title: Computer assisted mandibular reconstruction using a custom-made titan mesh tray and removable denture based on the top-down treatment technique.
abstract: OBJECTIVE
  The purpose of this report is to propose a computer assisted mandibular reconstruction procedure, utilizing a custom-made Ti-mesh tray with particulate cancellous bone and marrow, and a removable denture. This procedure was based on the top-down treatment technique, and reviews the case of a representative patient with mandibular continuity defect.
  
  
  METHODS
  The patient was a 74-year old female with a chief complaint of facial asymmetry and masticatory dysfunction. Due to gingival carcinoma, she underwent a segmental mandibulectomy on the left mandibule. On the VR space, using 3-D reconstructed computer tomography data, the residual right-side mandibular fragment was repositioned based on the condylar position and the occlusal relation. The mandibular fragment was then mirrored for a central sagittal plane. The position of the mirrored object was slightly arranged with the occlusal relation. Through the above operations, the landmark configuration, for the custom-made Ti-mesh tray as a virtual simulation model, was fabricated. On the physical model, we produced a custom-made Ti-mesh tray with a commercial Ti-mesh sheet. Surgical treatment was carried out using the tray. The denture pattern was designed by a dental technician on the VR space, fabricated using a 3D printer, and modified to create an impression tray with resin. Using the impression, the temporary removable denture was fabricated.
  
  
  CONCLUSIONS
  We propose a computer assisted design for a custom-made Ti-mesh tray and a removable denture, based on the Top-down treatment concept. We feel this technique is advantageous in reconstructing functional occlusion, and in accurately regaining dental and facial esthetics.
authors.affiliation: Department of Fixed Prosthodontics, School of Dental Medicine, Tsurumi University, Yokohama, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Ikawa
authors.affiliation: Department of Fixed Prosthodontics, School of Dental Medicine, Tsurumi University, Yokohama, Japan. Electronic address: shigeta-y@tsurumi-u.ac.jp.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Shigeta
authors.affiliation: Department of Fixed Prosthodontics, School of Dental Medicine, Tsurumi University, Yokohama, Japan.
authors.forename: Rio
authors.initials: R
authors.lastname: Hirabayashi
authors.affiliation: Department of Fixed Prosthodontics, School of Dental Medicine, Tsurumi University, Yokohama, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Hirai
authors.affiliation: Department of Fixed Prosthodontics, School of Dental Medicine, Tsurumi University, Yokohama, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Hirai
authors.affiliation: Dental Technician Training Institute, School of Dental Medicine, Tsurumi University, Yokohama, Japan.
authors.forename: Naohiko
authors.initials: N
authors.lastname: Harada
authors.affiliation: Dental Technician Training Institute, School of Dental Medicine, Tsurumi University, Yokohama, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Kawamura
authors.affiliation: Department of Fixed Prosthodontics, School of Dental Medicine, Tsurumi University, Yokohama, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D001853:Bone Marrow; D000071556:Cancellous Bone; D002277:Carcinoma / Q000601:surgery; D003761:Dental Impression Technique; D003779:Denture Design; D003832:Denture, Partial, Removable; D005260:Female; D005887:Gingival Neoplasms / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional; D008334:Mandible / Q000000981:diagnostic imaging / Q000601:surgery; D063168:Mandibular Osteotomy; D063175:Mandibular Reconstruction / Q000379:methods*; D066330:Printing, Three-Dimensional; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013526:Surgical Mesh; D014025:Titanium; D014057:Tomography, X-Ray Computed
chemical_list: D014025:Titanium
keywords: Computer tomography; Custom-made titan mesh tray; Mandibular reconstruction; Particulate cancellous bone and marrow; Top-down treatment technique