Tracking Tag Stabilization With a Small-Diameter Implant in an Edentulous Mandible to Assist Dynamically Navigated Surgery: A Case Report
This report describes the use of a temporary dental implant to secure a radiographic fiducial marker and patient-tracking tag to an edentulous mandible for dynamically guided implant placement into a fibula microvascular free flap. A small-diameter dental implant was placed into the anterior mandible to secure a radiographic fiducial marker followed by a patient tag. The patient tag allowed for tracking of the patient's mandible during placement of endosseous dental implants. Four endosseous dental implants were successfully placed into the edentulous fibula free flap mandibular reconstruction. Dynamic navigation using a small-diameter implant to secure radiographic fiducial markers and patient tags provides a novel technique to place implants into an edentulous microvascular free flap with minimal incision and reflection of soft tissue.
Figure 1. Surgical navigation system using stereoscopic camera, computer, jaw-tracking tag, and drill-tracking tag. Figure 2. (a) Small-diameter implant (SDI) placed in the midline of the reconstructed mandible (a). Radiographic fiducial marker and horizontal arm placed and anchored on the SDI. A small screw within the horizontal arm was tightened with a hex wrench to firmly secure it to the SDI. (b) Patient going through the CBCT scan with fiducial in place (c).
Cone-beam computerized tomography of osteoradionecrosis of the mandible (a) and pathologic fracture on the right side (b).
Virtually planned implants in dynamic navigation software in the (a) right and (b) left reconstructed mandible.
Patient tag in place secured on the small-diameter implant (a). Drill calibration on the patient tag (b). Placement of implants using dynamic navigation (c).
Panoramic radiograph of the reconstructed mandible with radiographic guide (a) and following implant placement (b). Postoperative cone-beam computerized tomography scan with placed implants (c).
Cone-beam computerized tomography images of the planned (yellow) and the actual implant positions (red) from lower left (a, b) to lower right (c, d) were superimposed to assess accuracy values.
Figure 8. Intraoral view of mandibular implants at the time of prosthetic rehabilitation (a), and wax try-in in place (b) with opposing edentulous maxilla (c) and with wax try-in of complete maxillary and mandibular hybrid prosthesis in place (d). Figure 9. Mandibular final prosthesis in place (a), anterior view with complete maxillary denture (b), facial view of the patient before (c) and after (d) and side view before (e) and after (f) prosthetic rehabilitation.
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