Reconstruction of complex mandibular defects using integrated dental custom-made titanium implants


Reconstruction of the craniofacial complex is challenging because of the unique anatomy, the presence of vital structures, and the diversity of defects. In craniofacial reconstruction, restoration of appearance and function is the primary goal. Autografts are the gold standard treatment, but they have several disadvantages, which has led to research into alloplastic materials.
The development of CADCAM systems allows for precise preoperative planning and design of patient-specific implants.
The workflow of custom-made implants is shown in Fig.1. Two-dimensional DICOM files were converted into 3-dimensional stereolithographic (STL) files and the custom-made implant was designed using ABGuided 3-dimensional software (A.B.Dental, Ashdod, Israel).
The skull and the implant were printed as an STL model in resin for compatibility tests using a 3-dimensional Objet260 Dental Selection printer (Stratasys©, Rehovot, Israel).
The titanium implant was then printed using a laser sintering 3-dimensional printer (EOS, Novi, MI, USA).
We present the case of a patient who had his facial bones reconstructed because of a large deficiency in the ramus, body, and angle of his right mandible caused by an ameloblas-toma.