Navarro Cuéllar C, Tousidonis Rial M, Antúnez-Conde R, Ochandiano Caicoya S, Navarro Cuéllar I, Arenas de Frutos G, Sada Urmeneta Á, García-Hidalgo Alonso MI, Navarro Vila C, Salmerón Escobar 
Journal of Clinical Medicine 2021 Apr 29; 10(9):1922OBJECTIVE
The purpose of this study was to evaluate the outcomes of the three-dimensional reconstruction of the fibula flap with iliac crest graft and dental implants through virtual surgical planning (VSP), STL models and CAD/CAM titanium mesh.
MATERIAL AND METHODS
Eight patients underwent three-dimensional reconstruction of the fibula flap with iliac crest graft and dental implants through virtual surgical planning (VSP), stereolitographic models (STL) and CAD/CAM titanium mesh. Vertical ridge augmentation and horizontal dimensions of the fibula, peri-implant bone resorption of the iliac crest graft, implant success rate and functional and aesthetic results were evaluated.
RESULTS
Vertical reconstruction ranged from 13.4 mm to 10.1 mm, with an average of 12.22 mm. Iliac crest graft and titanium mesh were able to preserve the width of the fibula, which ranged from 8.9 mm to 11.7 mm, with an average of 10.1 mm. A total of 38 implants were placed in the new mandible, with an average of 4.75 0.4 implants per patient and an osseointegration success rate of 94.7%. Two implants were lost during the osseointegration period (5.3%). Bone resorption was measured as peri-implant bone resorption at the mesial and distal level of each implant, with a variation between 0.5 mm and 2.4 mm, and with a mean of 1.43 mm. All patients were rehabilitated with a fixed implant prosthesis with good aesthetic and functional results.
CONCLUSION
The multi-stage implementation of virtual surgical planning (VSP) with the use of stereolithographic models (STL) and CAD/CAM titanium mesh for 3D mandibular defects offers a reconstructive accuracy, which was previously reliant on surgeon experience and intraoperative trial-and-error using 2D imaging modalities. It increases bone-to-bone contact, has a better mesh alignment and improves operative efficiency with reduced complication rates and minimal bone resorption. It provides an accurate three-dimensional reconstruction of the fibula flap, which leads to an optimized implant placement and dental alignment, thereby enhancing facial symmetry, aesthetic contour and function.
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