Resident, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center of Stomatology, Beijing, China, National Clinical Research Center for Oral Diseases, Beijing, China, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China, Beijing Key Laboratory of Digital Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China, National Medical Products Administration (NMPA) Key Laboratory for Dental Materials, Beijing, China.
Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Beijing, China, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China, Beijing Key Laboratory of Digital Stomatology, Beijing, China, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China, National Medical Products Administration (NMPA) Key Laboratory for Dental Materials, Beijing, China.
J Oral Maxillofac Surg. 2022 Nov;80(11):1858-1865. doi: 10.1016/j.joms.2022.07.140. Epub 2022 Aug 5.
The current standard for mandibular reconstruction is a contour-based approach using a fibular flap offering good cosmetic results but challenging to reconstruct using dental implants. An iliac flap is more amenable to implant placement and better suited for occlusion-driven reconstruction. We aimed to describe an occlusion-driven workflow that involves the use of digital surgical guides to perform mandibular reconstruction using an iliac flap; we also aimed to compare our results to those we achieved with conventional contour-based reconstruction.
This was a retrospective cohort study. All patients who underwent mandibular reconstruction with an iliac flap at our university hospital between September 2017 and December 2019 were considered eligible for the study. The inclusion criteria included mandibular defects after tumor ablation and stable preoperative occlusal relationship. The exclusion criteria were as follows: defects involving the condyle and ramus, temporomandibular joint disease, and obvious preoperative nontumor-related facial asymmetry. To evaluate surgical outcomes, patients were assigned to 2 groups based on the implemented surgical workflow: the occlusion-driven and traditional contour-driven groups. The intermaxillary distance, intermaxillary angle, surface deviation, and implantation rates were compared between the 2 groups. The operating time, length, and number of iliac bone segments were recorded. Intergroup differences were investigated using an independent samples t test and Fisher exact test.
Overall, 24 patients were included (13 in the occlusion-driven group and 11 in the contour-driven group). Implantation rate was higher in the occlusion-driven group (61.5%) compared with the contour-driven group (18.2%; P = .047). The average acceptable intermaxillary distance was greater in the occlusion-driven group (92.3 ± 27.7%) than in the contour-driven group (47.0 ± 47.6%; P = .01). The average intermaxillary angle was 88.2 ± 8.4° in the occlusion-driven group and 76.4 ± 10.3° in the contour-driven group (P < .01).
Digital surgical guides can precisely transfer virtual surgical planning to real-world mandibular surgery. An occlusion-driven workflow might provide a better intermaxillary jaw relationship than traditional contour-driven surgical procedures, resulting in improved mastication.
目前下颌骨重建的标准是基于形态的方法，使用腓骨皮瓣可以获得良好的美容效果，但用种植体进行重建具有挑战性。髂骨瓣更适合种植体的放置，更适合咬合驱动的重建。我们旨在描述一种基于咬合的工作流程，该流程涉及使用数字手术导板使用髂骨瓣进行下颌骨重建；我们还旨在将我们的结果与传统的基于形态的重建结果进行比较。
这是一项回顾性队列研究。所有在我们大学医院接受髂骨瓣下颌骨重建的患者均符合研究条件，时间为 2017 年 9 月至 2019 年 12 月。纳入标准包括肿瘤消融后下颌骨缺损和稳定的术前咬合关系。排除标准如下：涉及下颌骨髁突和升支的缺损、颞下颌关节疾病以及明显的术前非肿瘤相关的面部不对称。为了评估手术结果，根据实施的手术流程将患者分为两组：咬合驱动组和传统形态驱动组。比较两组患者的上下颌间距离、上下颌间角度、表面偏差和种植体植入率。记录手术时间、长度和髂骨段数量。采用独立样本 t 检验和 Fisher 确切检验比较组间差异。
共有 24 例患者纳入研究（咬合驱动组 13 例，形态驱动组 11 例）。咬合驱动组的种植体植入率（61.5%）高于形态驱动组（18.2%；P=.047）。咬合驱动组可接受的平均上下颌间距离（92.3±27.7%）大于形态驱动组（47.0±47.6%；P=.01）。咬合驱动组的平均上下颌间角度为 88.2±8.4°，形态驱动组为 76.4±10.3°（P<.01）。
数字手术导板可以将虚拟手术计划精确地转化为现实世界的下颌骨手术。基于咬合的工作流程可能比传统的基于形态的手术程序提供更好的颌间关系，从而改善咀嚼功能。
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