Using An In-House Approach to Cad/Cam Reconstruction of the Maxilla

Publication date: Available online 12 December 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Toshiaki Numajiri, Daiki Morita, Hiroko Nakamura, Shoko Tsujiko, Ryo Yamochi, Yoshihiro Sowa, Kenichiro Toyoda, Takahiro Tsujikawa, Akihito Arai, Makoto Yasuda, Shigeru Hirano
BackgroundComputer-assisted design (CAD) and computer-aided manufacturing (CAM) techniques are now in widespread use for maxillofacial reconstruction. However, CAD/CAM-manufactured surgical guides are commercially available only in the limited areas. To use this technology in areas where these commercial guides are not available, we have developed a CAD/CAM technique in which all processes are performed by the surgeon (in-house approach).PurposeOur aim is to describe our experience and the characteristics of our in-house CAD/CAM reconstruction of the maxilla.MethodThis was a retrospective study after maxillary reconstruction with a free osteocutaneous flap. Free CAD software was used for the virtual surgery and to design the cutting guides (maxilla and fibula), which were printed by a 3D printer. After the model surgery and prebending of the titanium plates, the actual reconstructions were performed. We compared the clinical information, preoperative plan, and postoperative reconstruction data. The reconstruction was judged as accurate if >80% of the reconstructed points were within 2 mm deviation.ResultsAlthough on-site adjustment was necessary in particular cases, all four reconstructions were judged as accurate. In total, 3 days were needed before the surgery for planning, printing, and prebending of the plates. The average ischemic time was 134 minutes: 70 minutes for flap suturing and bone fixation, and 64 minutes for vascular anastomoses. The mean deviation after reconstruction was 0.44 mm (standard deviation, 0.97). The deviations were 67.8%, 1 mm deviation; 93.8%, 2 mm deviation; and 98.6%, 3 mm deviation. The disadvantages of regular use of CAD/CAM reconstruction are the intraoperative changes in the defect size and local tissue scarring.ConclusionGood accuracy was obtained for CAD/CAM-guided reconstructions based on an in-house approach. The theoretical advantage of computer simulation contributes to the accuracy. An in-house approach may be an option for maxillary reconstruction.



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