Validation of a fibula graft cutting guide for mandibular reconstruction: experiment with rapid prototyping mandible model

Objective: We examined whether cutting a fibula graft with a surgical guide template, prepared with computer-aided design/computer-aided manufacturing (CAD/CAM), would improve the precision and accuracy of mandibular reconstruction. Methods: Thirty mandibular rapid prototype (RP) models were allocated to experimental (N = 15) and control (N = 15) groups. Thirty identical fibular RP models were assigned randomly, 15 to each group. For reference, we prepared a reconstructed mandibular RP model with a three-dimensional printer, based on surgical simulation. In the experimental group, a stereolithography (STL) surgical guide template, based on simulation, was used for cutting the fibula graft. In the control group, the fibula graft was cut manually, with reference to the reconstructed RP mandible model. The mandibular reconstructions were compared to the surgical simulation, and errors were calculated for both the STL surgical guide and the manual methods. Results: The average differences in three-dimensional, minimum distances between the reconstruction and simulation were 9.87 +/- 6.32mm (mean +/- SD) for the STL surgical guide method and 14.76 +/- 10.34mm (mean +/- SD) for the manual method. Discussion: The STL surgical guide method incurred less error than the manual method in mandibular reconstruction. A fibula cutting guide improved the precision of reconstructing the mandible with a fibula graft.