Patient-centred outcomes and dental implant placement in computer-aided free flap mandibular reconstruction: a systematic review and meta-analysis |
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| Institution: | 1. University of Glasgow Medical School, University Avenue, Glasgow G12 8QQ, United Kingdom;2. Department of Oral and Maxillofacial Surgery, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Road, Glasgow G51 4TF, United Kingdom;3. Department of Pathology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Road, Glasgow G51 4TF, United Kingdom;4. Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow G12 0YN, United Kingdom;1. ENT and Cervicofacial Surgery Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain;2. ENT and Cervicofacial Surgery Department. Villalba General University Hospital, Collado Villalba, Spain;3. Departamento de Mineralogía y Petrología, de la Facultad de Ciencias Geológicas de la Universidad Complutense de Madrid, Spain;4. Instituto de Investigación Sanitaria, Research Unit. Fundación Jiménez Diaz University Hospital, Madrid, Spain;1. Oral and Maxillofacial Surgery Unit, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK;2. Department of Colorectal and General Surgery, The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton WV10 0QP, UK;3. Department of Orthopaedics, Great Ormond St Hospital for Children, London WC1N 3JH, UK |
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| Abstract: | Computerised surgical planning (CSP) and computer-aided design and manufacturing (CAD/CAM) have been demonstrated to increase surgical accuracy and reduce operative time in free flap mandibular reconstruction, but evidence is lacking as to their impact on patient-centred outcomes. Implant-supported dental prostheses, however, have been associated with improved quality of life outcomes following free flap mandibular reconstruction. We aim to review reported patient-centred outcomes in mandibular reconstruction with CSP and CAD/CAM and determine whether use of these technologies is associated with higher rates of dental implant placement following free flap mandibular reconstruction. On December 20, 2020, a systematic review and meta-analysis were conducted according to PRISMA guidelines for studies reporting quality of life, functional outcomes, and rates of dental implant placement in computer-aided free flap mandibular reconstruction. A random-effects meta-analysis was performed to compare dental implant placement rates between surgeries using CSP and those using conventional freehand techniques. A total of 767 articles were screened. Nine articles reporting patient-centred outcomes and 16 articles reporting dental implant outcomes were reviewed. Of those reporting dental implant outcomes, five articles, representing a total of 302 cases, were included in the meta-analysis. Use of CSP was associated with a significant increase in the likelihood of dental implant placement, with an odds ratio of 2.70 (95% CI 1.52 to 4.79, p = 0.0007). Standardised reporting methods and controlled studies are needed to further investigate the impact of CSP and CAD/CAM technologies on functional outcomes and patient-reported quality of life in free flap mandibular reconstruction. Use of CSP and CAD/CAM technologies is associated with higher rates of dental implant placement in patients undergoing free flap mandibular reconstruction when compared to conventional freehand techniques. |
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| Keywords: | Computer-assisted surgery CAD-CAM three-dimensional printing free flap mandibular reconstruction dental implants |
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