Precision of simultaneous guided dental implantation in microvascular fibular flap reconstructions with and without additional guiding splints

Publication date: Available online 31 December 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Daniel Zweifel, Marius Gustav Bredell, Martin Lanzer, Claudio Rostetter, Martin Rücker, Stephan Studer

Abstract

Purpose

Dental rehabilitation in patients receiving free-flap reconstructive surgery to the mandible or maxilla is an important part of bringing patients back to normality both in a physical and a psychological way. It is therefore important to be able to do this in the fastest way possible.

Virtual pre-planned reconstructions of jaws with implants placed simultaneously are a good way to expedite this process and has the advantage of allowing true backward planning to get the bone where it prosthetically needs to be. Thus, the precise transfer of the virtually preplanned implant position to the intraoperative situation is crucial for prosthetic rehabilitation.

Patients and Methods

We compare a control group of patients (n=4, 15 implants) with pre-planned fibular reconstructions of the mandible with implants incorporated in the planning to a trial group of patients with an additional intraoperative splint for the verification of the implants angulation (n=4, 13 implants). The preoperative plan and the postoperative computed tomography (CT) are compared.

Results

The average positioning error at bone level was 0.9 mm in the trial group and 1.3 mm in the control. Average angulation error in the bucco-lingual plane was 2.9 degrees in the trial group and 5.5 degrees in the control; axially the difference was 6.3 degrees in the trial group and 4.1 degrees in the control.

Conclusion

Digitally backward-planned fibula cutting guides with direct dental implant positioning is feasible and the demonstrated precision is comparable to that of standard splint guided implant placement in the general population. While the axial angulation error has more to do with anatomical variance and positioning of the bony cutting guide, the trial population clearly profited from the additional splint in the important bucco-lingual angulation. Overall, we demonstrated a high level of precision over all implants in both groups.

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