Freudlsperger Christian, Bodem Jens Philipp, Engel Eva, Hoffmann Jürgen
From the *Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg; †Department of Oral and Maxillofacial Surgery, University Hospital Tübingen, and ‡Department of Prosthodontics and Dental Material Sciences, Center for Oral Medicine and Dentistry, University Hospital Tübingen, Tübingen, Germany.
J Craniofac Surg. 2014 May;25(3):980-2. doi: 10.1097/SCS.0000000000000551.
Because optimal reconstruction of maxillofacial defects requires functional rehabilitation, the current study demonstrates the successful secondary reconstruction of a large mandibular continuity defect using a fully digitally planned prefabricated free vascularized fibula with immediate implant-supported prosthodontic restoration. A 56-year-old man presented with a large mandibular continuity defect after resection of an enlarged squamous cell carcinoma arising from the floor of the mouth. For secondary reconstruction, the shape of the neomandible and implant position for support of the lower prosthesis were planned virtually. The combined cutting and drilling guide was printed in 3 dimensions. In a 2-step surgical approach, first, the implants were inserted into the fibula and covered with a split-thickness skin graft to form a neogingiva. In a second operation, the fibula was harvested, osteotomized, and fixed with the denture on the preinserted implants. The fibula was placed to its final position guided by the occlusion. Using three-dimensional virtual backward planning, it was feasible to perform a mandibular reconstruction with immediate prosthetic rehabilitation.
由于颌面缺损的最佳重建需要功能康复，当前研究展示了使用完全数字化规划的预制带血管游离腓骨并即刻进行种植体支持的修复体修复，成功地对大型下颌骨连续性缺损进行了二期重建。一名56岁男性因切除源于口底的增大的鳞状细胞癌后出现大型下颌骨连续性缺损。对于二期重建，通过虚拟规划新下颌骨的形状以及支持下部修复体的种植体位置。将组合切割和钻孔导板进行三维打印。采用两步手术方法，首先，将种植体植入腓骨并用断层皮片覆盖以形成新牙龈。在第二次手术中，切取腓骨、进行截骨并将义齿固定于预先植入的种植体上。根据咬合关系将腓骨放置到最终位置。使用三维虚拟逆向规划，即刻进行修复性康复的下颌骨重建是可行的。
