Computer-Aided Design and Three-Dimensional-Printed Surgical Templates for Second-Stage Mandibular Reconstruction.

It is extremely difficult in clinical practice to accurately reset the physiologic positions of the mandibular condyle and ramus because of ongoing bone remodeling, muscle stretching, occlusal disorders, and other factors; this makes it difficult to obtain a good shape for a reconstructed mandible, as well as a good condylar position. The present study aimed to investigate a standardized method for mandibular reconstruction in cases of obsolete mandibular defects, using a 3-dimensional (3D)-printed surgical template enhanced by computer-aided design. We collected computed tomography data preoperatively to computerize the physiologic positions of the mandibular condyle and ramus on the sagittal, axial, and coronal planes. Surgical simulation and 3D-printed template preparation were then conducted to assist in the implementation of actual surgery. Postoperative review was performed to assess the repositioning of the condyle, where patients were found to regain a satisfactory condyle position. Reconstruction error was ±0.56 mm, fulfilling the preoperative design. No complications and discomfort were reported. Overall, the combined use of computer-aided design and 3D-printed surgical templates can standardize mandibular reconstruction in cases of obsolete mandibular body defects.