The intention of oral rehabilitation in patients with mandibular defects is an early prosthetic treatment with maximum possible functionality and high accuracy. The present study describes a new computer-aided technique for mandibular reconstruction using a free vascularized iliac flap and simultaneous insertion of dental implants into the flap while it is still pedicled at the donor site. Based on preoperative computerized tomography data of the facial skeleton and the iliac crest donor site, a surgical guide transferred the virtual plan including information on the transplant dimensions and shape as well as the position of the dental implants into real-time surgery. Using postoperative computerized tomography scans, the actual situation were compared with the preoperative simulation. A mean difference of 0.75 mm (SD ± 0.72) for the flap shape and 0.70 mm (SD ± 0.44) for the implant position analysis was determined. A calculation of the closest point distance showed a surface deviation of <2 mm for the shape analysis in 93.3% of the values and <1 mm for implant position in 75.2% of the values. The mean angular deviation was 3.65°. Virtual surgical planning is a suitable method for mandibular reconstruction with vascularized iliac crest flaps and simultaneous implant surgery. It can be used to restore the anatomy of the mandible with a high accuracy and can help to shorten subsequent dental rehabilitation.
Keywords: computer-aided surgery; mandibular reconstruction; simultaneous implant surgery; surgical guide; vascularized iliac crest bone flap; virtual planning.