RECONSTRUCTION OF MANDIBULAR BONE DEFECTS USING THREE-DIMENSIONAL SKULL MODEL AND INDIVIDUALIZED TITANIUM PROSTHETICS FROM COMPUTER ASSISTED DESIGN_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GONG Zhenyu ¹ , LI Guohua ¹ , LIU Yanpu ² , HE Lisheng ² , ZHOU Bing ¹ , LI Dichen. ³

1Department of Stomatology, Fuzhou General Hospital, Nanjing Military Area Command of Chinese PLA, Fuzhou Fujian, 350025, P.R.China;;
2Department of Oral and Maxillofacial Surgery, College of Stomatology, Fourth Military Medical University;;
3Institute of Advanced Manufacturing Technique, Xi’an Jiaotong University.;

Corresponding author：

Keywords：

Mandibular bone defect; Three-dimensional skull model; Computer assisted design; Rapid prototyping

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【Abstract】 Objective To evaluate the feasibility and effectiveness of reconstruction of mandibular bone defects using three-dimensional skull model and individualized titanium prosthetics from computer assisted design. Methods Between July 2002 and November 2009, 9 patients with mandibular defects accepted restorative operation using individualized bone prosthetics. Among 9 cases, 4 were male and 5 were female, aged 19-55 years. The causes of mandibulectomy were benign lesions in 8 patients and carcinoma of gingival in 1 patient. Mandibular defects exceeded midline in 2 cases, involved condylar in 4 cases, and was limited in one side without involvement of temporo-mandibular joint in 3 cases. The range of bone defects was 9.0 cm × 2.5 cm-17.0 cm × 2.5 cm. The preoperative spiral CT scan was performed and three-diamensional skull model was obtained. Titanium prosthetics of mandibular defects were designed and fabricated through multi-step procedure of reverse engineering and rapid prototyping. Titanium prosthetics were used for one-stage repair of mandibular bone defects, then two-stage implant denture was performed after 6 months. Results The individualized titanium prosthetics were inserted smoothly with one-stage operative time of 10-23 minutes. All the cases achieved incision healing by first intention and the oblique mandibular movement was corrected. They all got satisfactory face, had satisfactory contour and good occlusion. In two-stage operation, no loosening of the implants was observed and the abutments were in good position with corresponding teeth which were designed ideally before operation. All cases got satisfactory results after 1-9 years of follow-up. At last follow-up, X-ray examinations showed no loosening of implants with symmetry contour. Conclusion Computer assisted design and three-dimensional skull model techniques could accomplish the design and manufacture of individualized prosthetic for the repair of mandibular bone defects.

Citation： GONG Zhenyu,LI Guohua,LIU Yanpu,HE Lisheng,ZHOU Bing,LI Dichen.. RECONSTRUCTION OF MANDIBULAR BONE DEFECTS USING THREE-DIMENSIONAL SKULL MODEL AND INDIVIDUALIZED TITANIUM PROSTHETICS FROM COMPUTER ASSISTED DESIGN. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(1): 83-86. doi: Copy

1.	technique in complex spine surgery. Arq Neuropsiquiatr, 2007, 65(2B): 443-445.
2.	reconstruction with free fibula osseous flaps. Int J Oral Maxillofac Surg, 2009, 38(2): 187-192.
3.	miniscrews with a stereolithographic surgical guide based on cone beam computed tomography data: a pilot study. Int J Oral Maxillofac Implants, 2011, 26(4): 860-865.
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5.	Surg, 2010, 68(9): 2115-2121.
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7.	Kimura A, Nagasao T, Kaneko T, et al. Adaquate fixation of plates for stability during mandibular reconstruction. J Craniomaxillofac Surg, 2006, 34(4): 193-200.
8.	郑卫国, 颜永年. 快速成形技术的原理、应用与发展. 计算机辅助设计与制造, 2001, (6): 3-5.
9.	Lee JW, Lan PX, Kim B, et al. Fabrication and characteristic analysis of a poly (propylene fumarate) scaffold using micro-stereolithography technology. J Biomed Mater Res B Appl Biomater, 2008, 87(1): 1-9.
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12.	吴国锋, 赵铱民, 叶晓兰, 等. 单侧眼眶部缺损修复的计算机辅助设计. 实用口腔医学杂志, 2003, 19(5): 405-407.
13.	龚振宇, 刘彦普, 周树夏, 等. 快速成型技术辅助颜面萎缩衬垫物设计. 第四军医大学学报, 2003, 24(13): 1189-1191.
14.	Mankovich NJ, Samson D, Pratt W, et al. Surgical planning using three-dimensional imaging and computer modeling. Otolaryngol Clin North Am, 1994, 27(5): 875-889.
15.	龚振宇, 刘彦普, 周树夏, 等. 基于反求工程和快速原型的下颌骨缺损的修复. 中华口腔医学杂志, 2004, 39(1): 9-11.
16.	Iseri U, Ozkurt Z, Kazazoglu E. Shear bond strengths of veneering porcelain to cast, machined and laser-sintered titanium. Dent Mater J, 2011, 30(3): 274-280.
17.	Almasri R, Drago CJ, Siegel SC, et al. Volumetric misfit in CAD/CAM and cast implant frameworks: a university laboratory study. J Prosthodont,.
18.	Wong RC, Tideman H, Merkx MA, et al. Review of biomechanical models used in studying the biomechanics of reconstructed mandibles. Int J Oral Maxillofac Surg, 2011, 40(4): 393-400.
19.	Juergens P, Krol Z, Zeilhofer HF, et al. Computer simulation and rapid prototyping for the reconstruction of the mandible. J Oral Maxillofac Surg, 2009, 67(10): 2167-2170.
20.	Leiggener C, Messo E, Thor A, et al. A selective laser sintering guide for transferring a virtual plan to real time surgery in composite mandibular.
21.	Morea C, Hayek JE, Oleskovicz C, et al. Precise insertion of orthodontic.
22.	Zhou LB, Shang HT, He LS, et al. Accurate reconstruction of discontinuous.
23.	Scalise JJ, Bryan J, Polster J, et al. Quantitative analysis of glenoid bone loss in osteoarthritis using three-dimensional computed tomography scans. J Shoulder Elbow Surg, 2008, 17(2): 328-335.
24.	, 20(4): 267-274.

1. technique in complex spine surgery. Arq Neuropsiquiatr, 2007, 65(2B): 443-445.
2. reconstruction with free fibula osseous flaps. Int J Oral Maxillofac Surg, 2009, 38(2): 187-192.
3. miniscrews with a stereolithographic surgical guide based on cone beam computed tomography data: a pilot study. Int J Oral Maxillofac Implants, 2011, 26(4): 860-865.
4. mandible using a reverse engineering/computer-aided design/rapid prototyping technique: a preliminary clinical study. J Oral Maxillofac.
5. Surg, 2010, 68(9): 2115-2121.
6. Mariani PB, Kowalski LP, Magrin J. Reconstruction of large defects postmandibulectomy for oral cancer using plates and myocutaneous flaps: a long-term follow-up. Int J Oral Maxillofac Surg, 2006, 35(5): 427-432.
7. Kimura A, Nagasao T, Kaneko T, et al. Adaquate fixation of plates for stability during mandibular reconstruction. J Craniomaxillofac Surg, 2006, 34(4): 193-200.
8. 郑卫国, 颜永年. 快速成形技术的原理、应用与发展. 计算机辅助设计与制造, 2001, (6): 3-5.
9. Lee JW, Lan PX, Kim B, et al. Fabrication and characteristic analysis of a poly (propylene fumarate) scaffold using micro-stereolithography technology. J Biomed Mater Res B Appl Biomater, 2008, 87(1): 1-9.
10. Paiva WS, Amorim R, Bezerra DA, et al. Aplication of the stereolithography.
11. 龚振宇, 刘彦普, 何黎升, 等. 用螺旋CT资料建立颅面三维模型. 口腔医学研究, 2003, 19(1): 4-6.
12. 吴国锋, 赵铱民, 叶晓兰, 等. 单侧眼眶部缺损修复的计算机辅助设计. 实用口腔医学杂志, 2003, 19(5): 405-407.
13. 龚振宇, 刘彦普, 周树夏, 等. 快速成型技术辅助颜面萎缩衬垫物设计. 第四军医大学学报, 2003, 24(13): 1189-1191.
14. Mankovich NJ, Samson D, Pratt W, et al. Surgical planning using three-dimensional imaging and computer modeling. Otolaryngol Clin North Am, 1994, 27(5): 875-889.
15. 龚振宇, 刘彦普, 周树夏, 等. 基于反求工程和快速原型的下颌骨缺损的修复. 中华口腔医学杂志, 2004, 39(1): 9-11.
16. Iseri U, Ozkurt Z, Kazazoglu E. Shear bond strengths of veneering porcelain to cast, machined and laser-sintered titanium. Dent Mater J, 2011, 30(3): 274-280.
17. Almasri R, Drago CJ, Siegel SC, et al. Volumetric misfit in CAD/CAM and cast implant frameworks: a university laboratory study. J Prosthodont,.
18. Wong RC, Tideman H, Merkx MA, et al. Review of biomechanical models used in studying the biomechanics of reconstructed mandibles. Int J Oral Maxillofac Surg, 2011, 40(4): 393-400.
19. Juergens P, Krol Z, Zeilhofer HF, et al. Computer simulation and rapid prototyping for the reconstruction of the mandible. J Oral Maxillofac Surg, 2009, 67(10): 2167-2170.
20. Leiggener C, Messo E, Thor A, et al. A selective laser sintering guide for transferring a virtual plan to real time surgery in composite mandibular.
21. Morea C, Hayek JE, Oleskovicz C, et al. Precise insertion of orthodontic.
22. Zhou LB, Shang HT, He LS, et al. Accurate reconstruction of discontinuous.
23. Scalise JJ, Bryan J, Polster J, et al. Quantitative analysis of glenoid bone loss in osteoarthritis using three-dimensional computed tomography scans. J Shoulder Elbow Surg, 2008, 17(2): 328-335.
24. , 20(4): 267-274.

Chinese Journal of Reparative and Reconstructive Surgery

RECONSTRUCTION OF MANDIBULAR BONE DEFECTS USING THREE-DIMENSIONAL SKULL MODEL AND INDIVIDUALIZED TITANIUM PROSTHETICS FROM COMPUTER ASSISTED DESIGN

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