Mandibular reconstruction using custom-made titanium mesh tray and autogenous particulate cancellous bone and marrow

Abstract

This paper introduces the mandibular reconstruction using a custom-made titanium mesh (Ti-mesh) tray and autogenous particulate cancellous bone and marrow (PCBM), with a representative case report. The Ti-mesh tray is accurately adapted to the mandibular defect and its configuration is suitable for reproducing the final dental occlusion in each patient by utilizing computer-aided design/computer-aided manufacture (CAD/CAM) and dental laboratory technology. Eleven patients with mandibular defects (9 segmental defects and 2 marginal defects) underwent the present mandibular reconstruction. All reconstructive surgeries were successful and postoperative facial contour was acceptable for most patients. Although fracture of the Ti-mesh tray was recognized within 3 months after surgery in 2 patients with mandibular defect including the mentum area, we carried out successful additional reconstructive surgeries using a reinforced Ti-mesh tray and PCBM in these 2 patients. Although the present mandibular reconstruction requires several improvements, it seems to be clinically more predictive than the conventional mandibular reconstruction.