Digital Workflow Using A Free 3-D Mesh Modeling Software as a Tool in the Treatment of a Pediatric Mandibular Fracture.

Abstract

The treatment of pediatric mandibular fractures is challenging due to the risk of injury to tooth germs and the potential of facial development disturbances. These cases require precise reduction and fixation to minimize such risks, while also promoting return to function. Long-term follow-up is of utmost importance, once the removal of osteosynthesis material due to plate migration might be required. Virtual surgical planning associated with 3-D printing optimizes functional and aesthetic outcomes, while reducing surgical time and intraoperative complications. This study aimed to describe the "in-house digital workflow" utilized to treat a complex mandibular fracture on a pediatric patient. Reduction and osteosynthesis using a 2.0 locking plate at the base of the mandible, placed as inferiorly as possible to avoid permanent tooth germs, through a submandibular approach, and dental splinting were planned for the case. An STL file of the mandible was generated from the computed tomography (CT) scan and used to simulate the reduction of the fractured segments. Upon achieving proper reduction, a prototype was printed, which was then used to pre-bend the load-bearing 2.0 mm titanium plate. An "in-house" virtual workflow facilitates case planning and fracture reduction, with greater efficiency and surgical precision, while allowing the operator to personalize their surgical practice, lowering costs, and expediting case management. This case illustrated the use of virtual planning on readily accessible software, associated with a 3-D printed model, resulting in reduced surgery time, lower blood loss, optimized workflow and decreased costs.