Al- Anbar Medical Journal

3D Reconstruction of Mandibular Defects using CAD/CAM Designed Zirconia Prosthesis

Document Type : Original articles

Author

Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Anbar, Ramadi, Anbar, Iraq

Abstract

Background: Reconstruction of mandibular defects with autogenous free bone graft is considered the preferred method. However, the optimum reconstruction technique of mandibular defects is still controversial.
Objective: To assess the efficacy and safety of the zirconia individual designed CAD/CAM prosthesis for the mandibular reconstruction.
Materials and Methods: We used a new method (zirconia prosthesis) for the reconstruction of mandibular defects due to various causes. The study was carried out in the Oral and Maxillofacial Department of Al-Ramadi Teaching Hospital during a period of 62 months from January 2012 to March 2017. Data were collected for each patient regarding the age, gender, site and cause of the defect, investigations, operative technique, complications, outcome, and the duration of the follow-up.
Results: Twenty patients, 14 were men and 6 women; the patients'''' ages ranged from 19 to 70 years. The majority of the defects were caused by tumors, while, 40% due to congenital or traumatic causes. The success rate of the prosthesis taking was 95%. And in these cases, esthetic and functional outcomes were restored or improved after the reconstruction in all subjects.
Conclusion: We described a novel method for mandibular reconstruction with zirconium individual-designed CAD/CAM model. We advise to use this method owing to the high success rate, the less major rate of complications in comparison with other methods, and high rate of functional and esthetic outcome.

Keywords

Main Subjects

References
[1]      M. Rashid, M. Zia-ul-Islam, and A. M. Bhatti, “The ‘expansile’supraclavicular artery flap for release of post-burn neck contractures,” J. Plast. Reconstr. Aesthetic Surg., vol. 59, no. 10, pp. 1094–1101, 2006.
[2]      A. Kalantar-Hormozi and B. Khorvash, “Repair of skin covering osteoradionecrosis of the mandible with the fasciocutaneous supraclavicular artery island flap: case report,” J. Cranio-Maxillofacial Surg., vol. 34, no. 7, pp. 440–442, 2006.
[3]      C. L. Ortiz, A. V. Carrasco, A. N. Torres, L. N. Sempere, and M. M. Mendoza, “Supraclavicular bilobed fasciocutaneous flap for postburn cervical contractures,” Burns, vol. 33, no. 6, pp. 770–775, 2007.
[4]      R. D. Foster, J. P. Anthony, A. Sharma, and M. A. Pogrel, “Vascularized bone flaps versus nonvascularized bone grafts for mandibular reconstruction: an outcome analysis of primary bony union and endosseous implant success,” Head Neck J. Sci. Spec. Head Neck, vol. 21, no. 1, pp. 66–71, 1999.
[5]      P.-Y. Lin, K. C. Lin, and S.-F. Jeng, “Oromandibular reconstruction: the history, operative options and strategies, and our experience,” ISRN Surg., vol. 2011, 2011.
[6]      E. Genden and B. H. Haughey, “Mandibular reconstruction by vascularized free tissue transfer,” Am. J. Otolaryngol., vol. 17, no. 4, pp. 219–227, 1996.
[7]      M. L. Urken et al., “Oromandibular reconstruction using microvascular composite flaps: report of 210 cases,” Arch. Otolaryngol. neck Surg., vol. 124, no. 1, pp. 46–55, 1998.
[8]      K. K. Yim and F. Wei, “Fibula osteoseptocutaneous flap for mandible reconstruction,” Microsurgery, vol. 15, no. 4, pp. 245–249, 1994.
[9]      B. H. Haughey, J. M. Fredrickson, A. J. Lerrick, A. Sclaroff, and W. D. Gay, “Fibular and iliac crest osteomuscular free flap reconstruction of the oral cavity,” Laryngoscope, vol. 104, no. 11, pp. 1305–1313, 1994.
[10]    H. Tideman and S. Lee, “The TL endoprosthesis for mandibular reconstruction—A metallic yet biological approach,” Asian J Oral Maxfac Surg, vol. 18, no. 5, 2006.
[11]    K. Sevin, I. Askar, A. Saray, and E. Yormuk, “Exposure of high-density porous polyethylene (Medpor®) used for contour restoration and treatment,” Br. J. Oral Maxillofac. Surg., vol. 38, no. 1, pp. 44–49, 2000.
[12]    S. Pilathadka, D. Vahalová, and T. Vosáhlo, “The Zirconia: a new dental ceramic material. An overview,” Prague Med Rep, vol. 108, no. 1, pp. 5–12, 2007.
[13]    M. Pinheiro and J. L. Alves, “The feasibility of a custom-made endoprosthesis in mandibular reconstruction: implant design and finite element analysis,” J. Cranio-Maxillofacial Surg., vol. 43, no. 10, pp. 2116–2128, 2015.
[14]    B. Spiessl, Internal fixation of the mandible: a manual of AO/ASIF principles. Springer Science & Business Media, 2012.
[15]    P. G. Cordeiro, J. J. Disa, D. A. Hidalgo, and Q. Y. Hu, “Reconstruction of the mandible with osseous free flaps: a 10-year experience with 150 consecutive patients.,” Plast. Reconstr. Surg., vol. 104, no. 5, pp. 1314–1320, 1999.
[16]    D. A. Hidalgo, “Fibula free flap: a new method of mandible reconstruction.,” Plast. Reconstr. Surg., vol. 84, no. 1, pp. 71–79, 1989.
[17]    B. P. Kumar, V. Venkatesh, K. A. J. Kumar, B. Y. Yadav, and S. R. Mohan, “Mandibular reconstruction: overview,” J. Maxillofac. Oral Surg., vol. 15, no. 4, pp. 425–441, 2016.
[18]    D. L. Hoexter, “Bone regeneration graft materials,” J. Oral Implantol., vol. 28, no. 6, pp. 290–294, 2002.
[19]    J. B. Quattlebaunr, J. T. Mellonig, and N. F. Hensel, “Antigenicity of freeze‐dried cortical bone allograft in human periodontal osseous defects,” J. Periodontol., vol. 59, no. 6, pp. 394–397, 1988.
[20]    I. Moldovan et al., “Mandibular reconstruction using free vascularized iliac crest grafts and dental implants,” Clujul Med., vol. 88, no. 3, p. 391, 2015.
[21]    P. Sadr-Eshkevari, A. Rashad, S. A. Vahdati, A. Garajei, B. Bohluli, and P. Maurer, “Alloplastic mandibular reconstruction: a systematic review and meta-analysis of the current century case series,” Plast. Reconstr. Surg., vol. 132, no. 3, p. 413e–427e, 2013.
[22]    L. Gui, L. Huang, and Z. Zhang, “Genioplasty and chin augmentation with Medpore implants: a report of 650 cases,” Aesthetic Plast. Surg., vol. 32, no. 2, pp. 220–226, 2008.
[23]    D. A. Hidalgo, A. L. Pusic, and F.-C. Wei, “Free-flap mandibular reconstruction: a 10-year follow-up study,” Plast. Reconstr. Surg., vol. 110, no. 2, pp. 438–449, 2002.
[24]    M. Y. Jia, J. J. Jiang, X. Y. Chu, R. T. Yuan, K. Wang, and L. X. Bu, “Clinical application of titanium plate reconstruction of mandibular defect: 10 years of follow up,” Zhonghua kou qiang yi xue za zhi= Zhonghua kouqiang yixue zazhi= Chinese J. Stomatol., vol. 51, no. 7, pp. 401–404, 2016.
[25]    H. J. Wenz, J. Bartsch, S. Wolfart, and M. Kern, “Osseointegration and clinical success of zirconia dental implants: a systematic review.,” Int. J. Prosthodont., vol. 21, no. 1, 2008.
[26]    I.-J. Kim and S.-Y. Shin, “Comparative study of new bone formation capability of zirconia bone graft material in rabbit calvarial,” J. Adv. Prosthodont., vol. 10, no. 3, pp. 167–176, 2018.
[27]    H. Shao et al., “Custom repair of mandibular bone defects with 3D printed bioceramic scaffolds,” J. Dent. Res., vol. 97, no. 1, pp. 68–76, 2018.
[28]    A. Tarsitano et al., “Accuracy of CAD/CAM mandibular reconstruction: A three-dimensional, fully virtual outcome evaluation method,” J. Cranio-Maxillofacial Surg., vol. 46, no. 7, pp. 1121–1125, 2018.
[29]    B. D. Foley, W. P. Thayer, A. Honeybrook, S. McKenna, and S. Press, “Mandibular reconstruction using computer-aided design and computer-aided manufacturing: an analysis of surgical results,” J. Oral Maxillofac. Surg., vol. 71, no. 2, pp. e111–e119, 2013.
Al- Anbar Medical Journal
Volume 15, Issue 2
December 2019
Page 24-29
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