Integrative and multi-disciplinary framework for the 3D rehabilitation of large mandibular defects

The restoration of mandibular defects, especially large deformities is regarded as the most challenging surgical procedure owing to complicated anatomy and the requirement of customized design. Presently, the commercially available reconstruction plates with standard shapes and sizes are frequently utilized. However, these typical plates exhibit several disadvantages, including high cost, poor performance, etc. They are ineffective and do not exactly match the bone contours. Besides, trial and miss approach and several revisions associated with these plates involve significant effort and time. To overcome these issues, a framework based on the integration of design, analysis, evaluation, and fabrication phases have been developed and implemented. The objective was the attainment of a cost-effective, reliable, and sturdy design for the mandibular implant. A customized plate merged with a mesh structure matching the patient bone contours as well as guide and support the growth of neighboring bones was the crux of this mandible implant. The proposed methodology was made of three primary pillars: technology unification, multi-disciplinary notion, and a quality emphasis. A lattice structure, instead of a solid framework was utilized to reconstruct the large mandibular defect. Indeed, the various porous structures were analyzed to finally derive the appropriate lattice structure. The scans from computer tomography were utilized to model the customized plate and scaffold framework, while electron beam melting was used to fabricate the implant. Moreover, the proposed implant design was analyzed using finite element analysis as well as the fabricated specimen was validated for mechanical and structural behavior. The biomechanical analysis outcome revealed lower stresses (214.77 MPa) as well as well-connected structures involving proper porosity and robust mechanical properties. The cost analysis also established that the employment of the proposed design would result in a lesser burden on the patient as compared to the existing practices.