for mandibular reconstruction.
A retrospective comparative study was conducted at the Maxillofacial and Dental Unit of the Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico (Milan, Italy). The study compared 15 patients in the CAD-CAM group with 10 patients in the conventional freehand group. Only benign pathologic lesions that required at least 3 fibular segments for reconstruction were included. The consumption of resources was estimated using micro-costing analysis (activity-based costing approach).
The CAD-CAM group included 15 patients (7 men and 8 women) with a mean age of 42.2 ± 1.5 years, and the conventional freehand group included 10 patients (4 men and 6 women) with a mean age of 40.8 ± 0.9 years. Although CAD-CAM was a statistically expensive procedure in the perioperative phase (P < .0001), no significant difference was shown in total health care costs between the 2 groups (P = .98).
CAD-CAM technology had a comparable expense to the conventional freehand technique, specifically for defects requiring at least 3 fibular segments.
BackgroundOral rehabilitation of patients after maxillofacial reconstructive surgery represents a challenge and stable prosthetic retention can be achieved with the use of dental implants.PurposeThis ...retrospective report aimed to evaluate implant‐based oral rehabilitation following maxillofacial reconstruction with free fibula flaps.Materials and MethodsA total of 14 patients who had reconstruction with fibula flaps either by CAD/CAM or conventional surgery were included in this study. A total of 56 implants (40 in flaps, 16 in native bone) were evaluated. Follow‐up after reconstructive surgery ranged between 3.25 and 6.3 years. Follow‐up after implant surgery ranged between 1.5 and 3.8 years.ResultsOverall survival rate was 85.7% in free fibula flaps and 85.6% in dental implants. Eight implants were lost in three patients and all of these failures were in dental implants inserted in free flaps. According to the results on patient basis, the implant survival was not influenced by any variable.ConclusionsThe maxillofacial reconstruction with free fibula flap and oral rehabilitation with implant‐supported prostheses after ablative surgery can be considered as an effective and safe procedure with successful aesthetic and functional outcomes.
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CMK, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
The osteogenic potential of vascularized periosteum has been described in a few cases in the literature, and many different factors have been pointed out as plausible. Our aim was to review the ...literature in order to give a complete overview of this topic and to report on our clinical experience.
Our experience includes three patients who underwent maxillectomy and FFF reconstruction. A progressive reduction in mouth opening was noticed in the months after surgery, and CT scans showed calcified tissue around the pedicle. Surgical revisions were performed. No recurrences were noticed. A full systematic literature review was conducted, including studies published on or before September 2016.
Clinically, free flap pedicle ossification is presented as trismus, hard swelling, and severe pain during movements, although the diagnosis is scarce and often fortuitous. From January 2010 to January 2016 we performed 68 FFF reconstructions, and the incidence of FFF pedicle ossification in our experience was 4.4%.
Ossification of FFF pedicle is uncommon, but when it occurs, it has dramatic clinical consequences. Follow-up CT scan can be useful in diagnosis. In our experience, surgery should be performed only when the patient is symptomatic.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
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