Modabber Ali, Möhlhenrich Stephan Christian, Ayoub Nassim, Hajji Mohammad, Raith Stefan, Reich Sven, Steiner Timm, Ghassemi Alireza, Hölzle Frank
1 Department of Oral, Maxillofacial and Plastic Facial Surgery, RWTH Aachen University Hospital, Aachen, Germany.
2 Department of Prosthodontics and Dental Materials, RWTH Aachen University Hospital, Aachen, Germany.
J Oral Implantol. 2015 Oct;41(5):e189-94. doi: 10.1563/aaid-joi-D-13-00341. Epub 2014 Jun 19.
The intention of oral rehabilitation in patients with mandibular defects is an early prosthetic treatment with maximum possible functionality and high accuracy. The present study describes a new computer-aided technique for mandibular reconstruction using a free vascularized iliac flap and simultaneous insertion of dental implants into the flap while it is still pedicled at the donor site. Based on preoperative computerized tomography data of the facial skeleton and the iliac crest donor site, a surgical guide transferred the virtual plan including information on the transplant dimensions and shape as well as the position of the dental implants into real-time surgery. Using postoperative computerized tomography scans, the actual situation were compared with the preoperative simulation. A mean difference of 0.75 mm (SD ± 0.72) for the flap shape and 0.70 mm (SD ± 0.44) for the implant position analysis was determined. A calculation of the closest point distance showed a surface deviation of <2 mm for the shape analysis in 93.3% of the values and <1 mm for implant position in 75.2% of the values. The mean angular deviation was 3.65°. Virtual surgical planning is a suitable method for mandibular reconstruction with vascularized iliac crest flaps and simultaneous implant surgery. It can be used to restore the anatomy of the mandible with a high accuracy and can help to shorten subsequent dental rehabilitation.
下颌骨缺损患者口腔修复的目的是尽早进行修复治疗，以实现尽可能高的功能和精度。本研究描述了一种新的计算机辅助技术，用于下颌骨重建，该技术使用带血管蒂的游离髂骨瓣，并在瓣仍与供区相连时同时将牙种植体植入瓣内。基于面部骨骼和髂嵴供区的术前计算机断层扫描数据，手术导板将包括移植体尺寸和形状信息以及牙种植体位置的虚拟计划转换为实时手术。通过术后计算机断层扫描，将实际情况与术前模拟进行比较。确定瓣形状的平均差异为0.75 mm（标准差±0.72），种植体位置分析的平均差异为0.70 mm（标准差±0.44）。最近点距离计算显示，93.3%的形状分析值表面偏差<2 mm，75.2%的种植体位置值表面偏差<1 mm。平均角度偏差为3.65°。虚拟手术规划是一种适用于带血管蒂髂骨瓣下颌骨重建和同期种植手术的方法。它可用于高精度恢复下颌骨解剖结构，并有助于缩短后续牙齿修复时间。
