Research On Guidance Method For Mandible Reconstruction With Simultaneous Fibular Free Flap And Dental Implant Insertion Based On Augmented Reality Technology

The jaw bone serves as an indispensable support structure in the oral and maxillofacial region.Defect of jaw bone can lead to facial deformities and functional impairments such as difficulties with eating and speaking,seriously affecting patients’ physical and mental health and quality of life.In recent years,the repair and reconstruction of mandibular defects have entered the stage of functional restoration,with the ultimate goal of achieving both form and function to improve patients’ quality of life.Currently,mandible reconstruction with simultaneous fibular free flap(FFF)and dental implant insertion can greatly restore patients’ oral and maxillofacial functions,such as chewing and aesthetics,to the greatest extension,thus improving patients’ quality of life.Surgical guidance based on augmented reality(AR)technology is a newly developed method in recent years.The use of AR technology can overlay virtual surgical plans onto the surgical site,providing visual guidance for the surgeon and improving the efficiency and accuracy of the surgery.Until now,no studies have reported on the application of augmented reality(AR)technology in mandible reconstruction with simultaneous FFF and dental implant insertion.Therefore,this article aims to explore the AR-based guidance method for mandible reconstruction with simultaneous FFF and dental implant insertion.The study is divided into two parts.The first part aims to explore the method of using image markers for AR guidance in FFF reconstruction for mandibular defects.The second part aims to investigate the method of using natural features for markerless AR guidance in FFF reconstruction and simultaneous implant placement for mandibulectomy defects,and to verify its accuracy and feasibility through cadaveric experiments.In the first part of this study,7 fibular specimens and 7 lower limb specimens were used to conduct experiments on AR-guided FFF osteotomy based on image markers.The results showed that the length error of FFF osteotomy using this method was 1.18±0.84 mm,and the angular deviation of the end surface was 5.45± 1.47°.In the second part,three mandibular specimens,three 3D-printed mandibular phantoms,and six fibular specimens were used to conduct experiments on natural-featurebased AR-guided mandibulectomy with simultaneous FFF reconstruction and implant insertion.Three implants were inserted in each fibular specimen.The results showed that the mandibulectomy length error was 2.25±0.80 mm,the angular deviation of the end surface was 7.85±3.46°,the FFF osteotomy length error was 1.09±0.81 mm,the angular deviation of the end surface was 10.21 ±6.63°,and the entrance point position error of the implants was 1.25±0.80 mm,with an angular deviation of 3.55±2.46°.The results of this study suggest that the AR-guided system for mandibular resection with simultaneous FFF reconstruction and implant placement is a potential precise and feasible method for functional reconstruction of mandibular defects.