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Prosthetically guided mandibular reconstruction using a fibula free flap: three-dimensional Bologna plate, an alternative to the double-barrel technique

  • Author Footnotes
    1 Achille Tarsitano and Francesco Ceccariglia contributed equally and are co-first authors.
    A. Tarsitano
    Footnotes
    1 Achille Tarsitano and Francesco Ceccariglia contributed equally and are co-first authors.
    Affiliations
    IRCCS Azienda Ospedaliero Universitaria di Bologna, Oral and Maxillofacial Surgery Unit, Policlinico di Sant’Orsola, Bologna, Italy

    Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
    Search for articles by this author
  • Author Footnotes
    1 Achille Tarsitano and Francesco Ceccariglia contributed equally and are co-first authors.
    F. Ceccariglia
    Correspondence
    Corresponding author. IRCCS Azienda Ospedaliero Universitaria di Bologna, Oral and Maxillofacial Surgery Unit, Policlinico di Sant’Orsola, Bologna, Italy. Tel: +39 0512144197.
    Footnotes
    1 Achille Tarsitano and Francesco Ceccariglia contributed equally and are co-first authors.
    Affiliations
    IRCCS Azienda Ospedaliero Universitaria di Bologna, Oral and Maxillofacial Surgery Unit, Policlinico di Sant’Orsola, Bologna, Italy
    Search for articles by this author
  • M. Bevini
    Affiliations
    IRCCS Azienda Ospedaliero Universitaria di Bologna, Oral and Maxillofacial Surgery Unit, Policlinico di Sant’Orsola, Bologna, Italy
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  • L. Breschi
    Affiliations
    Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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  • P. Felice
    Affiliations
    Unit of Oral Surgery, Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
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  • C. Marchetti
    Affiliations
    IRCCS Azienda Ospedaliero Universitaria di Bologna, Oral and Maxillofacial Surgery Unit, Policlinico di Sant’Orsola, Bologna, Italy

    Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
    Search for articles by this author
  • Author Footnotes
    1 Achille Tarsitano and Francesco Ceccariglia contributed equally and are co-first authors.
Published:August 26, 2022DOI:https://doi.org/10.1016/j.ijom.2022.08.006

      Abstract

      The fibula free flap represents the gold standard for mandibular reconstruction. However, when harvested as a single barrel, this flap does not allow the native mandibular height to be restored, which is required for implant-supported dental rehabilitation of the patient. The aim of this study was to present a new design for a patient-specific three-dimensionally printed reconstructive plate (3DBO-PSI) that positions the fibula bone at the height of the resected mandibular alveolar bone while restoring the mandibular profile to ensure a correct morphological outcome. Twenty patients were enrolled prospectively between January 2019 and May 2022. All patients underwent a segmental mandibular resection and prosthetically guided reconstruction making use of a fibula free flap supported by the 3DBO-PSI. The mean follow-up period was 20 months. All microvascular and implant-related complications were recorded. Microvascular failure occurred in two patients. No PSI-related complications were recorded during the postoperative follow-up. The proposed reconstructive method was found to be reliable and reproducible. In all treated patients, the bony flap appeared to be adequately positioned to maintain the preoperative intermaxillary relationship, as planned. To date, dental rehabilitation has been completed in seven patients.

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