Digital Short-Segment Drilling Guides For Complex Mandibular Fractures

To establish a fully digital workflow utilizing segmented short-segment drilling guides(SSDGs) for the treatment of complex mandibular fractures, and to evaluate its applicability and accuracy. Preoperative CT data facilitated virtual surgical planning using MIMICS software, enabling precise fracture reduction based on anatomical landmarks and occlusal relationships. Reconstruction plates were pre-bent on 3D-printed mandibular models. Digital screw path information was then captured via CBCT scans of these models. This data informed the design of SSDGs and osteotomy guides in 3-matic software. From August 2023 to August 2024, open reduction and internal fixation were performed on a consecutive cohort of patients with complex mandibular fractures utilizing this digital workflow. All patients underwent postoperative CT scans within one month. Three-dimensional comparisons were conducted, using preoperative mandibular models as reference and postoperative models for measurement, to quantify accuracy. Ten patients with complex mandibular fractures were consecutively enrolled. Successful mandibular fracture reduction was achieved in all cases using our digital workflow. Three-dimensional analysis revealed a mean average deviation distance of (0.35±0.53) mm between preoperatively planned and postoperative mandibular models. The RMS was (1.83±0.90) mm. The percentages of points exhibiting deviations less than 2mm, 1mm, and 0.5mm were (77.96±16.64)%, (56.26±22.85)%, and (36.02±23.24)%, respectively. Our workflow, combining virtual surgery with fully digital SSDGs, enables precise reduction of complex mandibular fractures with simple preoperative preparation. It particularly advantageous for the treatment of complex mandibular fractures.