The Precision of Different Types of Plates Fabricated with a Computer-Aided Design and Manufacturing System in Mandibular Reconstruction with Fibular Free Flaps

Background: Computer-assisted surgery (CAS) has been introduced to mandible reconstruction with fibular free flap in cutting guide placement. When CAS is cooperated with different plate fixations, the results show various degrees of errors by which this study aimed to evaluate. Methods Mock surgeries were conducted in 3D-printed mandibles with either 2 types of defects; limited or extensive, reconstructed from 2 ameloblastoma patients. Three types of fixations; miniplate, manually bending reconstruction plate and patient-specific plates are tested, each of which was performed 3 times in each type of defects, adding up to 18 surgeries. One with the least errors was selected and applied with patients whose 3D-printed mandibles derived. Finally, in vivo errors were compared with the mock. Results In limited defect, average errors show no statistical significance among all types. In extensive defect, patient-specific plate had a significantly lower average condylar error than manually bending reconstruction plate and miniplate (8.09±2.52 mm vs. 25.49±2.72 and 23.13±13.54 mm, respectively). When patient-specific plate was applied in vivo , the errors were not significantly different from the mock. Conclusion Patient-specific plates cooperated with CAS shows the least errors. Nevertheless, manually bent reconstruction plates and miniplates could be applied in limited defects with caution.