Patient-Specific 3D-Printed Titanium Implant for Mandibular Reconstruction after Ameloblastoma Resection: A Review of the Digital Surgical Workflow
DOI:
https://doi.org/10.5281/zenodo.22206024Keywords:
Ameloblastoma, Mandibular Reconstruction, Virtual Surgical Planning, Patient-Specific Implant, Additive ManufacturingAbstract
r function rather than survival — is what has driven the digital workflow further in this disease than in oncological resection generally.
Objectives:To review the published evidence on virtual surgical planning, patient-specific implants and additively manufactured titanium in
n mandibular reconstruction after ameloblastoma resection, and to establish what the digital workflow demonstrably improves.
Material and Methods:A narrative review. MEDLINE, Embase and the Cochrane Library were searched from January 2010 to May 2026 for
r cohort studies, comparative series, systematic reviews with meta-analysis and accuracy studies addressing virtual planning, computer-aided design
and patient-specific implants in mandibular reconstruction. Values were extracted from the primary reports and tabulated without pooling.
Results:Recurrence after conservative excision of ameloblastoma is reported between 55% and 90%, against 15% to 25% after segmental resection
n with margin, which establishes the defect that must then be reconstructed. Meta-analysis of virtual planning against freehand technique shows
operative time reduced by 44.6 minutes and ischaemia time shortened, with reconstruction accuracy improved — intercondylar deviation of 2.0 mm
against 3.9 mm and gonial angle deviation of 3.6 degrees against 7.7 degrees — but no difference in major or minor complications.
Conclusion:The digital workflow reliably improves geometric accuracy and operative efficiency. It has not been shown to reduce complications,
, and the evidence for patient-specific titanium implants specifically remains observational. Its strongest justification in ameloblastoma is that
accurate restoration of occlusal geometry is what makes later dental rehabilitation possible in a young patient.
Abbreviations:VSP – Virtual Surgical Planning, CAD-CAM – Computer-Aided Design and Manufacturing, PSI – Patient-Specific Implant,
, FFF – Fibula Free Flap, CT – Computed Tomography, OR – Odds Ratio.
References
Reichart PA, Philipsen HP, Sonner S. "Ameloblastoma: biological profile of 3677 cases". Eur J Cancer B Oral Oncol 31B(1995):86-99.
Effiom OA, Ogundana OM, Akinshipo AO, Akintoye SO. "Ameloblastoma: current etiopathological concepts and management". Oral Dis 24(2018):307-316.
Almeida RA, Andrade ES, Barbalho JC, Vajgel A, Vasconcelos BC. "Recurrence rate following treatment for primary multicystic ameloblastoma: systematic review and meta-analysis". Int J Oral Maxillofac Surg 45(2016):359-367.
Hertog D, Bloemena E, Aartman IH, van-der-Waal I. "Histopathology of ameloblastoma of the jaws; some critical observations based on a 40 years single institution experience". Med Oral Patol Oral Cir Bucal 17(2012):e76-e82.
Sham E, Leong J, Maher R, Schenberg M, Leung M, et al. "Mandibular ameloblastoma: clinical experience and literature review". ANZ J Surg 79(2009):739-744.
Chuka R, Abdullah W, Rieger J, Nayar S, Seikaly H, et al. "Implant utilization and time to prosthetic rehabilitation in conventional and advanced fibular free flap reconstruction of the maxilla and mandible". Int J Prosthodont 30(2017):289-294.
Wang F, Huang W, Zhang C, Sun J, Qu X, et al. "Functional outcome and quality of life after a maxillectomy: a comparison between an implant supported obturator and implant supported fixed prostheses in a free vascularized flap". Clin Oral Implants Res 28(2017):137-143.
Hidalgo DA. "Fibula free flap: a new method of mandible reconstruction". Plast Reconstr Surg 84(1989):71-79.
Hirsch DL, Garfein ES, Christensen AM, Weimer KA, Saddeh PB, et al. "Use of computer-aided design and computer-aided manufacturing to produce orthognathically ideal surgical outcomes: a paradigm shift in head and neck reconstruction". J Oral Maxillofac Surg 67(2009):2115-2122.
Wilde F, Hanken H, Probst F, Schramm A, Heiland M, et al. "Multicenter study on the use of patient-specific CAD/CAM reconstruction plates for mandibular reconstruction". Int J Comput Assist Radiol Surg 10(2015):2035-2051.
Pogrel MA, Montes DM. "Is there a role for enucleation in the management of ameloblastoma?". Int J Oral Maxillofac Surg 38(2009):807-812.
Beecher SM, Lennon P, O’Shaughnessy M, Barry CP. "Recurrent ameloblastoma involving fibula neo-mandible: management with digital planning and reconstruction using a contralateral free fibula flap". Cureus 12(2020):e7880.
Roser SM, Ramachandra S, Blair H, Grist W, Carlson GW, et al. "The accuracy of virtual surgical planning in free fibula mandibular reconstruction: comparison of planned and final results". J Oral Maxillofac Surg 68(2010):2824-2832.
Barr ML, Haveles CS, Rezzadeh KS, Nolan IT, Castro R, et al. "Virtual surgical planning for mandibular reconstruction with the fibula free flap: a systematic review and meta-analysis". Ann Plast Surg 84(2020):117-122.
Rommel N, Kesting MR, Rohleder NH, Bauer FMJ, Wolff KD, et al. "Mandible reconstruction with free fibula flaps: outcome of a cost-effective individual planning concept compared with virtual surgical planning". J Craniomaxillofac Surg 45(2017):1246-1250.
Pucci R, Weyh A, Smotherman C, Valentini V, Bunnell A, et al. "Accuracy of virtual planned surgery versus conventional free-hand surgery for reconstruction of the mandible with osteocutaneous free flaps". Int J Oral Maxillofac Surg 49(2020):1153-1161.
Tang NSJ, Ahmadi I, Ramakrishnan A. "Virtual surgical planning in fibula free flap head and neck reconstruction: a systematic review and meta-analysis". J Plast Reconstr Aesthet Surg 72(2019):1465-1477.
Powcharoen W, Yang WF, Yan Li K, Zhu W, Su YX. "Computer-assisted versus conventional freehand mandibular reconstruction with fibula free flap: a systematic review and meta-analysis". Plast Reconstr Surg 144(2019):1417-1428.
May MM, Howe BM, O’Byrne TJ, Alexander AE, Morris JM, et al. "Short and long-term outcomes of three-dimensional printed surgical guides and virtual surgical planning versus conventional methods for fibula free flap reconstruction of the mandible: decreased nonunion and complication rates". Head Neck 43(2021):2342-2352.
Kernen F, Kramer J, Wanner L, Wismeijer D, Nelson K, et al. "A review of virtual planning software for guided implant surgery: data import and visualization, drill guide design and manufacturing". BMC Oral Health 20(2020):251.
Ren W, Gao L, Li S, Chen C, Li F, et al. "Virtual planning and 3D printing modeling for mandibular reconstruction with fibula free flap". Med Oral Patol Oral Cir Bucal 23(2018):e359-e366.
Schepers RH, Raghoebar GM, Vissink A, Stenekes MW, Kraeima J, et al. "Accuracy of fibula reconstruction using patient-specific CAD/CAM reconstruction plates and dental implants: a new modality for functional reconstruction of mandibular defects". J Craniomaxillofac Surg 43(2015):649-657.
Kraeima J, Dorgelo B, Gulbitti HA, Steenbakkers RJHM, Schepman KP, et al. "Multi-modality 3D mandibular resection planning in head and neck cancer using CT and MRI data fusion: a clinical series". Oral Oncol 81(2018):22-28.
Ganry L, Hersant B, Quilichini J, Leyder P, Meningaud JP. "Study of medical education in 3D surgical modelling by surgeons with free open-source software: example of mandibular reconstruction with fibula free flap and creation of its surgical guides". J Stomatol Oral Maxillofac Surg 119(2018):262-267.
Bosc R, Hersant B, Carloni R, Niddam J, Bouhassira J, et al. "Mandibular reconstruction after cancer: an in-house approach to manufacturing cutting guides". Int J Oral Maxillofac Surg 46(2017):24-31.
Zweifel DF, Simon C, Hoarau R, Pasche P, Broome M. "Are virtual planning and guided surgery for head and neck reconstruction economically viable?". J Oral Maxillofac Surg 73(2015):170-175.
Fatima A, Hackman TG, Wood JS. "Cost-effectiveness analysis of virtual surgical planning in mandibular reconstruction". Plast Reconstr Surg 143(2019):1185-1194.
Kumar VV, Ebenezer S, Kammerer PW, Jacob PC, Kuriakose MA, et al. "Implants in free fibula flap supporting dental rehabilitation: implant and peri-implant related outcomes of a randomized clinical trial". J Craniomaxillofac Surg 44(2016):1849-1858.
Weitz J, Wolff KD, Kesting MR, Nobis CP. "Development of a novel resection and cutting guide for mandibular reconstruction using free fibula flap". J Craniomaxillofac Surg 46(2018):1975-1978.
van Baar GJC, Forouzanfar T, Liberton NPTJ, Winters HAH, Leusink FKJ. "Accuracy of computer-assisted surgery in mandibular reconstruction: a systematic review". Oral Oncol 84(2018):52-60.
Rendenbach C, Sellenschloh K, Gerbig L, Morlock MM, Beck-Broichsitter B, et al. "CAD-CAM plates versus conventional fixation plates for primary mandibular reconstruction: a biomechanical in vitro analysis". J Craniomaxillofac Surg 45(2017):1878-1883.
