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. 2020 Oct-Dec;10(4):608-614.
doi: 10.1016/j.jobcr.2020.08.018. Epub 2020 Aug 27.

Application of CAD/CAM technology for surgical treatment of condylar head fractures: A preliminary study

Tetiana Pavlychuk  1 , Denis Chernogorskyi  1 , Yurii Chepurnyi  1 , Andreas Neff  2 , Andrii Kopchak  1
Affiliations

Application of CAD/CAM technology for surgical treatment of condylar head fractures: A preliminary study

Tetiana Pavlychuk et al. J Oral Biol Craniofac Res. 2020 Oct-Dec.

Abstract

Objectives: The aim of the present study was to improve the accuracy and reliability of ORIF in patients with condylar head fractures (CHFs) by developing a design for patient specific fixators, navigation and repositioning guides, as well as the algorithms of their clinical application.

Materials and methods: 14 patients with 16 CHFs were treated by ORIF with the use of CAD/CAM technology. After virtual reduction of the bony fragments, the appropriate length and diameter of the screws was chosen. In biomechanically unfavorable cases (type p) patient specific reinforcement plates were used together with the positional screws for reinforcement of the bone-fixator system. And in cases of severely comminuted fractures patient specific 3-D plate was applied.

Results: The CT data, obtained immediately after the operation revealed the good anatomical reduction. Any deviations of the small fragments noted were near 1 mm in all cases. Postoperative clinical examination at 3 months follow up showed good occlusion and mouth opening not less than 3 cm in all patients. The lateral and anterior mobility of the mandible was restored with small limitations of protrusive mobility in 1 case. All the patients were satisfied with the outcomes.

Conclusions: The application of the CAD/CAM technologies and the new design of the surgical guides and patient specific reinforcement plates for CHFs helps to improve the accuracy and quality of fragments reduction and stability of fixation with minimal risks of intraoperative complications.

Clinical relevance: CAD/CAM technologies improve the clinical effectiveness of treatment patients with the CHFs.

Keywords: CAD/CAM technology; Condylar head fractures; PSI; Patient specific reinforcement plate; Screw ostheosynthesys.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Algorithms of clinical application of patient specific fixators, navigation and repositioning guides in patients with CHFs.
Fig. 2
Fig. 2
Preoperative planning (A, B) of patient with CHF (type p) and design of the surgical guide for repositioning and angulation of screw fixation (C, D, E) and CT after fixation (F) (note: all PSI components to be removed after ORIF with positional screws).
Fig. 3
Fig. 3
Preoperative planning (A, B) of patient with CHF (type p, the biomechanically unfavorable fractures), design of the surgical guide for repositioning and angulation of screw fixation (C, D). E, F - PSRP and surgical guide for reduction and reinforcement of the conventional two screw fixation system (lateral component to be left in site as a washer device), G, H- CT after fixation.
Fig. 4
Fig. 4
Preoperative planning (A) of patient with CHF (the case of major fragmented (comminuted) fractures). Design of a patient specific titanium 3-D plate in (B, C, D) and CT after fixation (E, F).
Fig. 5
Fig. 5
Intraoperative photo of repositioning and navigation surgical guide (A), patient specific reinforcement plate (B) and patient specific titanium 3-D plate (C).
See this image and copyright information in PMC

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