Salinero Lauren, Boczar Daniel, Barrow Brooke, Berman Zoe P, Diep Gustave K, Trilles Jorge, Howard Rachel, Chaya Bachar F, Rodriguez Colon Ricardo, Rodriguez Eduardo D
Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 222 E 41st Street, New York, NY, USA.
Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 222 E 41st Street, New York, NY, USA.
Br J Oral Maxillofac Surg. 2022 Dec;60(10):1283-1291. doi: 10.1016/j.bjoms.2022.09.006. Epub 2022 Sep 28.
Computerised surgical planning (CSP) and computer-aided design and manufacturing (CAD/CAM) have been demonstrated to increase surgical accuracy and reduce operative time in free flap mandibular reconstruction, but evidence is lacking as to their impact on patient-centred outcomes. Implant-supported dental prostheses, however, have been associated with improved quality of life outcomes following free flap mandibular reconstruction. We aim to review reported patient-centred outcomes in mandibular reconstruction with CSP and CAD/CAM and determine whether use of these technologies is associated with higher rates of dental implant placement following free flap mandibular reconstruction. On December 20, 2020, a systematic review and meta-analysis were conducted according to PRISMA guidelines for studies reporting quality of life, functional outcomes, and rates of dental implant placement in computer-aided free flap mandibular reconstruction. A random-effects meta-analysis was performed to compare dental implant placement rates between surgeries using CSP and those using conventional freehand techniques. A total of 767 articles were screened. Nine articles reporting patient-centred outcomes and 16 articles reporting dental implant outcomes were reviewed. Of those reporting dental implant outcomes, five articles, representing a total of 302 cases, were included in the meta-analysis. Use of CSP was associated with a significant increase in the likelihood of dental implant placement, with an odds ratio of 2.70 (95% CI 1.52 to 4.79, p = 0.0007). Standardised reporting methods and controlled studies are needed to further investigate the impact of CSP and CAD/CAM technologies on functional outcomes and patient-reported quality of life in free flap mandibular reconstruction. Use of CSP and CAD/CAM technologies is associated with higher rates of dental implant placement in patients undergoing free flap mandibular reconstruction when compared to conventional freehand techniques.
计算机辅助手术规划（CSP）以及计算机辅助设计与制造（CAD/CAM）已被证明可提高游离皮瓣下颌骨重建手术的准确性并缩短手术时间，但关于它们对以患者为中心的结局的影响，目前尚缺乏证据。然而，种植体支持的牙修复体与游离皮瓣下颌骨重建术后生活质量的改善相关。我们旨在回顾已报道的采用CSP和CAD/CAM进行下颌骨重建时以患者为中心的结局，并确定使用这些技术是否与游离皮瓣下颌骨重建术后更高的牙种植体植入率相关。2020年12月20日，根据PRISMA指南进行了一项系统评价和荟萃分析，纳入报告计算机辅助游离皮瓣下颌骨重建中生活质量、功能结局及牙种植体植入率的研究。采用随机效应荟萃分析比较使用CSP的手术与使用传统徒手技术的手术之间的牙种植体植入率。共筛选了767篇文章。回顾了9篇报告以患者为中心结局的文章和16篇报告牙种植体结局的文章。在那些报告牙种植体结局的文章中，5篇文章（共302例）被纳入荟萃分析。使用CSP与牙种植体植入可能性的显著增加相关，优势比为2.70（95%CI 1.52至4.79，p = 0.0007）。需要标准化的报告方法和对照研究，以进一步调查CSP和CAD/CAM技术对游离皮瓣下颌骨重建中功能结局和患者报告的生活质量的影响。与传统徒手技术相比，使用CSP和CAD/CAM技术与游离皮瓣下颌骨重建患者更高的牙种植体植入率相关。
