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Zhong S, Shi Q, Van Dessel J, Gu Y, Lübbers HT, Yang S, Sun Y, Politis C. Biomechanical feasibility of non-locking system in patient-specific mandibular reconstruction using fibular free flaps. J Mech Behav Biomed Mater 2023; 148:106197. [PMID: 37875041 DOI: 10.1016/j.jmbbm.2023.106197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 10/26/2023]
Abstract
Mandibular reconstruction with free fibular flaps is frequently used to restore segmental defects. The osteosythesis, including locking and non-locking plate/screw systems, is essential to the mandibular reconstruction. Compared with the non-locking system that requires good adaption between plate and bone, the locking system appears to present a better performance by locking the plate to fixation screws. However, it also brings about limitations on screw options, a higher risk of screw failure, and difficulties in screw placement. Furthermore, its superiority is undermined by the advancing of patient-specific implant design and additive manufacturing. A customized plate can be designed and fabricated to accurately match the mandibular contour for patient-specific mandibular reconstruction. Consequently, the non-locking system seems more practicable with such personalized plates, and its biomechanical feasibility ought to be estimated. Finite element analyses of mandibular reconstruction assemblies were conducted for four most common segmental mandibular reconstructions regarding locking and non-locking systems under incisal biting and right molars clenching, during which the influencing factor of muscles' capacity was introduced to simulate the practical loadings after mandibular resection and reconstruction surgeries. Much higher, somewhat lower, and similar maximum von Mises stresses are separately manifested by the patient-specific mandibular reconstruction plate (PSMRP), fixation screws, and reconstructed mandible with the non-locking system than those with the locking system. Equivalent maximum displacements are identified between PSMRPs, fixation screws, and reconstructed mandibles with the non-locking and locking system in all four reconstruction types during two masticatory tasks. Parallel maximum and minimum principal strain distributions are shared by the reconstructed mandibles with the non-locking and locking system in four mandibular reconstructions during both occlusions. Conclusively, it is feasible to use the non-locking system in case of patient-specific mandibular reconstruction with fibular free flaps based on the adequate safety, comparable stability, and analogous mechanobiology it presents compared with the locking system in a more manufacturable and economical way.
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Affiliation(s)
- Shengping Zhong
- Department of Imaging & Pathology, Biomedical Sciences Group, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
| | - Qimin Shi
- Department of Imaging & Pathology, Biomedical Sciences Group, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium; Yantai Research Institute, Harbin Engineering University, Qingdao Avenue 1, 264000, Yantai, PR China
| | - Jeroen Van Dessel
- Department of Imaging & Pathology, Biomedical Sciences Group, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
| | - Yifei Gu
- Department of Imaging & Pathology, Biomedical Sciences Group, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium; Department of Dentistry, Dushu Lake Hospital Affiliated to Soochow University, Chongwen Road 9, 215000, Suzhou, PR China
| | - Heinz-Theo Lübbers
- Clinic for Cranio-Maxillofacial Surgery, University Hospital of Zurich, Frauenklinikstrasse 24, Zurich, CH-8091, Switzerland
| | - Shoufeng Yang
- Yantai Research Institute, Harbin Engineering University, Qingdao Avenue 1, 264000, Yantai, PR China.
| | - Yi Sun
- Department of Imaging & Pathology, Biomedical Sciences Group, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium.
| | - Constantinus Politis
- Department of Imaging & Pathology, Biomedical Sciences Group, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
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Klasen JRS, Thatcher GP, Bleedorn JA, Soukup JW. Virtual surgical planning and 3D printing: Methodology and applications in veterinary oromaxillofacial surgery. Front Vet Sci 2022; 9:971318. [PMID: 36337192 PMCID: PMC9635215 DOI: 10.3389/fvets.2022.971318] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/28/2022] [Indexed: 12/19/2023] Open
Abstract
Virtual surgical planning is the process of planning and rehearsing a surgical procedure completely within the virtual environment on computer models. Virtual surgical planning and 3D printing is gaining popularity in veterinary oromaxillofacial surgery and are viable tools for the most basic to the most complex cases. These techniques can provide the surgeon with improved visualization and, thus, understanding of the patients' 3D anatomy. Virtual surgical planning is feasible in a clinical setting and may decrease surgical time and increase surgical accuracy. For example, pre-operative implant contouring on a 3D-printed model can save time during surgery; 3D-printed patient-specific implants and surgical guides help maintain normocclusion after mandibular reconstruction; and the presence of a haptic model in the operating room can improve surgical precision and safety. However, significant time and financial resources may need to be allocated for planning and production of surgical guides and implants. The objectives of this manuscript are to provide a description of the methods involved in virtual surgical planning and 3D printing as they apply to veterinary oromaxillofacial surgery and to highlight these concepts with the strategic use of examples. In addition, the advantages and disadvantages of the methods as well as the required software and equipment will be discussed.
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Affiliation(s)
| | - Graham P. Thatcher
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Jason A. Bleedorn
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Jason W. Soukup
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, United States
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