ABSTRACT
BACKGROUND: Calvarial bone grafts have been one of the grafting options that provides predictable results for three-dimensional reconstruction of severely atrophied ridges owing to their low resorption and rapid revascularization, thus providing adequate volume for implant insertion. The aim of this study was to introduce a computer-guided technique for calvarial graft harvest to minimize the complications known with grafting from this donor site. MATERIALS AND METHODS: Eight patients, suffering from severely atrophied, completely edentulous maxillary ridges, with an age range (21-30 years) were operated on (six males and two females). A custom-made guide for each patient based on preoperative computed tomography (CT) was fabricated for harvesting the outer table cortical bone blocks from the parietal bone, then particulate bone was collected with an auto-chip maker. Bilateral sinus lifting was indicated in all cases. The bone blocks were fixed intraorally and the bone particulates filled the gaps and the volume created by sinus lifting, then the whole complex was covered with collagen membranes fixed with titanium tacks. Immediate and 6 months CT were requested for evaluation of the guide accuracy and the graft integration, respectively. RESULTS: In all cases, the guide was found to accurately fit into its preplanned position and to correctly locate the anticipated harvest site with the needed dimensions of the bone blocks. No intraoperative complications were encountered such as breakage through the inner table or cerebrospinal fluid leakage. Postoperatively, all the cases showed uneventual healing except one case that had an anterior dehiscence. CONCLUSION: The computer-guided calvarial bone blocks harvest from the parietal bone is safe and predictable technique for three-dimensional reconstruction of severely atrophic edentulous maxilla.
Subject(s)
Alveolar Bone Loss/surgery , Alveolar Ridge Augmentation/methods , Maxilla/surgery , Plastic Surgery Procedures/methods , Skull/transplantation , Surgery, Computer-Assisted/methods , Adult , Alveolar Bone Loss/diagnostic imaging , Bone Transplantation/methods , Female , Humans , Imaging, Three-Dimensional , Male , Maxilla/diagnostic imaging , Radiography, Panoramic , Tomography, X-Ray Computed , Young AdultABSTRACT
The aim of the current study was to evaluate the accuracy of computer-guided mandibular fracture reduction. A total of 24 patients with fractured mandible were included in the current study. A preoperative cone beam computed tomography (CBCT) scan was performed on all of the patients. Based on CBCT, three-dimensional reconstruction and virtual reduction of the mandibular fracture segments were done and a virtual bone borne surgical guide was designed and exported as Standard Tessellation Language file. A physical guide was then fabricated using a three-dimensional printing machine. Open reduction and internal fixation was done for all of the patients and the fracture segments were anatomically reduced with the aid of the custom-fabricated surgical guide. Postoperative CBCT was performed after 7 days and results of which were compared with the virtually reduced preoperative mandibular models. Comparison of values of lingula-sagittal plane, inferior border-sagittal plane, and anteroposterior measurements revealed no statistically significant differences between the virtual and the clinically reduced CBCT models. Based on the results of the current study, computer-based surgical guide aid in obtaining accurate anatomical reduction of the displaced mandibular fractured segments. Moreover, the computer-based surgical guides were found to be beneficial in reducing fractures of completely and partially edentulous mandibles.
