title: Accuracy of secondary maxillofacial reconstruction with prefabricated fibula grafts using 3D planning and guided reconstruction.
abstract: BACKGROUND
  We compared the pre-operative 3D-surgical plan with the surgical outcome of complex two-stage secondary reconstruction of maxillofacial defects using inserted implants in the prefabricated fibula graft.
  
  
  METHODS
  Eleven reconstructions of maxillofacial defects with prefabricated fibulas were performed using a 3D virtual planning. Accuracy of placement of the fibula grafts and dental implants was compared to pre-operative 3D virtual plans by superimposing pre-operative and post-operative CT-scans: we first superimposed the CT-scans on the antagonist jaw, to represent the outcome of occlusion, and then superimposed on the planned fibula segments.
  
  
  RESULTS
  Superimposing the CT scans on the antagonist jaws revealed a median deviation of the fibula segments and implants of 4.7 mm (IQR:3-6.5 mm) and 5.5 mm (IQR:2.8-7 mm) from the planned position, respectively. Superimposing of the CT scans on the fibula segments revealed a median difference of fibula and implant placement of 0.3 mm (IQR:0-1.6 mm) and 2.2 mm (IQR:1.5-2.9 mm), respectively.
  
  
  CONCLUSIONS
  The final position of the fibula graft is determined by the occlusion of the denture, which is designed from the 3D plan. From a prosthodontic perspective, the accuracy of 3D-surgical planning of reconstruction of maxillofacial defects with a fibula graft and the implants allows for a favorable functional position of the implants and fibula graft.
authors: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: r.h.schepers@umcg.nl.
authors: Rutger H
authors: RH
authors: Schepers
authors: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors: Joep
authors: J
authors: Kraeima
authors: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors: Arjan
authors: A
authors: Vissink
authors: Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors: Lars U
authors: LU
authors: Lahoda
authors: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors: Jan L N
authors: JL
authors: Roodenburg
authors: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors: Harry
authors: H
authors: Reintsema
authors: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors: Gerry M
authors: GM
authors: Raghoebar
authors: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors: Max J
authors: MJ
authors: Witjes
mesh_terms: D016025:Bone Transplantation; D015921:Dental Implants; D005360:Fibula / Q000601:surgery* / Q000637:transplantation; D006801:Humans; D021621:Imaging, Three-Dimensional; D056948:Orthognathic Surgical Procedures; D010347:Patient Care Planning; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D015921:Dental Implants
keywords: 3D; Fibula; Implants; Mandible; Maxilla; Reconstruction