Tso Theodore V, Do Nicholas, Park Sohyun S, Burris Briana, Crum Eric
Division of Maxillofacial Surgery and Hospital Dentistry, Harbor-UCLA Medical Center, Torrance, Calif.
Division of Regenerative and Reconstructive Sciences, UCLA School of Dentistry, Los Angeles, Calif.
Plast Reconstr Surg Glob Open. 2022 Sep 28;10(9):e4542. doi: 10.1097/GOX.0000000000004542. eCollection 2022 Sep.
Fibula flap reconstruction with primary dental implant placement has been established as a successful procedure for composite mandibular defects. When using virtual surgical planning, these techniques typically require additional personnel and materials preoperatively and intraoperatively to fabricate occlusal-based guidance and prosthesis. The authors present a technique utilizing a custom-made implant-supported prosthesis completed before surgery that greatly reduces lead time and needed resources. The authors follow the established workflow of segmental mandibulectomy and fibula flap reconstruction using premanufactured cutting guides and placement of dental implants. Cylindrical holes along the implant axes are included in the printed surgical model provided by the guide manufacturer. Acrylic resin and abutments are added to the model to a positioning stent for use during surgery that does not require intraoperative modification before fibula inset. This ensures optimal position for facial esthetics and fixed dental rehabilitation. The presented technique uses printed models already provided by the guide manufacturer, reducing preparation time and requiring fewer personnel and materials intraoperatively. This is an approach to the jaw-in-a-day procedure with a lower barrier to entry that may be used by new craniofacial teams.
带牙种植体一期植入的腓骨瓣重建术已被确立为修复下颌骨复合缺损的一种成功术式。在使用虚拟手术规划时，这些技术通常在术前和术中需要额外的人员和材料来制作咬合导向装置和假体。作者介绍了一种技术，即利用术前完成的定制种植体支持的假体，这大大缩短了准备时间并减少了所需资源。作者遵循使用预制切割导板和植入牙种植体的节段性下颌骨切除术及腓骨瓣重建的既定工作流程。导板制造商提供的打印手术模型中包含沿种植体长轴的圆柱形孔。将丙烯酸树脂和基台添加到模型上，制成一个定位支架，用于手术期间，在腓骨植入前无需术中修改。这确保了面部美观和固定牙修复的最佳位置。所介绍的技术使用导板制造商已提供的打印模型，减少了准备时间，并且术中所需人员和材料更少。这是一种“一日下颌骨重建”手术的方法，入门门槛较低，新的颅面团队也可采用。
