Evolution in Bone Synthesis

The difficulty with the fixation method in jaws reconstruction with fibula flap is related to the number of osteotomies required and the length of the bone segments needed. The larger the defect in the jaw, the more osteotomies are necessary, and the more complex the procedure becomes. Length and angle of the bone segments have a direct effect on their position, which affect the final facial bone contour. Generally speaking, fixation techniques can be divided into rigid and nonrigid forms of fixation. Nonrigid fixation uses interosseous wire fixation, wire mesh fixation, overlay and onlay bone grafting, titanium tray fixation, and Kirschner wire fixation. Studies have not been able to demonstrate any difference in the rate of bone healing between the rigid and nonrigid fixation methods in mandibular reconstruction. Nevertheless, nonrigid fixation methods are rarely used in today’s clinical practice, because they prove to be laborious. Rigid fixation methods use lag screw fixation, staples, titanium tray fixation, external fixation appliances, miniplates, and diverse reconstruction plates. Locking mandibular reconstruction plate is one of the most important technological advances in mandibular fixation: it becomes unnecessary for the plate to intimately contact the underlying bone in all areas, thus avoiding compression of periosteal blood perfusion of the underlying cortical bone. Following the Hidalgo experience (1989), in the early 2000s the use of miniplates as opposed to reconstruction plates (lower profiles and smaller screw diameters) has been the subject of intense debate. Custom-made pre-bent reconstruction plates are the most recent and the final step of the virtual design process. Only custom reconstruction pre-bent plates prove to be superior to miniplates or to modern reconstruction plates. Adding cost and different health economies limit worldwide accessibility and diffusion of this technology innovation.