Lingual Application of Pre-Bent Reconstruction Plate for Segmental Mandibular Defect: Easy and Accurate Method Through the Buccal Drilling Approach Using Computer-Aided Design/Computer-Aided Manufacturing Surgical Guides.

To prevent or treat for complications of reconstruction plate, such as metal plate fracture, plate exposure, and formation of skin fistula, the use of reconstruction plates on the mandibular lingual aspect has been introduced. However, this method increases the difficulty of surgery and lengthens the surgery time. In this study, the authors aimed to present a method to apply for reconstruction plates on the lingual side of the mandible to overcome the complications associated with the use of these plates. In the proposed method, the reconstruction plate was bent and fixed by a specially designed screws on a three-dimensional model created through a pre-operative virtual surgical simulation. Next, the model, prebent reconstruction plant, and screw were 3-dimensionally scanned and then superimposed precisely onto the three-dimensional model generated through the virtual surgical simulation. After extracting the three-dimensional path of the screws on the superimposed model, a surgical guide was prepared to drill screw holes in the buccal side of the mandible by transferring the extracted paths. The proposed surgical method using virtual surgical planning and surgical guides makes mandibular lingual application of the prebent reconstruction plates convenient, fast, and precise through drilling in the buccal side of the mandible.