Outcomes of mandibular reconstruction using three-dimensional custom-made porous titanium prostheses.

Humans Dental Implants Mandibular Reconstruction / methods Titanium Porosity Bone Transplantation / methods
Mandibular osteotomy Mandibular reconstruction Oral neoplasms Titanium

Journal

Journal of stomatology, oral and maxillofacial surgery
ISSN: 2468-7855
Titre abrégé: J Stomatol Oral Maxillofac Surg
Pays: France
ID NLM: 101701089

Informations de publication

Date de publication:
02 2023
Historique:
received: 03 01 2022
revised: 18 07 2022
accepted: 05 09 2022
pubmed: 10 9 2022
medline: 15 2 2023
entrez: 9 9 2022
Statut: ppublish

Résumé

Our aim was to report the long-term outcomes of mandibular reconstruction using CAD-CAM-designed 3D-printed porous titanium implants in patients not amenable to a free vascularized fibula flap reconstruction. The implants were designed with ProPlan CMF® 2.2 software and manufactured with a Selective Laser Melting (SLM) "layer-by-layer" 3D-printing of pure porous titanium powder beds. Primary endpoints were implant exposure and implant removal calculated using Gray's tests. Secondary endpoints were predictive factors of implant exposure and implant removal, and rates of dental rehabilitation. Thirty-six patients were operated between 2015 and 2017 and were included in this study. Reconstruction using a porous titanium 3D-printed implant was proposed due to medical contraindication for a fibula free flap (n = 13), due to the failure of a previous fibula free flap reconstruction (n = 7), or due to refusal of a fibula free flap reconstruction by the patient (n = 16). The medical indications for mandibular reconstruction were a primary tumor requiring mandibulectomy in nine patients, mandibular osteoradionecrosis requiring mandibulectomy in nineteen patients, and secondary reconstruction in eight patients. The 2-year rates of implant exposure and implant removal were 69.4% and 52.8%. Reconstruction of the symphysis was a high-risk exposure variable (OR 30; p = 0.0003). Only one patient underwent a successful dental rehabilitation. The use of a porous titanium 3D- implant for mandibular reconstruction in head and neck cancer patients resulted in high rates of implant exposure and of implant removal, notably when symphysis involvement.

Sections du résumé

BACKGROUND
Our aim was to report the long-term outcomes of mandibular reconstruction using CAD-CAM-designed 3D-printed porous titanium implants in patients not amenable to a free vascularized fibula flap reconstruction.
METHODS
The implants were designed with ProPlan CMF® 2.2 software and manufactured with a Selective Laser Melting (SLM) "layer-by-layer" 3D-printing of pure porous titanium powder beds. Primary endpoints were implant exposure and implant removal calculated using Gray's tests. Secondary endpoints were predictive factors of implant exposure and implant removal, and rates of dental rehabilitation.
RESULTS
Thirty-six patients were operated between 2015 and 2017 and were included in this study. Reconstruction using a porous titanium 3D-printed implant was proposed due to medical contraindication for a fibula free flap (n = 13), due to the failure of a previous fibula free flap reconstruction (n = 7), or due to refusal of a fibula free flap reconstruction by the patient (n = 16). The medical indications for mandibular reconstruction were a primary tumor requiring mandibulectomy in nine patients, mandibular osteoradionecrosis requiring mandibulectomy in nineteen patients, and secondary reconstruction in eight patients. The 2-year rates of implant exposure and implant removal were 69.4% and 52.8%. Reconstruction of the symphysis was a high-risk exposure variable (OR 30; p = 0.0003). Only one patient underwent a successful dental rehabilitation.
CONCLUSION
The use of a porous titanium 3D- implant for mandibular reconstruction in head and neck cancer patients resulted in high rates of implant exposure and of implant removal, notably when symphysis involvement.

Identifiants

DOI: 10.1016/j.jormas.2022.09.002 PMID: 36084893
pubmed: 36084893
pii: S2468-7855(22)00249-X
doi: 10.1016/j.jormas.2022.09.002
pii:
doi:

Substances chimiques

Dental Implants 0
Titanium D1JT611TNE

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

101281

Informations de copyright

Copyright © 2022 Elsevier Masson SAS. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest The authors have no competing interest to disclose.

Auteurs

Fabienne Haroun (F)

Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris Saclay, 114 Rue Edouard Vaillant, Villejuif 94800, France; BioMaps (UMR1281), University Paris Saclay, CNRS, INSERM, CEA, Orsay, France.

Nadia Benmoussa (N)

Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris Saclay, 114 Rue Edouard Vaillant, Villejuif 94800, France.

François Bidault (F)

BioMaps (UMR1281), University Paris Saclay, CNRS, INSERM, CEA, Orsay, France; Department of Radiology, Gustave Roussy Institute, University Paris Saclay, Villejuif, France.

Nathalie Lassau (N)

BioMaps (UMR1281), University Paris Saclay, CNRS, INSERM, CEA, Orsay, France; Department of Radiology, Gustave Roussy Institute, University Paris Saclay, Villejuif, France.

Antoine Moya-Plana (A)

Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris Saclay, 114 Rue Edouard Vaillant, Villejuif 94800, France.

Nicolas Leymarie (N)

Department of Plastic and Reconstructive Surgery, Gustave Roussy Institute, University Paris Saclay, Villejuif, France.

Jean-François Honart (JF)

Department of Plastic and Reconstructive Surgery, Gustave Roussy Institute, University Paris Saclay, Villejuif, France.

Fréderic Kolb (F)

Plastic and Reconstructive Surgery, UC San Diego, University of California, CA, United States.

Quentin Qassemyar (Q)

Department of Plastic Surgery, Tenon Hospital, AP-HP, Paris, France.

Philippe Gorphe (P)

Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris Saclay, 114 Rue Edouard Vaillant, Villejuif 94800, France. Electronic address: Philippe.gorphe@gustaveroussy.fr.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Outcomes of mandibular reconstruction using...
questionsmedicales.fr › Technologie, industrie et agriculture › Produits manufacturés › Matériaux biomédicaux et dentaires › Matériaux dentaires › Implants dentaires › Outcomes of mandibular reconstruction using...
questionsmedicales.fr › Procédures de chirurgie maxillofaciale et buccodentaire › Procédures de chirurgie orthognathique › Reconstruction mandibulaire › Outcomes of mandibular reconstruction using...
questionsmedicales.fr › Produits chimiques inorganiques › Métaux › Métaux légers › Titane › Outcomes of mandibular reconstruction using...
questionsmedicales.fr › Phénomènes physiques › Phénomènes mécaniques › Porosité › Outcomes of mandibular reconstruction using...
questionsmedicales.fr › Procédures de chirurgie opératoire › Transplantation › Transplantation de tissu › Transplantation osseuse › Outcomes of mandibular reconstruction using...