R. Preud’homme*a (M.)
a Master 2, Caen, FRANCE
* camille.faudrin@atout-org.com
Purpose: The objective of this work was to analyze the positioning accuracy of the DEOS mandibular bone distraction device, and to compare the positioning accuracy of the new generation DEOS with the old one, in mandibular reconstruction in patients with facial gunshot trauma.
Materials and Methods: Among the uses of DEOS reported in the literature, we selected 7 interesting cases (5 cases with a clinical outcome at the end of distraction different from the preoperative simulation, and 2 cases with a satisfactory clinical outcome). The mandibles and the two versions of DEOS of these 7 cases were 3D printed. After performing the in vitro surgery, the mandibles with the new generation DEOS were 3D CT-scanned, then the old generation DEOS were put in place before performing a second scan acquisition. The image sets obtained are virtually reconstructed to measure the differences in distances on reference points between the scanned mandibles carrying the DEOS and the preoperative simulations
Results: The new generation DEOS provides a better placement accuracy than the old generation DEOS, with a mean distance to simulation of 3.16mm (SD=1.73mm) for the new DEOS versus 7.25mm (SD=4.33mm) for the old DEOS, p=6. 10x10-10. This significant difference was also found in the position of the condyles and the distracted mobile segment.
Discussion: The differences in accuracy between the two versions of the DEOS could translate clinically into improved aesthetics and facial functions. The improved accuracy of mandibular reconstruction with the fixed DEOS could facilitate dental rehabilitation by osteointegrated implants by directly placing the neoformed mandibular arcade in good relationship with the maxillary arcade, as intended during surgical planning.
Conclusion: This study shows a significant improvement in the precision of placement of the new generation DEOS compared to the old one, which can be translated clinically into an improved quality of reconstruction, which will have to be proven later by a new clinical study.