CAD/CAM+ 3D Printing in Mandibular Reconstruction: A Controlled Clinical Trial

Objectives: To evaluate the effect of 3D printed mandible and CAD/CAM surgical guide plate in mandibular defects caused by mandibular benign lesions.
Methods: Patients with mandibular benign lesions of mandible and requires segmental mandibulectomy and fibular flap reconstruction was recruited and divided into intervention group and control group. Patients in the intervention group got CT scan of the mandible and fibula. The mandible and fibula were reconstructed by specialized software and surgical guide plate were designed and produced via CAD/CAM device. The post-reconstructed mandible was also simulated via another software and 3D-printed, followed by bending of the reconstructed titanium plate on this model. Patients got mandibulectomy and fibula molding with the surgical guide aided and their mandible was reconstructed via the pre-bended titanium plate. Patients in the control group got CT scan of the mandible and mandibulectomy, fibula molding and intra-operative reconstructive plate bending were conducted via the surgeons’ clinical experience. Operation time, facial asymmetry, masticatory efficacy and patients’ quality of life were recorded 6 months after surgery.
Results: 17 participants in intervention group and 23 in the control group were recruited between Feb 2014 and Feb 2016. One fibular flap in each group were failed with no known disease recurrence were recorded. Surgical time were averagely shorten for 63 minutes in intervention group (P<0.001) by shorten of fibula molding and reconstructive plate bending. Significant facial asymmetry (over 5% difference) were observed in 3 participants in intervention group and 11 in control group (P=0.037). Quality of life assessed by OHIP-14 revealed higher quality of life in intervention group with no statistical significance (intervention: 12.35±5.68 vs Control: 10.27±6.32) (P=0.14). And No difference were observed in masticatory efficacy.

Conclusions: Preliminary results indicated that CAD/CAM and 3D printing techniques could significantly reduce surgical time in mandibular reconstruction and had higher cosmetic function.