Journal article
What factors Influence Success of Mandibular Reconstructions with Patient Specific Selective Laser Melted Reconstruction Plates?
Journal of oral and maxillofacial surgery, Vol.83(10), pp.1271-1278
10/2025
DOI: 10.1016/j.joms.2025.05.024
PMID: 40550483
Abstract
Background
Patient specific reconstruction is becoming more ubiquitous in craniomaxillofacial surgery. There is a paucity of information on what factors may influence case success.
Purpose
The study purpose was to estimate patient specific hardware failure rate and to identify risks factors associated with hardware failure.
Study Design, Setting, Sample
A retrospective cohort study was implemented using data from subjects treated with selectively laser melted (SLM) reconstruction plates at the University of Iowa. Subjects were excluded if follow up was less than 3 months, data was not complete, or the subjects were not treated with a SLM plate.
Predictor Variables
The predictor variables were composed of heterogenous variables grouped into the following categories: demographics, etiology, mandibular characteristics, and reconstruction plate characteristics such as number of screws proximal and distal to fracture/defect.
Main Outcome Variable
The primary outcome variable was time to screw failure (yes/no) which was determined by examining subject radiographic data, and if it was clinical reason for removal of the reconstruction plate.
Covariates
The only covariate is sex.
Analyses
Descriptive statistics were calculated for each variable. Bivariate Cox regression analyses were performed to assess the association between each variable and the hazard of screw failure. Alpha=0.05 was considered significant.
Results
The sample included 131 subjects. Median follow up time was 11.0 (IQR 14.0) months. There was 1 (0.8%) plate fracture and 10 (7.6%) screw failures. Subjects with one additional screw proximal to the fracture/defect (e.g., from 3 to 4, or 4 to 5, or 5 to 6) had a 63% higher hazard of screw failure at any given time over the follow up period (HR = 1.63, p=0.04, 95% CI 1.02-2.63). Subjects with one additional screw distal to the fracture/defect had a 58% higher hazard of screw failure (HR = 1.58, p=0.01, 95% CI 1.10-2.26). Among patients with continuity defects (n = 49), those who received a bone graft had a 85% lower hazard of screw failure compared to those who did not receive a graft (HR = 0.15, p=.03, 95% CI 0.03-0.851).
Conclusion and Relevance
SLM reconstruction plate fracture is rare. Adding additional screws proximal and distal to a fracture/defect may lead to a higher hazard of hardware failure. Using a bone graft for continuity defects may lead to a lower hazard of hardware failure.
Details
- Title: Subtitle
- What factors Influence Success of Mandibular Reconstructions with Patient Specific Selective Laser Melted Reconstruction Plates?
- Creators
- Jeffrey S. Marschall - University of IowaMitchell Frerichs - University of IowaThomas Keith - University of IowaSteven Fletcher - University of IowaDoug Kendrick - University of Iowa, Oral and Maxillofacial SurgeryChris Kepros - University of IowaKirk Fridrich - University of IowaRichard Burton - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Journal of oral and maxillofacial surgery, Vol.83(10), pp.1271-1278
- DOI
- 10.1016/j.joms.2025.05.024
- PMID
- 40550483
- NLM abbreviation
- J Oral Maxillofac Surg
- ISSN
- 0278-2391
- eISSN
- 1531-5053
- Publisher
- W B SAUNDERS CO-ELSEVIER INC; PHILADELPHIA
- Language
- English
- Electronic publication date
- 06/06/2025
- Date published
- 10/2025
- Academic Unit
- Craniofacial Anomalies Research Center; Oral and Maxillofacial Surgery; Hospital Dentistry; Otolaryngology
- Record Identifier
- 9984832187202771
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