Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Pok Fu Lam, Hong Kong Special Administrative Region.
Discipline of Prosthodontics, Faculty of Dentistry, The University of Hong Kong, Pok Fu Lam, Hong Kong Special Administrative Region.
Clin Implant Dent Relat Res. 2021 Feb;23(1):43-53. doi: 10.1111/cid.12954. Epub 2020 Nov 12.
Conventional freehand immediate placement of dental implants is technically challenging in the jaw reconstructive surgery. Computer-aided surgery might be the best solution, however, there has not been any standard approach to ensure the accuracy and efficiency of simultaneous dental implants in fibula flap jaw reconstruction.
We aim to evaluate the clinical outcome of simultaneous dental implant in fibula flap using the "three-in-one" patient-specific surgical guide (3-in-1-PSSG) in an open-label, prospective, single-arm, and single-center clinical trial.
A novel computer-aided designed and three-dimensional (3D) printed 3-in-1-PSSG, which contains functions of fibula segmentation, surgical plate positioning and implant placement, was used to facilitate the reconstructive surgery and simultaneous dental implant placement. The intraoperative success of dental implant placement, implant survival rate and accuracy of dental implant placement were reported.
From November 2018 to June 2020, 15 consecutive patients with 48 dental implants were enrolled in this study. Fifteen 3-in-1-PSSGs were fabricated with a mean number of dental implants per guide of 3.2 ± 1.5. The intraoperative success rate of this approach was 14 out of 15. With an average follow-up period of 40 weeks, the overall implant survival rate was 83.3% (40/48). Eight implants were removed due to two fibula flap failures. The mean deviation at the implant platform and implant apex were 2.8 mm (interquartile range [IQR]: 1.9-3.4) and 3.2 mm (IQR: 2.0-4.6), and the angular deviation was 2.5° (IQR: 1.1-6.8).
Our preliminary data indicated that the 3D printed 3-in-1-PSSG facilitated simultaneous dental implant in fibula flap jaw reconstruction with a favorable intraoperative success and short-term clinical outcome. It might be a viable alternative to allow one-step immediate oral rehabilitation in patients underwent jaw reconstruction with free flaps. Long-term results with a larger sample size are warranted.
在颌骨重建手术中，传统的徒手即刻植入牙种植体技术具有挑战性。计算机辅助手术可能是最好的解决方案，但在腓骨瓣颌骨重建中，还没有任何标准方法来确保同时植入牙种植体的准确性和效率。
我们旨在通过一项开放标签、前瞻性、单臂、单中心的临床试验，评估使用“三合一”患者专用手术导板（3-in-1-PSSG）在腓骨瓣中同时植入牙种植体的临床效果。
一种新型的计算机辅助设计和三维（3D）打印的 3-in-1-PSSG，具有腓骨分割、手术板定位和种植体放置功能，用于辅助重建手术和同时植入牙种植体。报告了牙种植体放置的术中成功率、种植体存活率和种植体放置的准确性。
从 2018 年 11 月至 2020 年 6 月，连续纳入 15 例患者的 48 颗牙种植体，共 15 例患者使用 3-in-1-PSSG。每个导板的平均种植体数量为 3.2±1.5。该方法的术中成功率为 14/15。平均随访 40 周后，种植体总体存活率为 83.3%（40/48）。8 颗种植体因 2 例腓骨瓣失败而被取出。种植体平台和种植体根尖的平均偏差为 2.8mm（四分位距[IQR]：1.9-3.4）和 3.2mm（IQR：2.0-4.6），角度偏差为 2.5°（IQR：1.1-6.8）。
我们的初步数据表明，3D 打印的 3-in-1-PSSG 辅助腓骨瓣颌骨重建中同时植入牙种植体具有良好的术中成功率和短期临床效果。它可能是一种可行的替代方法，允许在接受游离皮瓣颌骨重建的患者中进行一步即刻口腔修复。需要更大样本量的长期结果。
