title: Accuracy of fibula reconstruction using patient-specific CAD/CAM reconstruction plates and dental implants: A new modality for functional reconstruction of mandibular defects.
abstract: BACKGROUND
  The purpose of this study was to analyze the accuracy of mandibular reconstruction using patient-specific computer-aided designed and computer-aided manufactured (CAD/CAM) reconstruction plates as a guide to place fibula grafts and dental implants in a one-stage procedure using pre-operative 3D virtual planning.
  
  
  METHODS
  Seven consecutive patients were analyzed retrospectively, the 3D accuracy of placement of the fibula grafts and dental implants was compared to the virtual plan.
  
  
  RESULTS
  Six out of seven flaps survived for an average follow-up time of 9.4 months. The outcome was compared to the virtual plan, superimposed on the mandible. For the fibula segments, the mean deviation (SD) was 3.0 (1.8) mm and the mean angulation (SD) was 4.2° (3.2°). For the implants, the mean deviation (SD) was 3.3 (1.3) mm and the mean angulation (SD) was 13.0° (6.7°). The mean (SD) mandibular resection plane deviation was 1.8 (0.9) mm.
  
  
  CONCLUSIONS
  A patient-specific reconstruction plate is a valuable tool in the reconstruction of mandibular defects with fibula grafts and dental implants. Implant angulation showed a greater deviation from the virtual plans in patients with a sharp ventral fibula rim, where the guide is removed after pilot drilling of the implants.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: r.h.schepers@umcg.nl.
authors.forename: Rutger H
authors.initials: RH
authors.lastname: Schepers
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: g.m.raghoebar@umcg.nl.
authors.forename: Gerry M
authors.initials: GM
authors.lastname: Raghoebar
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: a.vissink@umcg.nl.
authors.forename: Arjan
authors.initials: A
authors.lastname: Vissink
authors.affiliation: Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: m.w.stenekes@umcg.nl.
authors.forename: Martin W
authors.initials: MW
authors.lastname: Stenekes
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands. Electronic address: j.kraeima@umcg.nl.
authors.forename: Joep
authors.initials: J
authors.lastname: Kraeima
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: j.l.n.roodenburg@umcg.nl.
authors.forename: Jan L
authors.initials: JL
authors.lastname: Roodenburg
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: h.reintsema@umcg.nl.
authors.forename: Harry
authors.initials: H
authors.lastname: Reintsema
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: m.j.h.witjes@umcg.nl.
authors.forename: Max J
authors.initials: MJ
authors.lastname: Witjes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D016025:Bone Transplantation / Q000379:methods*; D017076:Computer-Aided Design; D054893:Cone-Beam Computed Tomography / Q000379:methods; D015921:Dental Implants; D005260:Female; D005360:Fibula / Q000601:surgery; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000637:transplantation; D006085:Graft Survival; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D063175:Mandibular Reconstruction / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D010347:Patient Care Planning; D066230:Patient-Specific Modeling; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000379:methods; D060053:Transplant Donor Site / Q000601:surgery; D016896:Treatment Outcome; D014584:User-Computer Interface
chemical_list: D015921:Dental Implants
keywords: 3D; Fibula; Implants; Mandible; Plates; Reconstruction