J Korean Assoc Oral Maxillofac Surg.  2019 Oct;45(5):276-284. 10.5125/jkaoms.2019.45.5.276.

The effect of fixation plate use on bone healing during the reconstruction of mandibular defects

Affiliations
  • 1Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, Korea. ywpark@gwnu.ac.kr

Abstract


OBJECTIVES
This study sought to compare efficiency results between the use of a customized implant (CI) and a reconstruction plate (RP) in mandibular defect reconstruction in an animal model.
MATERIALS AND METHODS
Fifteen rabbits underwent surgery to create a defect in the right side of the mandible and were randomly divided into two groups. For reconstruction of the mandibular defect, the RP group (n=5) received five-hole mini-plates without bone grafting and the CI group (n=10) received fabricated CIs based on the cone-beam computed tomography (CBCT) data taken preoperatively. The CI group was further divided into two subgroups depending on the time of CBCT performance preoperatively, as follows: a six-week CI (6WCI) group (n=5) and a one-week CI (1WCI) group (n=5). Daily food intake amount (DFIA) was measured to assess the recovery rate. Radiographic images were acquired to evaluate screw quantity. CBCT and histological examination were performed in the CI subgroup after sacrifice.
RESULTS
The 1WCI group showed the highest value in peak average recovery rate and the fastest average recovery rate. In terms of reaching a 50% recovery rate, the 1WCI group required the least number of days as compared with the other groups (2.6±1.3 days), while the RP group required the least number of days to reach an 80% recovery rate (7.8±2.2 days). The 1WCI group showed the highest percentage of intact screws (94.3%). New bone formation was observed in the CI group during histological examination.
CONCLUSION
Rabbits with mandibular defects treated with CI showed higher and faster recovery rates and more favorable screw status as compared with those treated with a five-hole mini-plate without bone graft.

Keyword

Mandibular reconstruction; Mandibular defect; 3D printing; Customized implant; Reconstruction plate

MeSH Terms

Bone Transplantation
Cone-Beam Computed Tomography
Eating
Mandible
Mandibular Reconstruction
Models, Animal
Osteogenesis
Printing, Three-Dimensional
Rabbits
Transplants

Figure

  • Fig. 1 Flow chart of preoperative customized implant fabrication. (CBCT: cone-beam computed tomography)

  • Fig. 2 A. Individual computed tomography (CT) scans of rabbits were used for designing surgical guide. B. Customized implant (CI) was designed using individual CT scans based on preplanned mandibular defects. C. The cross section of a CI mimicked the internal porous structure of the mandible.

  • Fig. 3 Marking of the recession margin was made by temporary fixation of the reconstruction plate. The defect was then created by the use of a reciprocating saw. Final fixation of the plate was performed.

  • Fig. 4 The surgical guide was used to mark the recession margin before vertical osteotomy. The defect was then created by the use of a reciprocating saw. Customized implant (CI) with micro-screws was used for fixation of each implant in CI group.

  • Fig. 5 Average recovery rate (%) of each groups. (6WCI: six-week customized implant, RP: reconstruction plate, 1WCI: one-week customized implant)

  • Fig. 6 Days required to reach 50% and 80% recovery rate in each individuals. (6WCI: six-week customized implant, 1WCI: one-week customized implant, RP: reconstruction plate)

  • Fig. 7 The customized implant (CI) sample show bone overgrowth the main body of the implant with no screw loosening while there was sign of screw loosening on the reconstruction plate sample.

  • Fig. 8 Reconstructed images based on computed tomography scans after sacrifice. A. Rabbit with no loosened screws. B. Rabbit with loosened screws (arrow).

  • Fig. 9 A. Histologic examination showed evidence of bony ingrowth (asterisks) into the porous structure of the customized implant (CI) in the rabbit with no loosened screws. B. In the case of the animal with plate exposure and unstable CI, bony ingrowth into the CI was not observed. A, B. Goldner trichrome stain. Scale bars=200 µm.


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