The concept of Prosthetically Guided Maxillofacial and Implant Surgery for maxillary reconstruction

A viable protocol for the reconstruction of the maxilla after cancer ablation was tested, taking into account final rehabilitation with an implant-supported fixed prosthesis, and using CAD-CAM technology. The protocol involved seven steps: surgical planning of the bony resections, CAD and rapid prototyping of cutting guides, titanium mesh, and bone plate, maxillofacial surgery, oral implant surgery, and prosthetic rehabilitation. CAD-CAM technology was used for each step, to design and prototype the surgical guides and the bone plate for the maxillofacial surgery; to make the impression of implants; and to prototype the framework of the final prosthetic rehabilitation. With respect to the maxillofacial surgery, to evaluate the margins of the bone cuts, the planes of the postoperative cuts were compared with those planned in the virtual environment. The accuracy of the rapid prototyping and intraoperative surgical positioning protocol was evaluated. With regard to implants and prosthetic rehabilitation, the framework confirmed a passive fit on implants using the Sheffield test, and occlusal and interproximal points of contact resulted clinically as projected virtually. Prosthetically Guided Maxillofacial and Implant Surgery is a viable method to reproduce the correct anatomy of the maxillary arches in relation to the prosthetic needs of rehabilitation. Moreover, the protocol presented in this paper offers some adjunctive benefits, such as time and cost saving and ideal aesthetic facial contouring.