Virtual planning,simultaneous dental implantation and CAD/CAM plate fixation: a paradigm change in maxillofacial reconstruction |
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| Affiliation: | 1. Associate Professor, Department of General Dentistry, Chang Gung Memorial Hospital, Linkou, Taiwan, Republic of China;1. Adjunct Lecturer, School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China;2. Associate Professor, Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan, Republic of China;2. Associate Professor, Center for Neuropsychiatry, China Medical University Hospital, Taichung, Taiwan, Republic of China;3. Associate Professor, Department of Social Work, Asia University, Taichung, Taiwan, Republic of China;3. Researcher, Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan, Republic of China;4. Adjunct Assistant Professor, School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China;4. Associate Professor, Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei, Taiwan, Republic of China;1. Resident, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy, and Maxillofacial and Dental Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy;2. Postdoctoral Student, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy, and Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy;3. Research Associate, Maxillofacial and Dental Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy, and Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy;4. Resident, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy, and Maxillofacial and Dental Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy;6. Research Associate, Maxillofacial and Dental Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy, and Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy;5. Adjunct Professor, Maxillofacial and Dental Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy, and Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy;7. Professor, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy;1. Clinical Staff, Maxillofacial Oncology and Microvascular Reconstruction, Department of Oral and Maxillofacial Surgery, McGill University Health Centre, Montreal, QC, Canada;2. Director and Associate Professor, Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, McGill University; and Chief, Department of Dentistry and Oral and Maxillofacial Surgery, McGill University Health Centre, Montreal, QC, Canada;1. Associate Professor, Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón Madrid, Spain;2. Assistant Professor, Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain;3. Assistant Professor, Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón Madrid, Spain;4. Assistant Professor, Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain;6. Assistant Professor, Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón Madrid, Spain;5. Assistant Professor, Facultad de Odontología, Universidad de Murcia, Murcia, Spain;1. University Hospital Giessen, Dept. for Maxillofacial Surgery, (Head: Prof. Dr. Hans-Peter Howaldt), Klinikstr. 33, 35392, Giessen, Germany;2. University Hospital Kiel, Dept. for Maxillofacial Surgery, (Head: Prof. Dr. Joerg Wiltfang), Arnold-Heller-Straße 16, 24105, Kiel, Germany;3. Experimental Trauma Surgery, Faculty of Medicine, Justus Liebig University Giessen, Germany;4. Justus-Liebig-University Giessen, Department of Prosthodontics, Schlangenzahl 14, 35392 Giessen, Germany;1. Consultant, Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Zurich, Zurich, Switzerland;2. Private Practitioner, Winterthur, Switzerland;3. Consultant, Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Zurich, Zurich, Switzerland;4. Resident, Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Zurich, Zurich, Switzerland;6. Professor, Head of Department, Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Zurich, Zurich, Switzerland;5. Consultant, Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Zurich, Zurich, Switzerland |
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| Abstract: | Prosthetic rehabilitation in patients undergoing reconstructive surgery using vascularized free flaps is challenging, and functional rehabilitation of the patient with a fixed prosthesis is rare. Virtually planned maxillofacial reconstruction including simultaneous dental implantation according to the prosthodontic ideal position of the implants could further enhance dental rehabilitation. The data of 21 patients undergoing fibula free flap reconstructive surgery with CAD/CAM patient-specific reconstruction plates during the years 2015–2018 were analysed, including the applicability of the virtual plan, flap survival, duration of surgery, ischemia time, simultaneous dental implantation, implant exposure, and postoperative complications. The virtual plan could be translated to surgery in all cases. In total, 76 dental implants were simultaneously placed during primary reconstruction in the 21 patients. For 38.1% of these patients, the implants could be uncovered in secondary surgery; the mean duration until exposure was 7.6 months. The implant survival rate was 97.4% (74/76). Wound infection requiring a secondary intervention occurred in 23.8% of patients during follow-up. Virtually planned reconstruction with a fibula free flap, simultaneous dental implantation, and CAD/CAM plates allows early and functional dental rehabilitation. A dental workflow should be integrated into the virtual planning, and prosthetically favourable implant positions should determine the position of the fibula segments. |
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| Keywords: | virtual planning reconstruction fibula free flap dental implants CAD/CAM plates |
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