PDF(Pubmed)
Abstract：
BACKGROUND: Tumorous diseases of the jaw demand effective treatments, often involving continuity resection of the jaw. Reconstruction via microvascular bone flaps, like deep circumflex iliac artery flaps (DCIA), is standard. Computer aided planning (CAD) enhances accuracy in reconstruction using patient-specific CT images to create three-dimensional (3D) models. Data on the accuracy of CAD-planned DCIA flaps is scarce. Moreover, the data on accuracy should be combined with data on the exact positioning of the implants for well-fitting dental prosthetics. This study focuses on CAD-planned DCIA flaps accuracy and proper positioning for prosthetic rehabilitation.
METHODS: Patients post-mandible resection with CAD-planned DCIA flap reconstruction were evaluated. Postoperative radiograph-derived 3D models were aligned with 3D models from the CAD plans for osteotomy position, angle, and flap volume comparison. To evaluate the DCIA flap\'s suitability for prosthetic dental rehabilitation, a plane was created in the support zone and crestal in the middle of the DCIA flap. The lower jaw was rotated to close the mouth and the distance between the two planes was measured.
RESULTS: 20 patients (12 males, 8 females) were included. Mean defect size was 73.28 ± 4.87 mm; 11 L defects, 9 LC defects. Planned vs. actual DCIA transplant volume difference was 3.814 ± 3.856 cm³ (p = 0.2223). The deviation from the planned angle was significantly larger at the dorsal osteotomy than at the ventral (p = 0.035). Linear differences between the planned DCIA transplant and the actual DCIA transplant were 1.294 ± 1.197 mm for the ventral osteotomy and 2.680 ± 3.449 mm for the dorsal (p = 0.1078). The difference between the dental axis and the middle of the DCIA transplant ranged from 0.2 mm to 14.8 mm. The mean lateral difference was 2.695 ± 3.667 mm in the region of the first premolar.
CONCLUSIONS: The CAD-planned DCIA flap is a solution for reconstructing the mandible. CAD planning results in an accurate reconstruction enabling dental implant placement and dental prosthetics.
METHODS: Patients post-mandible resection with CAD-planned DCIA flap reconstruction were evaluated. Postoperative radiograph-derived 3D models were aligned with 3D models from the CAD plans for osteotomy position, angle, and flap volume comparison. To evaluate the DCIA flap\'s suitability for prosthetic dental rehabilitation, a plane was created in the support zone and crestal in the middle of the DCIA flap. The lower jaw was rotated to close the mouth and the distance between the two planes was measured.
RESULTS: 20 patients (12 males, 8 females) were included. Mean defect size was 73.28 ± 4.87 mm; 11 L defects, 9 LC defects. Planned vs. actual DCIA transplant volume difference was 3.814 ± 3.856 cm³ (p = 0.2223). The deviation from the planned angle was significantly larger at the dorsal osteotomy than at the ventral (p = 0.035). Linear differences between the planned DCIA transplant and the actual DCIA transplant were 1.294 ± 1.197 mm for the ventral osteotomy and 2.680 ± 3.449 mm for the dorsal (p = 0.1078). The difference between the dental axis and the middle of the DCIA transplant ranged from 0.2 mm to 14.8 mm. The mean lateral difference was 2.695 ± 3.667 mm in the region of the first premolar.
CONCLUSIONS: The CAD-planned DCIA flap is a solution for reconstructing the mandible. CAD planning results in an accurate reconstruction enabling dental implant placement and dental prosthetics.
摘要：
背景：颌骨肿瘤疾病需要有效的治疗，通常涉及下颌的连续性切除。通过微血管骨瓣重建，如旋髂深动脉皮瓣（DCIA），是标准的。计算机辅助规划(CAD)提高了使用患者特异性CT图像来创建三维(3D)模型的重建精度。有关CAD计划的DCIA襟翼精度的数据很少。此外，准确性数据应与植入物的精确定位数据相结合，以实现良好的牙科修复。这项研究的重点是CAD计划的DCIA皮瓣的准确性和正确定位以进行假肢康复。
方法：对CAD计划的DCIA皮瓣重建的下颌骨切除术后患者进行评估。术后X线片衍生的3D模型与CAD截骨位置计划中的3D模型对齐，angle,和皮瓣体积比较。为了评估DCIA皮瓣对假牙修复的适用性，在支撑区创建了一架飞机，并在DCIA皮瓣的中部创建了一架飞机。旋转下颌以闭合嘴，并测量两个平面之间的距离。
结果：20例患者（12例男性，包括8名女性）。平均缺陷尺寸为73.28±4.87mm；11L缺陷，9个LC缺陷。计划与实际DCIA移植体积差为3.814±3.856cm²(p=0.2223).背侧截骨术与计划角度的偏差明显大于腹侧（p=0.035）。腹侧截骨术计划的DCIA移植与实际的DCIA移植之间的线性差异为1.294±1.197mm，背侧为2.680±3.449mm（p=0.1078）。牙轴与DCIA移植中部之间的差异范围为0.2mm至14.8mm。第一前磨牙区域的平均横向差为2.695±3.667mm。
结论：CAD计划的DCIA皮瓣是重建下颌骨的解决方案。CAD计划可实现精确的重建，从而实现牙科植入物的放置和牙科修复。
方法：对CAD计划的DCIA皮瓣重建的下颌骨切除术后患者进行评估。术后X线片衍生的3D模型与CAD截骨位置计划中的3D模型对齐，angle,和皮瓣体积比较。为了评估DCIA皮瓣对假牙修复的适用性，在支撑区创建了一架飞机，并在DCIA皮瓣的中部创建了一架飞机。旋转下颌以闭合嘴，并测量两个平面之间的距离。
结果：20例患者（12例男性，包括8名女性）。平均缺陷尺寸为73.28±4.87mm；11L缺陷，9个LC缺陷。计划与实际DCIA移植体积差为3.814±3.856cm²(p=0.2223).背侧截骨术与计划角度的偏差明显大于腹侧（p=0.035）。腹侧截骨术计划的DCIA移植与实际的DCIA移植之间的线性差异为1.294±1.197mm，背侧为2.680±3.449mm（p=0.1078）。牙轴与DCIA移植中部之间的差异范围为0.2mm至14.8mm。第一前磨牙区域的平均横向差为2.695±3.667mm。
结论：CAD计划的DCIA皮瓣是重建下颌骨的解决方案。CAD计划可实现精确的重建，从而实现牙科植入物的放置和牙科修复。
