Primary reconstruction of resected proximal mandibular segments: a novel protocol using patient-specific poly ether-ether ketone (peek) condylar replicas

Abstract

Purpose: This study aims to evaluate the efficiency of computer-aided design and computer-aided manufacturing (CAD/CAM), mirror-imaged Polyetheretherketone (PEEK) assembly that aimed to duplicate both of the exact anatomic position and the configuration of the resected mandibular condyle, post segmental proximal tumor resection. Methods: Five patients were included in the study; diagnosed for mandibular ramus locally aggressive tumors, involving or markedly jeopardizing the mandibular condyles. All of the patients were subjected to a fully guided reconstructive protocol that implements guided resection, guided alignment of a pre-bent reconstruction plate, secured to a (CAD/CAM) fabricated, mirror-imaged (PEEK), looking forward to duplicating both of the anatomic location and the configuration of the amputated mandibular ramus and condyle. Results: Clinical evaluation revealed acceptable recovery of the maximal mouth opening and limited postoperative malocclusion and mandibular deviation. The computed radiographic superimposition between the virtual plane and the one- week postoperative C.T. revealed decreased linear condyle displacement in both the mediolateral and anteroposterior directions versus an increased linear vertical displacement and decreased axial angular rotation versus increased sagittal angular rotation. The replication between the virtually planned condylar location and that surgically duplicated was judged as good to excellent among all the cases. Conclusion: The novel simulation and allocation of the customized (PEEK) assembly represents a simple and efficient modality to reconstruct both of the lost condylar position and configuration. However, the anterior extension of the resected proximal mandibular segment deemed determinant to the success of the identical surgical execution of the virtual preplanned arrangemen