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Patient-centred outcomes and dental implant placement in computer-aided free flap mandibular reconstruction: a systematic review and meta-analysis

Published:September 28, 2022DOI:https://doi.org/10.1016/j.bjoms.2022.09.006

      Abstract

      Computerised surgical planning (CSP) and computer-aided design and manufacturing (CAD/CAM) have been demonstrated to increase surgical accuracy and reduce operative time in free flap mandibular reconstruction, but evidence is lacking as to their impact on patient-centred outcomes. Implant-supported dental prostheses, however, have been associated with improved quality of life outcomes following free flap mandibular reconstruction. We aim to review reported patient-centred outcomes in mandibular reconstruction with CSP and CAD/CAM and determine whether use of these technologies is associated with higher rates of dental implant placement following free flap mandibular reconstruction. On December 20, 2020, a systematic review and meta-analysis were conducted according to PRISMA guidelines for studies reporting quality of life, functional outcomes, and rates of dental implant placement in computer-aided free flap mandibular reconstruction. A random-effects meta-analysis was performed to compare dental implant placement rates between surgeries using CSP and those using conventional freehand techniques. A total of 767 articles were screened. Nine articles reporting patient-centred outcomes and 16 articles reporting dental implant outcomes were reviewed. Of those reporting dental implant outcomes, five articles, representing a total of 302 cases, were included in the meta-analysis. Use of CSP was associated with a significant increase in the likelihood of dental implant placement, with an odds ratio of 2.70 (95% CI 1.52 to 4.79, p = 0.0007). Standardised reporting methods and controlled studies are needed to further investigate the impact of CSP and CAD/CAM technologies on functional outcomes and patient-reported quality of life in free flap mandibular reconstruction. Use of CSP and CAD/CAM technologies is associated with higher rates of dental implant placement in patients undergoing free flap mandibular reconstruction when compared to conventional freehand techniques.

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      References

        • Rendenbach C.
        • Hölterhoff N.
        • Hischke S.
        • et al.
        Free flap surgery in Europe: an interdisciplinary survey.
        Int J Oral Maxillofac Surg. 2018; 47: 676-682
        • Davies J.C.
        • Chan H.H.
        • Jozaghi Y.
        • et al.
        Analysis of simulated mandibular reconstruction using a segmental mirroring technique.
        J Craniomaxillofac Surg. 2019; 47: 468-472
        • Succo G.
        • Berrone M.
        • Battiston B.
        • et al.
        Step-by-step surgical technique for mandibular reconstruction with fibular free flap: application of digital technology in virtual surgical planning.
        Eur Arch Otorhinolaryngol. 2015; 272: 1491-1501
        • Zhang M.
        • Rao P.
        • Xia D.
        • et al.
        Functional reconstruction of mandibular segment defects with individual preformed reconstruction plate and computed tomographic angiography-aided iliac crest flap.
        J Oral Maxillofac Surg. 2019; 77: 1293-1304
        • Avraham T.
        • Franco P.
        • Brecht L.E.
        • et al.
        Functional outcomes of virtually planned free fibula flap reconstruction of the mandible.
        Plast Reconstr Surg. 2014; 134: 628-634
        • Shen Y.
        • Sun J.
        • Li J.
        • et al.
        Using computer simulation and stereomodel for accurate mandibular reconstruction with vascularized iliac crest flap.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2012; 114: 175-182
        • Okcu Y.
        • Rustemeyer J.
        Continuity defects of the mandible: comparison of three techniques for osseous reconstruction and their impact on implant loading.
        J Craniomaxillofac Surg. 2018; 46: 858-867
        • Qu X.
        • Wang M.
        • Xu L.
        • et al.
        Occlusion guided double-barreled fibular osteoseptocutaneous free flap for refined mandibular reconstruction aided by virtual surgical planning.
        J Craniofac Surg. 2017; 28: 1472-1476
        • Zhang W.B.
        • Yu Y.
        • Wang Y.
        • et al.
        Improving the accuracy of mandibular reconstruction with vascularized iliac crest flap: role of computer-assisted techniques.
        J Craniomaxillofac Surg. 2016; 44: 1819-1827
        • Zhou Z.
        • Zhao H.
        • Zhang S.
        • et al.
        Evaluation of accuracy and sensory outcomes of mandibular reconstruction using computer-assisted surgical simulation.
        J Craniomaxillofac Surg. 2019; 47: 6-14
        • Ong H.S.
        • Liu J.N.
        • Ahmed A.
        • et al.
        Improved accuracy of hemimandibular reconstructions involving the condyle by utilizing hydroformed reconstruction plates rather than hand-bent stock plates.
        Head Neck. 2019; 41: 3168-3176
        • Toro C.
        • Robiony M.
        • Costa F.
        • et al.
        Feasibility of preoperative planning using anatomical facsimile models for mandibular reconstruction.
        Head Face Med. 2007; 3: 5
        • Goodson A.M.
        • Kittur M.A.
        • Evans P.L.
        • et al.
        Patient-specific, printed titanium implants for reconstruction of mandibular continuity defects: a systematic review of the evidence.
        J Craniomaxillofac Surg. 2019; 47: 968-976
        • Li P.
        • Xuan M.
        • Liao C.
        • et al.
        Application of intraoperative navigation for the reconstruction of mandibular defects with microvascular fibular flaps-preliminary clinical experiences.
        J Craniofac Surg. 2016; 27: 751-755
        • Barr M.L.
        • Haveles C.S.
        • Rezzadeh K.S.
        • et al.
        Virtual surgical planning for mandibular reconstruction with the fibula free flap: a systematic review and meta-analysis.
        Ann Plast Surg. 2020; 84: 117-122
        • Powcharoen W.
        • Yang W.F.
        • Yan Li K.
        • et al.
        Computer-assisted versus conventional freehand mandibular reconstruction with fibula free flap: a systematic review and meta-analysis.
        Plast Reconstr Surg. 2019; 144: 1417-1428
        • Pucci R.
        • Weyh A.
        • Smotherman C.
        • et al.
        Accuracy of virtual planned surgery versus conventional free-hand surgery for reconstruction of the mandible with osteocutaneous free flaps.
        Int J Oral Maxillofac Surg. 2020; 49: 1153-1161
        • Rogers S.N.
        • Lowe D.
        • Fisher S.E.
        • et al.
        Health-related quality of life and clinical function after primary surgery for oral cancer.
        Br J Oral Maxillofac Surg. 2002; 40: 11-18
        • Bouchet B.
        • Raoul G.
        • Julieron B.
        • Wojcik T.
        Functional and morphologic outcomes of CAD/CAM-assisted versus conventional microvascular fibular free flap reconstruction of the mandible: a retrospective study of 25 cases.
        J Stomatol Oral Maxillofac Surg. 2018; 119: 455-460
        • Wijbenga J.G.
        • Schepers R.H.
        • Werker P.M.
        • et al.
        A systematic review of functional outcome and quality of life following reconstruction of maxillofacial defects using vascularized free fibula flaps and dental rehabilitation reveals poor data quality.
        J Plast Reconstr Aesthet Surg. 2016; 69: 1024-1036
        • Kumar V.V.
        • Jacob P.C.
        • Ebenezer S.
        • et al.
        Implant supported dental rehabilitation following segmental mandibular reconstruction- quality of life outcomes of a prospective randomized trial.
        J Craniomaxillofac Surg. 2016; 44: 800-810
        • Pappalardo M.
        • Tsao C.K.
        • Tsang M.L.
        • et al.
        Long-term outcome of patients with or without osseointegrated implants after resection of mandibular ameloblastoma and reconstruction with vascularized bone graft: functional assessment and quality of life.
        J Plast Reconstr Aesthet Surg. 2018; 71: 1076-1085
        • de Groot R.J.
        • Rieger J.M.
        • Chuka R.
        • et al.
        Functional outcomes and quality of life after segmental mandibulectomy and reconstruction with a reconstruction plate or bone graft compared to a digitally planned fibula free flap.
        Int J Prosthodont. 2019; 32: 393-401
      1. Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Available from URL: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp [last accessed October 10, 2020].

        • Katsuragi Y.
        • Kayano S.
        • Akazawa S.
        • et al.
        Mandible reconstruction using the calcium-sulphate three-dimensional model and rubber stick: a new method, 'mould technique', for more accurate, efficient and simplified fabrication.
        J Plast Reconstr Aesthet Surg. 2011; 64: 614-622
        • Monaco C.
        • Stranix J.T.
        • Avraham T.
        • et al.
        Evolution of surgical techniques for mandibular reconstruction using free fibula flaps: The next generation.
        Head Neck. 2016; 38: E2066-E2073
        • Bosc R.
        • Hersant B.
        • Carloni R.
        • et al.
        Mandibular reconstruction after cancer: an in-house approach to manufacturing cutting guides.
        Int J Oral Maxillofac Surg. 2017; 46: 24-31
        • Goormans F.
        • Sun Y.
        • Bila M.
        • et al.
        Accuracy of computer-assisted mandibular reconstructions with free fibula flap: Results of a single-center series.
        Oral Oncol. 2019; 97: 69-75
        • Allen Jr, R.J.
        • Nelson J.A.
        • Polanco T.O.
        • et al.
        Short-term outcomes following virtual surgery-assisted immediate dental implant placement in free fibula flaps for oncologic mandibular reconstruction.
        Plast Reconstr Surg. 2020; 146: 768-776
        • Sawh-Martinez R.
        • Parsaei Y.
        • Wu R.
        • et al.
        Improved temporomandibular joint position after 3-dimensional planned mandibular reconstruction.
        J Oral Maxillofac Surg. 2017; 75: 197-206
        • Rana M.
        • Chin S.J.
        • Muecke T.
        • et al.
        Increasing the accuracy of mandibular reconstruction with free fibula flaps using functionalized selective laser-melted patient-specific implants: a retrospective multicenter analysis.
        J Craniomaxillofac Surg. 2017; 45: 1212-2129
        • Chang E.I.
        • Boukovalas S.
        • Liu J.
        • et al.
        Reconstruction of posterior mandibulectomy defects in the modern era of virtual planning and three-dimensional modeling.
        Plast Reconstr Surg. 2019; 144: 453-462
        • Ritschl L.M.
        • Fichter A.M.
        • Grill F.D.
        • et al.
        Bone volume change following vascularized free bone flap reconstruction of the mandible.
        J Craniomaxillofac Surg. 2020; 48: 859-867
        • Panchal H.
        • Shamsunder M.G.
        • Petrovic I.
        • et al.
        Dental implant survival in vascularized bone flaps: a systematic review and meta-analysis.
        Plast Reconstr Surg. 2020; 146: 637-648
        • Cracchiolo J.R.
        • Klassen A.F.
        • Young-Afat D.A.
        • et al.
        Leveraging patient-reported outcomes data to inform oncology clinical decision making: introducing the FACE-Q Head and Neck Cancer Module.
        Cancer. 2019; 125: 863-872
        • Singer S.
        • Amdal C.D.
        • Hammerlid E.
        • et al.
        International validation of the revised European Organisation for Research and Treatment of Cancer Head and Neck Cancer Module, the EORTC QLQ-HN43: Phase IV.
        Head Neck. 2019; 41: 1725-1737
        • Bedogni A.
        • Bettini G.
        • Bedogni G.
        • et al.
        Safety of boneless reconstruction of the mandible with a CAD/CAM designed titanium device: the replica cohort study.
        Oral Oncol. 2021; 112: 105073
        • Mounir M.
        • Abou-ElFetouh A.
        • ElBeialy W.
        • et al.
        Patient-specific alloplastic endoprosthesis for reconstruction of the mandible following segmental resection: a case series.
        J Craniomaxillofac Surg. 2020; 48: 719-723
        • Lopez C.D.
        • Diaz-Siso J.R.
        • Witek L.
        • et al.
        Three dimensionally printed bioactive ceramic scaffold osseoconduction across critical-sized mandibular defects.
        J Surg Res. 2018; 223: 115-122
        • Tuna T.
        • Yilmaz B.
        • Hermanns-Sachweh B.
        • et al.
        From a CAD/CAM-milled, allogeneic bone block to an implant-supported fixed partial denture with angulated screw channel: a case report.
        Quintessence Int. 2021; 52: 56-63