Mandibular reconstruction systems and procedures

Abstract

In general, a disclosed aspect comprises a process that includes: providing a bone section; attaching a cutting guide to the bone section; cutting the bone section into multiple bone graft sections using the cutting guide; arranging the multiple bone graft sections in a neomandibular position; attaching a temporary fixation plate to the multiple bone graft sections after arranging them in the neomandibular position; removing the cutting guide from the multiple bone graft sections after attaching the temporary fixation plate; and attaching a final fixation plate to the multiple bone graft sections after removing the cutting guide.and removal of the temporary fixation plate from the multiple bone graft segments after application of the final fixation plate to create a neomandibular assembly.

Description

GENERAL STATE OF THE ART

[0001] Embodiments of the present invention generally relate to surgical systems and methods and include in particular patient-specific cutting / alignment guides and triangular plates for mandibular reconstruction as well as related techniques for their use and implementation. BRIEF SUMMARY OF THE INVENTION

[0002] A patient-specific cutting guide and alignment fixation can be used to precisely cut fibular bone grafts at predetermined locations and then adjust the grafts into a final orientation to construct a new mandible. In some embodiments, a patient-specific triangular plate is inserted between two rows of fibular grafts to provide the jaw structure while also allowing the screws inserted into the fibular grafts to be countersunk. Two rows of fibular grafts can be used on a case-by-case basis to build up bone height for positioning dental implants, which are to be inserted simultaneously. Embodiments of the present invention also include single-barrel or single-row configurations.In this respect, in some embodiments a single row of fibular implants can be used to achieve bone height for positioning dental implants.

[0003] In exemplary embodiments, there would be a portion of the natural mandible that would require reconstruction. Often, this would be a defect created during surgery by mandibular osteotomies. In some cases, the area requiring reconstruction can be considered a defect. In an exemplary procedure, surgical steps might involve dividing the free fibular flap and removing it from the patient's leg. Next, the cutting / alignment guide can be located and secured to the fibula using temporary fixation screws, for example, two for each segment. Careful incisions can then be made along the cutting guide surfaces, taking care not to incise the vascular pedicle.Once excess bone has been removed, the cutting / alignment guide can be bent or shaped to form the neomandible. Next, a triangular plate can be inserted into the depression above the cutting guide, and monocortical screws can be inserted into the fibular implant segments, securing them to the plate. The neomandible can then be positioned in the natural mandibular defect region, and an occlusal splint can be used to verify alignment. The plate can be secured to the natural mandible using bicortical screws. Finally, dental implants can be inserted at predetermined locations that do not interfere with the cortical screws while also being properly angled for inclusion in a dental bridge.

[0004] In one aspect, embodiments of the present invention include cutting and alignment guide assemblies for use in orthopedic and dental surgical procedures. Exemplary cutting and alignment guide designs can be used for applications in microsurgery, plastic surgery, the ear, nose and throat region, the oral and maxillofacial region, and other applications.Exemplary cutting and alignment guide assemblies may include a first section configured to engage a first bone graft segment, a second section configured to engage a second bone graft segment, a first fixation mechanism configured to couple the first section to the first bone graft segment, and a second fixation mechanism configured to couple the second section to the second bone graft segment. The first and second sections may be coupled via a hinge mechanism. In some cases, the hinge mechanism allows the first and second sections to pivot relative to each other, enabling the assembly to be converted from a straight alignment to a curved configuration.In some cases, the first fixation mechanism includes a first temporary fixation screw. In some cases, the first fixation mechanism includes a first temporary fixation screw and a second, more temporary fixation screw. In some cases, the first fixation mechanism includes a first temporary fixation screw and a second, more temporary fixation screw, and the second fixation mechanism includes a first temporary fixation screw and a second temporary fixation screw.Once the joint mechanism has been used to couple the first and second bone graft segments, the first bone graft segment and the second bone graft segment can, in some cases, be temporarily fixed together using a first temporary fixation screw and a second temporary fixation screw on the first bone graft segment, a first temporary fixation screw and a second temporary fixation screw on the second bone graft segment, and a temporary fixation plate.

[0005] According to some embodiments, a joint mechanism of a cutting and alignment assembly may include a flexural joint or a pin joint. In some cases, the joint mechanism is a flexural joint. In some cases, the joint mechanism is a pin joint. In some cases, a cutting and alignment guide assembly may include a first magnet and a second magnet operatively connected to the first section. In some cases, the cutting and alignment guide assembly may further include a third section configured to engage a third bone graft section and a third fixation mechanism configured to couple the third section to the third bone graft section. The second and third sections may be coupled via a second joint mechanism.In some cases, the second joint mechanism includes a bending joint or a pin joint.

[0006] According to some embodiments, a cutting and alignment guide assembly may include a third section configured to engage a third bone graft section, a fourth section configured to engage a fourth bone graft section, a third fixation mechanism configured to couple the third section to the third bone graft section, and a fourth fixation mechanism configured to couple the fourth section to the fourth bone graft section. In some cases, the second and third sections are coupled via a second joint mechanism, and the third and fourth sections are coupled via a third joint mechanism.Although the description of exemplary embodiments may include only four fibular sections, it is understood that the present disclosure encompasses configurations involving a ramus-to-symphyseal reconstruction or a condyle-to-condyle reconstruction comprising four parts, six parts (e.g., angle-to-angle reconstruction with full double barrel or double row), or more than six parts. In this respect, in some cases, a cutting and alignment guide assembly may include a fifth section configured to engage a fifth bone graft segment and a sixth section configured to engage a sixth bone graft segment. In some cases, the fourth and fifth sections are coupled via a fourth joint mechanism, and the fifth and sixth sections are coupled via a fifth joint mechanism.In other cases, a cutting and alignment guide assembly may include seven or more sections configured to engage seven or more bone graft sections.

[0007] According to some embodiments, a cutting and alignment guide assembly can be configured to support a saw blade at a first cutting position and a second cutting position, and the distance between the first and second cutting positions can be within a range of approximately 20 mm to approximately 100 mm. In some cases, the assembly is configured to support a saw blade at a first and second cutting position, and the distance between the first and second cutting positions can be within a range of approximately 30 mm to approximately 50 mm. In some cases, the assembly is configured to accommodate a saw blade with a cutting edge length within a range of approximately 25 mm to approximately 45 mm.In some cases, the assembly is configured to accept a saw blade with a thickness of approximately 0.5 mm. In some cases, a cutting and alignment guide assembly may include or be used in conjunction with a triangular cross-sectional plate. In some cases, a triangular cross-sectional plate may have one or more countersunk holes configured to accept one or more screws. In some cases, a cutting and alignment guide assembly may be configured to produce a first pre-operational planning cutting plane and a second pre-operational planning cutting plane, with the first and second pre-operational planning cutting planes evenly spaced around an orthogonal axis. In some cases, the axis may be a hinge axis.

[0008] In another aspect, embodiments of the present invention comprise neomandibular assemblies for implantation into a patient's natural mandible or a natural mandibular defect region. Exemplary neomandibular assemblies include a first section, a first bone graft section, a first fixation mechanism securing the first section to the first bone graft section, a second bone graft section, a second fixation mechanism securing the second section to the second bone graft section, and a coupling mechanism connecting the first and second sections. In some cases, the coupling mechanism includes a hinge mechanism that pivotally connects the first and second sections.In some embodiments, neomandibular assemblies may further include a third section, a third bone graft section, and a third fixation mechanism that secures the third section to the third bone graft section. In some embodiments, neomandibular assemblies may further include a third section, a third bone graft section, a third fixation mechanism that secures the third section to the third bone graft section, a fourth section, a fourth bone graft section, and a fourth fixation mechanism that secures the fourth section to the fourth bone graft section.

[0009] In another aspect, exemplary neomandibular assemblies include an upper bone graft segment, a first lower bone graft segment, a second upper bone graft segment, a second lower bone graft segment, a first upper fixation mechanism securing the first segment to the second upper bone graft segment, and a first lower fixation mechanism securing the first segment to the second lower bone graft segment. Additional segments may also be present. In some cases, neomandibular assemblies may further include a dental clamping plate secured to both the first upper bone graft segment and the second upper bone graft segment.In some cases, neomandibular assemblies may also include a dental clamping plate secured to the first upper bone graft segment by a first dental fixation mechanism and to the second upper bone graft segment by a second dental fixation mechanism. In some cases, neomandibular assemblies may also include a dental clamping plate secured to the first upper bone graft segment by a first dental fixation mechanism comprising one or more dental screws and to the second upper bone graft segment by a second dental fixation mechanism comprising one or more dental screws.In some cases, neomandibular assemblies may further include a dental clamping plate secured to the first upper bone graft segment via a first dental fixation mechanism comprising a first snap-lock retention and a first dental screw, and secured to the second upper bone graft segment via a second dental fixation mechanism comprising a second snap-lock retention and a second dental screw.In another aspect, exemplary neomandibular assemblies include a first section, a first upper bone graft section, a first lower bone graft section, a first upper fixation mechanism securing the first section to the first upper bone graft section, a first lower fixation mechanism securing the first section to the first lower bone graft section, a second section, a second upper bone graft section, a second lower bone graft section, a second upper fixation mechanism securing the second section to the second upper bone graft section, and a second lower fixation mechanism securing the second section to the second lower bone graft section.In some cases, the neomandibular assemblies may also include a dental clamping plate that serves to hold the first and second sections in a fixed position relative to each other. In some cases, neomandibular assemblies may also include a dental clamping plate that is secured to the first upper bone graft section and to the second upper bone graft section. In some cases, neomandibular assemblies may also include a dental clamping plate that is secured to the first upper bone graft section by a first dental fixation mechanism and to the second upper bone graft section by a second dental fixation mechanism.In some cases, neomandibular assemblies may further include a dental clamping plate secured to the first upper bone graft segment by a first dental fixation mechanism comprising one or more dental screws, and secured to the second upper bone graft segment by a second dental fixation mechanism comprising one or more dental screws. In some cases, neomandibular assemblies may further include a dental clamping plate secured to the first upper bone graft segment by a first dental fixation mechanism comprising a first snap-lock retention and a first dental screw, and secured to the second upper bone graft segment by a second dental fixation mechanism comprising a second snap-lock retention and a second dental screw.In some cases, the dental plate does not include dental implants and instead serves as a temporary fixation plate. Screws are placed to hold the plate in position, which in turn holds the bone graft segments in place. This allows the fixation mechanisms applied to the bone graft segments to be removed, and the final fixation plate to be applied. The temporary fixation plate and screws are then removed.

[0010] In another aspect, embodiments of the present invention include methods for implanting a neomandibular assembly into a patient's natural mandible. Exemplary methods involve removing a fibular bone with a free flap from the patient, positioning the cutting and alignment guide assembly adjacent to the patient's fibular bone, the cutting and alignment guide assembly comprising a first section and a second section. Methods may also include using the cutting and alignment guide assembly as a cutting guide to cut a first bone graft segment and a second bone graft segment from the fibular bone.Procedures may further involve fixing the first bone graft segment to the first section of the cutting and alignment guide assembly and fixing the second bone graft segment to the second section of the cutting and alignment guide assembly to produce the neomandibular assembly. Procedures may also involve implanting the neomandibular assembly into the patient's natural mandible or natural mandibular defect. Some procedures may involve using the cutting and alignment guide assembly as a cutting guide to cut a third bone graft segment of the fibula. Some procedures may involve fixing the third bone graft segment to a third section of the cutting and alignment guide assembly prior to implanting the neomandibular assembly into the patient's natural mandible or natural mandibular defect.

[0011] Three methods for fixing the neomandible to the natural mandible are described. These methods can also be used to fix the neomandible to the ramus. In the first, referred to in this document as the "standard fixation," a planar extension (referred to in this document as a "flange") can be bicortically fixed to the natural mandible. However, this flange may protrude beyond the surrounding soft tissue.

[0012] In the second method, referred to in this document as "countersunk fixation," two or more round flanges can extend from the first section toward the natural mandible. A drill guide is positioned over the natural mandible, and two drill holes are created. Because these holes are critical for alignment, the drill guide can be fixed to the natural mandible with screws, and the drill itself can have more plastic / metal on it than a standard drill guide. This drill guide prevents any significant tilt away from the axis. The flanges can then be inserted into the holes. With this type of fixation, the flange does not protrude into the soft tissue. An additional fixation method over the first section to the natural mandible, such as a countersunk pressure screw over a K-wire, would be placed to complete the stability of the construction.

[0013] In the third procedure, referred to in this document as "embedded fixation," a planar flange with multiple through-holes extends from the first segment toward the natural mandible. A cutting guide can be placed over the natural mandible at the insertion site. This area of ​​the natural mandible is hollowed out, including the outer cortex. The flange is advanced into the defect, and monocortical fixation is performed. This means a screw is passed through each hole and the entire length of the natural mandible to engage the inner cortex. With this type of fixation, the flange does not protrude into the soft tissue. An additional fixation technique over the first segment of the natural mandible, such as an embedded pressure screw over a K-wire, may be employed.

[0014] While various procedures for fixing the neomandible to the natural mandible are described, it is understood that other fixation methods may be used. These methods may include those that create a soft tissue protrusion and those that do not.

[0015] In general, a disclosed aspect comprises a process that includes: providing a bone section; attaching a cutting guide to the bone section; cutting the bone section into multiple bone graft sections using the cutting guide; arranging the multiple bone graft sections in a neomandibular position; attaching a temporary fixation plate to the multiple bone graft sections after arranging them in the neomandibular position; removing the cutting guide from the multiple bone graft sections after attaching the temporary fixation plate; and attaching a final fixation plate to the multiple bone graft sections after removing the cutting guide.and removal of the temporary fixation plate from the multiple bone graft segments after application of the final fixation plate to create a neomandibular assembly.

[0016] Embodiments of the method may include one or more of the following features. In some embodiments, the cutting guide is an articulated cutting guide comprising multiple cutting guide sections connected by at least one joint; and includes arranging the multiple bone graft sections in a neomandibular position and bending the sections around the at least one joint. In some embodiments, attaching the temporary fixation plate to the multiple bone graft sections comprises attaching the temporary fixation plate to cephalic surfaces of the multiple bone graft sections. In some embodiments, attaching the temporary fixation plate to the multiple bone graft sections comprises attaching the temporary fixation plate to the multiple bone graft sections with multiple screws.In some embodiments, attaching the temporary fixation plate to the multiple bone graft segments includes the following: attaching the temporary fixation plate to the multiple bone graft segments with multiple monocortical fixation screws. Some embodiments include implanting the neomandibular assembly into a mandibular defect region of a patient. Some embodiments include placing dental implants at predetermined locations on the neomandibular assembly.

[0017] In general, a disclosed aspect features a neomandible comprising: several bone graft segments arranged in a neomandible position; a cutting guide attached to the several bone graft segments; and a temporary fixation plate attached to the several bone graft segments.

[0018] Embodiments of the neomandible may include one or more of the following features. In some embodiments, the cutting guide is an articulated cutting guide comprising multiple cutting guide sections connected by at least one joint. Some embodiments include an alignment guide, wherein the cutting guide comprises multiple cutting guide sections, and wherein the alignment guide is attached to the multiple cutting guide sections. In some embodiments, the temporary fixation plate is attached to the cephalic surfaces of the multiple bone graft sections. In some embodiments, the temporary fixation plate is attached to the multiple bone graft sections by multiple screws. In some embodiments, the temporary fixation plate is attached to the multiple bone graft sections by multiple monocortical fixation screws.

[0019] In general, a disclosed aspect comprises a method that includes: providing at least one bone segment; attaching a first cutting guide and a second cutting guide to the at least one bone segment; cutting the at least one bone segment into multiple bone graft segments using the first and second cutting guides; arranging the multiple bone graft segments in an upper neomandibular position and a lower neomandibular position using the first and second cutting guides; attaching an upper temporary fixation plate to the bone graft segments arranged in the upper neomandibular position; attaching a lower temporary fixation plate to the bone graft segments arranged in the lower neomandibular position;Removal of the first and second cutting guides from the multiple bone graft sections after application of the upper temporary fixation plate and the lower temporary fixation plate; application of a jaw plate between the bone graft sections arranged in the upper neomandibular position and the bone graft sections arranged in the lower neomandibular position; and removal of the temporary fixation plates from the multiple bone graft sections after application of the jaw plate to create a neomandibular assembly.

[0020] Embodiments of the method may include one or more of the following features. Some embodiments include aligning the bone graft sections arranged in the superior neomandibular position with the bone graft sections arranged in the inferior neomandibular position. In some embodiments, the first and second cutting guides are connected by a further joint; and aligning the bone graft sections includes rotating the first and second cutting guides about the further joint. In some embodiments, the first cutting guide is an articulated cutting guide comprising multiple cutting guide sections connected by at least one joint; and includes arranging the multiple bone graft sections in at least one of the superior neomandibular positions and bending the multiple cutting guide sections about the at least one joint.In some embodiments, the first cutting guide comprises multiple cutting guide sections; and the method further comprises attaching an alignment guide to the multiple cutting guide sections of the first cutting guide. In some embodiments, attaching the upper temporary fixation plate to the bone graft sections arranged in the upper neomandibular position comprises attaching the upper temporary fixation plate to cephalic surfaces of the bone graft sections arranged in the upper neomandibular position; and attaching the lower temporary fixation plate to the bone graft sections arranged in the lower neomandibular position comprises attaching the lower temporary fixation plate to cephalic surfaces of the bone graft sections arranged in the lower neomandibular position.In some embodiments, the attachment of the upper and lower temporary fixation plates includes the following: attaching the upper and lower temporary fixation plates with multiple screws. In some embodiments, the multiple screws are monocortical fixation screws. Some embodiments include implanting the neomandibular assembly into a mandibular defect region of a patient. Some embodiments include placing dental implants at predetermined locations on the neomandibular assembly.

[0021] These and other embodiments are described in more detail in the following description with reference to the attached drawing figures. BRIEF DESCRIPTION OF THE DRAWINGS

[0022] Specific embodiments of the disclosed device, surgical systems, or methods are now described with reference to the drawings. Nothing in this detailed description is intended to imply that any specific component, feature, or step is essential to the invention. Fig. Figure 1 presents aspects of a preoperative planning procedure for designing a patient-specific cutting / alignment guide according to some embodiments. Fig. Figure 2 illustrates an aspect of a surgical procedure for mandibular reconstruction according to some embodiments. Fig. Figure 3 presents aspects of a cutting / alignment guide assembly according to some embodiments. Fig. Figure 4 presents an expanded view of aspects of a surgical system or neomandible according to some embodiments. Fig. Figure 5 illustrates aspects of a cutting guide according to some embodiments. Fig. Figure 6 illustrates aspects of a cutting guide according to some embodiments. Fig. Figure 7 illustrates aspects of a cutting guide according to some embodiments. Fig. Figure 8A illustrates aspects of a pen according to some embodiments. Fig. 8B and Fig. Section 8C illustrates aspects of a magnet according to some embodiments. Fig. 9A and Fig. Figure 9B illustrates aspects of a temporary fixing screw according to some embodiments. Fig. 10 illustrates aspects of a surgical system according to some embodiments. Fig. 11A and Fig. Figure 11B illustrates aspects of a surgical system according to some embodiments. Fig. 12A and Fig. Figure 12B illustrates aspects of a surgical system according to some embodiments. Fig. 13A and Fig. Figure 13B illustrates aspects of a cutting guide assembly according to some embodiments. Fig. 14A and Fig. Figure 14B illustrates aspects of a surgical system according to some embodiments. Fig. Figure 15 illustrates aspects of a cutting guide assembly according to some embodiments. Fig. 16 illustrates aspects of a surgical system according to some embodiments. Fig. 17 illustrates aspects of a surgical system according to some embodiments. Fig. Figure 18 illustrates aspects of a neomandibula according to some embodiments. Fig. 19 illustrates aspects of a surgical system according to some embodiments. Fig. 20A and Fig. Figure 20B illustrates aspects of a triangular cross-sectional plate according to some embodiments. Fig. 21A and Fig. Figure 21B illustrates aspects of a screw according to some embodiments. Fig. 22A illustrates aspects of a surgical system according to some embodiments. Fig. 22B and Fig. 22C illustrate aspects of a related surgical system according to some embodiments. Fig. Figure 23 illustrates aspects of a triangular cross-sectional plate according to some embodiments. Fig. Figures 24A, 24B, 24C and 24D illustrate aspects of preoperative planning cutting planes according to some embodiments. Fig. 25 illustrates aspects of a surgical system according to some embodiments. Fig. 26 illustrates aspects of a surgical system according to some embodiments. Fig. 27 illustrates aspects of a surgical system according to some embodiments. Fig. 28 illustrates aspects of a screw according to some embodiments. Fig. 29A and Fig. 29B illustrates aspects of a dental clamping plate according to some embodiments. Fig. Figure 30 illustrates aspects of a dental localizer storage according to some embodiments. Fig. 31 illustrates aspects of a surgical system according to some embodiments. Fig. Figure 32 illustrates aspects of a dental lag screw according to some embodiments. Fig. Figure 33 illustrates aspects of a combination of a threaded plate and a dental locking screw according to some embodiments. Fig. Figure 34 illustrates aspects of a combination of a threaded plate and a dental locking screw according to some embodiments. Fig. 35A and Fig. Figure 35B illustrates aspects of an angular locking mechanism of a right-hand joint according to some embodiments. Fig. 36A and Fig. Figure 36B illustrates aspects of a left-angle locking mechanism of a left-hand joint according to some embodiments. Fig. 37A and Fig. Figure 37B illustrates aspects of an adjusting screw according to some embodiments. Fig. Figure 38 illustrates aspects of a rigid rod of a cutting / alignment guide according to some embodiments. Fig. 39A and Fig. Figure 39B illustrates aspects of a cutting / alignment guide spring according to some embodiments. Fig. 40 illustrates aspects of a surgical system according to some embodiments. Fig. 41 illustrates aspects of a surgical system according to some embodiments. Fig. 42 illustrates aspects of a surgical system according to some embodiments. Fig. Figures 43A-E illustrate a “recessed fixation” of the neomandible to the natural mandible according to some embodiments of the disclosed techniques. Fig. 43A illustrates the natural mandible and the first section according to some embodiments of the disclosed techniques. Fig. Figure 43B illustrates the natural mandible with an attached drill guide according to some embodiments of the disclosed techniques. Fig. 43C illustrates the natural mandible and the first section after drilling holes into the natural mandible according to some embodiments of the disclosed techniques. Fig. 43D illustrates the natural mandible after it has been connected to the first section, according to some embodiments of the disclosed techniques. Fig. Figure 43E illustrates the connected natural mandible and the first section with a pressure screw that is passed through the first lower bone graft section and into the natural mandible via a K-wire, according to some embodiments of the disclosed techniques. Fig. Figures 44-48 further illustrate a “recessed fixation” of the neomandible to the natural mandible according to some embodiments of the disclosed techniques. Fig. Figure 44 illustrates a neomandibula according to some embodiments of the disclosed techniques. Fig. 45 is a left-sided view of the neomandible from Fig. 44 according to some embodiments of the disclosed techniques. Fig. Figure 46 illustrates the natural mandible with an inserted bore guide according to some embodiments of the disclosed techniques. Fig. Figure 47 illustrates the natural mandible after drilling holes into the natural mandible according to some embodiments of the disclosed techniques. Fig. Figure 48 illustrates the natural mandible, wherein the neomandible is inserted into the natural mandible, according to some embodiments of the disclosed techniques. Fig. Figure 49 is a flowchart illustrating a process for implanting a neomandibular assembly into a mandibular defect region of a patient using a countersunk fixation, according to some embodiments of the disclosed techniques. Fig. Figures 50A-E illustrate an “embedded fixation” of the neomandible to the natural mandible according to some embodiments of the disclosed techniques. Fig. 50A illustrates the natural mandible and the first section according to some embodiments of the disclosed techniques. Fig. Figure 50B illustrates the natural mandible with an attached cutting guide according to some embodiments of the disclosed techniques. Fig. Figure 50C illustrates the natural mandible and the first section after cutting a channel into the natural mandible according to some embodiments of the disclosed techniques. Fig. Figure 50D illustrates the natural mandible after it has been connected to the first section, according to some embodiments of the disclosed techniques. Fig. Figure 50E illustrates a possible method of additional fixation, namely a K-wire passed through the first lower bone graft segment and into the natural mandible, according to some embodiments of the disclosed techniques. Fig. Figure 50F illustrates the connected natural mandible and the first segment with a pressure screw that is passed over the K-wire through the first lower bone graft segment and into the natural mandible, according to some embodiments of the disclosed techniques. Fig. Figures 51-54 further illustrate an “embedded fixation” of the neomandible to the natural mandible according to some embodiments of the disclosed techniques. Fig. Figure 51 illustrates a neomandibula according to some embodiments of the disclosed techniques. Fig. Figure 52 illustrates the natural mandible with an inserted cutting guide according to some embodiments of the disclosed techniques. Fig. Figure 53 illustrates the natural mandible after cutting a channel into the natural mandible according to some embodiments of the disclosed techniques. Fig. Figure 54 illustrates the natural mandible, wherein the neomandible is inserted into the natural mandible, according to some embodiments of the disclosed techniques. Fig. Figure 55 is a flowchart illustrating a process for implanting a neomandibular assembly into a mandibular defect region of a patient using an embedded fixation, according to some embodiments of the disclosed techniques. Fig. Figures 56-63 illustrate a mandibular single-barrel reconstruction technique using a temporary fixation plate according to some embodiments of the disclosed techniques. Fig. Figure 56 illustrates a section of a natural bone. Fig. Figure 57 illustrates the natural fibula segment from Fig. 56 with marked bone graft sections. Fig. Figure 58 illustrates the bone graft sections from Fig. 57, after emerging from the natural fibula segment Fig. 56 were cut, according to some embodiments of the disclosed techniques. Fig. Figure 59 illustrates the bone graft sections arranged in a neomandibular position, as well as a temporary fixation plate configured to hold the bone graft sections in the neomandibular position, according to some embodiments of the disclosed techniques. Fig. Figure 60 illustrates the temporary fixation plate attached to the bone graft sections using screws, according to some embodiments of the disclosed techniques. Fig. Figure 61 illustrates the bone graft sections with the attached temporary fixation plate according to some embodiments of the disclosed techniques. Fig. Figure 62 illustrates the bone graft sections, wherein the temporary fixation plate is attached using screws and the final fixation plate is attached, for example, using screws, according to some embodiments of the disclosed techniques. Fig. Figure 63 illustrates the removal of the temporary fixation plate and screws 6000 from the bone graft sections according to some embodiments of the disclosed techniques. Fig. Figure 64 is a flowchart illustrating a process for constructing a neomandibular assembly according to some embodiments of the disclosed techniques. Fig. Figures 65-69 illustrate a mandibular double-barrel reconstruction technique using temporary fixation plates according to some embodiments of the disclosed techniques. Fig. Figure 65 illustrates articulated cutting guides that are bent to arrange the bone graft sections in an upper neomandibular position and a lower neomandibular position, according to some embodiments of the disclosed techniques. Fig. Figure 66 illustrates the temporary fixation plates attached to the bone graft sections according to some embodiments of the disclosed techniques. Fig. Figure 67 illustrates bending the articulated cutting guide to align the bone graft sections located in the upper neomandibular position with the bone graft sections located in the lower neomandibular position, according to some embodiments of the disclosed technique. Fig. Figure 68 illustrates the placement of a jaw plate between the bone graft sections located in the upper neomandibular position and the bone graft sections located in the lower neomandibular position to create a double-barrel neomandibular prosthesis, according to some embodiments of the disclosed technique. Fig. Figure 69 illustrates the double-barrel neomandibula from Fig. 68, which is attached to a natural mandible, according to some embodiments of the disclosed techniques. Fig. Figure 70 is a flowchart illustrating a process for constructing a neomandibular assembly according to some embodiments of the disclosed techniques. DETAILED DESCRIPTION OF THE INVENTION

[0023] Currently available mandibular reconstruction systems and techniques can be complex and involve long recovery times. Virtual surgical planning and guided resection and reconstruction of mandibular defects often involve intricate virtual 3D surgical planning. The accuracy of a virtually planned operation depends on the execution of the procedure. Embodiments of the present invention include systems and methods for cutting customized and precise bone grafts, which are particularly well-suited for use with patients with variable mandibular geometries and for addressing different locations of defects (e.g., tumors) for mandibular reconstruction.Exemplary embodiments disclosed in this document provide simple methods for cutting and forming bone grafts into desired shapes, which advantageously provide the surgeon with improved procedural control, resulting in a shorter operating time and better reproduction of the patient's mandibular contour.

[0024] With existing surgical techniques, dental reconstruction is often delayed by 3-6 months after mandibular reconstruction surgery. Embodiments of the present invention include systems and methods that enable the simultaneous insertion of dental implants during the operation, which can significantly reduce the overall recovery time and also the period during which the patient would be without teeth.

[0025] Currently available mandibular reconstruction systems often include plates and screws that protrude into the surrounding soft tissue and can cause irritation. Embodiments of the present invention include systems and methods for inserting a triangular plate and screws between fibular grafts, which can reduce irritation while also reducing the negative space between two rows of fibular graft. Additionally, a triangular plate exhibits greater structural stiffness along multiple axes of rotation than a thin rectangular outer plate.

[0026] Existing mandibular reconstruction systems include devices that are not patient-specific and are limited to mandibular osteotomies located around the symphysis region. Some existing systems involve multiple moving parts and require multiple steps to achieve a surgical outcome. Some existing systems include plate designs that do not work with stacked rows of fibular grafts and also do not include countersunk screws between bones. Embodiments of the present invention provide a unique solution to many of these disadvantages.

[0027] Mandibular reconstruction systems as disclosed in this document may include a cutting / alignment guide with multiple moving parts. For example, a cutting / alignment guide assembly may include three primary moving parts: a left, middle, and right section. Each section may be fixed to a fibula using one or more temporary fixation screws. Either U-shaped or flat cutting guide surfaces may be present on each side of the cutting guide sections. A joint may be present between each cutting guide section, located at the intersection of the cutting planes. The joints may be held together by press-fit dowel pins. Each joint may also have angle-limiting surfaces for aligning the cutting / alignment guide in the straight or curved position.In some cases, a triangular cross-sectional plate may have recessed holes for the screws, for example, two screws for each section of the fibula.

[0028] Now, with reference to the drawings, it states Fig. 1 Aspects of a preoperative planning procedure 100 for designing a patient-specific cutting / alignment guide according to some embodiments of the disclosed techniques. As described here, a triangular plate can be used for a double-row fibular graft and a rectangular plate can be used for a single-row fibular graft. In some cases, a rectangular plate can be used in the mid-mandibular position with the traction device for dental implantation. In some cases, a triangular plate can be used for a single-row graft.

[0029] Now, with reference to Fig. Procedure 100 may include obtaining a library of virtual templates (102). Library 102 may include cortical screws (104), plate design templates (106), dental implants (108), dental bridge templates (110), and similar templates (110). Procedure 100 may include performing patient 3D CT scans and / or similar scans (112). Procedure 100 may include generating a virtual reconstruction based on the scans and virtual templates (114).

[0030] Procedure 100 may involve, in case 116, performing a 3D scan or having a patient bite down on a deformable mold. Procedure 100 may involve, in case 118, creating patient-specific occlusal scans and / or molds.

[0031] Procedure 100 can include determining, at 120, whether sufficient fibular length and neomandibular height are present for a double-row fibular graft. This determination can be made by a physician. If a double-row fibular graft is required, Procedure 122 can include fabricating a patient-specific triangular plate, and at 124, fabricating a patient-specific cutting and alignment guide according to specified cutting planes. If a double-row fibular graft is not required, Procedure 100 can include fabricating, at 126, a patient-specific rectangular or triangular plate, and at 128, fabricating a patient-specific cutting and alignment guide according to specified cutting planes.

[0032] Fig. 2 presents aspects of a surgical procedure 200 for mandibular reconstruction according to some embodiments of the disclosed techniques. According to some embodiments, a procedure in microsurgery, plastic surgery, in the ear, nose and throat region, the oral and maxillofacial region, the orthopedic region, the dental region or another surgical field may involve 202 dividing a free fibular flap and removing it from the leg.

[0033] Next, the procedure may involve cutting graft segments using a patient-specific cutting and alignment guide. In some embodiments, the guide may be 3D-printed. The cutting / alignment guide may be located and secured to the fibula using one or more temporary fixation screws (e.g., one for each segment). Exemplary fixation screw configurations provide torsional stability. Careful incisions may then be made along the cutting guide surfaces, taking care not to cut vessels on the fibularis longus muscle. Once excess bone has been removed, the cutting / alignment guide may be bent to form the neomandible.Next, a triangular plate can be inserted into the recess above the incisal guide, and monocortical screws can be inserted into the fibular implant segments, securing them to the plate. Then, the neomandible can be placed in the natural mandible or at the natural mandibular defect region, and an occlusal splint can be inserted at 208 to verify alignment. The plate can then be secured to the natural mandible at 210 using bicortical screws. Next, dental implants can be inserted at 212 at predetermined locations that do not interfere with the cortical screws while also being properly angled for adequate inclusion of a dental bridge. According to some embodiments, a microsurgeon may choose to perform the microsurgical reconstruction and then make the osteotomies and incisions.In some embodiments, a microsurgeon may choose to perform the bone work and then carry out the microsurgical reconstruction.

[0034] Fig. Figure 3 describes aspects of a cutting / alignment guide assembly 300, which includes three primary moving parts: a left cutting guide or left section 310, a middle cutting guide or middle section 320, and a right cutting guide or right section 330. The assembly 300 also includes temporary fixing screws 312A, 312B, dowel pin joints 324A, 324B, and magnets 336A, 336B. Furthermore, the assembly 300 includes a joint position lock 340. Thus, a cutting / alignment guide assembly 300 can include three primary moving parts: a left 310, a middle 320, and a right section 330. Each section can be fixed to a fibula using one or more temporary fixing screws. In some cases, more than two temporary fixing screws may be used.Each side of the cutting guide sections can have either U-shaped or flat cutting guide surfaces. A joint can be located between each cutting guide section at the intersection of the cutting planes. The joints can be held together with press-fit dowel pins. Each joint can also have angle-limiting surfaces for aligning the cutting / alignment guide in the straight or curved position. The patient-specific cutting guide and alignment fixation 300 can be used to precisely cut fibular bone grafts at predetermined locations and then adjust the grafts into a final alignment to construct a new mandible.

[0035] Fig. Figure 4 provides an exploded view of aspects of an exemplary surgical system 400 according to embodiments of the present invention. As shown here, the system 400 includes a cutting / alignment guide assembly 402 comprising several parts, namely a left cutting guide or left section 410, a middle cutting guide or middle section 420, and a right cutting guide or right section 430. The assembly 402 also includes temporary fixing screws 412A, 412B, 422A, 422B, 432A, 432B, dowel pin joints 424A, 424B, and magnets 416A, 416B, 426A, 426B, 436A, 436B. In some embodiments, magnets may be optional. As shown in Figure 4, the assembly may include temporary fixing screws 412A, 412B, 422A, 422B, 432A, 432B, and magnets 416A, 416B, 426A, 426B, 436A, 436B. Fig. As shown in Figure 4, the system 400 also includes a first fibula graft 442, a second fibula graft 444, a third fibula graft 446, as well as adjusting screws 411A, 411B, 411C, 411D, a left angle lock 413A and a right angle lock 413B.

[0036] In some embodiments, magnets on one side of each cutting guide surface can serve to maintain a constant bias on one side and reduce blade chatter. In some embodiments, the systems can include a two-part cutting / alignment guide. In some embodiments, the systems can include a four-part or more cutting / alignment guide.

[0037] Cutting guides can be 3D printed from biocompatible surgical guide resin or can be made from Radel ®-Polyphenylsulfone (PPSU), stainless steel, or any other biocompatible material. A triangular plate can be 3D printed from biocompatible titanium alloys, such as Ti 6A1-4V, or can be manufactured from stainless steel, titanium, or any other biocompatible alloy.

[0038] Embodiments of the present invention include systems and methods comprising a cutting / alignment guide configured to cut bone grafts ranging in size from 20 to 100 millimeters in length. In some cases, a cutting / alignment guide may be configured to cut bone grafts ranging in size from 30 to 50 millimeters in length. In some cases, the cutting guides may be configured to accommodate blades with a cutting edge length of 25 to 45 millimeters and a blade thickness of up to 0.5 millimeters. In some cases, systems and devices may incorporate flexural joints instead of joints with pins. In some cases, systems or devices may incorporate a long, patient-specific outer plate.In some cases, systems and devices may incorporate one or more miniplates to secure a single row of fibular grafts, instead of a triangular plate. In some cases, systems or devices may incorporate one or more miniplates in a double-barrel configuration.

[0039] Advantageously, embodiments disclosed in this document provide the capability to be used for both cutting and forming a bone graft for any section of the mandible, and the ability to accommodate varying mandibular sizes and shapes in the patient. Furthermore, exemplary embodiments include techniques involving the insertion of a triangular plate and screws between fibular grafts, which can reduce irritation and simultaneously utilize the negative space between two rows of fibular graft. Additionally, a triangular plate exhibits greater structural stiffness on multiple axes of rotation than a thin rectangular outer plate.Thus, the systems and methods disclosed in this document may be preferable to existing plate and screw systems that protrude into the surrounding soft tissue and cause irritation. Furthermore, exemplary systems and methods disclosed in this document enable the use of a reduced number of parts and steps involved in cutting and shaping fibular grafts into their final position. The exemplary simplification devices facilitate easy operation and reduce the likelihood of a surgeon misplacing or mixing up parts.

[0040] Fig. Figure 5 represents aspects of a left cutting guide 510 which includes an angle locking holder 517. Fig. Figure 6 represents aspects of a medium cutting guide 620, which includes a first angle locking holder 617A and a second angle locking holder 617B. Fig. Figure 7 represents aspects of a right cutting guide 730, which includes an angle locking holder 717. Fig. 8A represents aspects of a pin 800, such as an M2X8 dowel pin. Fig. 8B and Fig. Sections 8C and 8C represent aspects of a magnet 810 according to embodiments of the present invention. In some cases, a magnet 810 may be a neodymium magnet measuring 10 x 20 x 1.7 mm.

[0041] Fig. 9A and Fig. Figure 9B describes aspects of a temporary fixing screw 900 according to embodiments of the present invention. In some cases, a fixing screw 900 may be a 4 mm hex-driven screw. In some cases, a fixing screw 900 may have a length L of approximately 20 mm. Embodiments of the present invention also include alternative configurations.

[0042] Fig. Figure 10 provides a cross-sectional view of aspects of a surgical system 1000 according to embodiments of the present invention. As shown here, a surgical system 1000 comprises a fibular graft segment 1042, a cutting guide section 1010, and a temporary fixation screw 1012A.

[0043] Fig. 11A represents a surgical system 1100 in a curved configuration or orientation. With reference to Fig. 11A includes the surgical system 1100, a left section 1110, a middle section 1120, and a right section 1130. In Fig. Figure 11A also shows an angle lock 1102 of the right joint, which is inserted into the joint connecting the middle section 1120 and the right section 1130. The angle lock 1102 of the right joint is in Fig. 35A, B shown in more detail. Fig. 11B is exhibiting the surgical system 1100. Fig. 11A in a straight configuration or orientation.

[0044] Fig. Figure 12A shows an isometric view of a surgical system 1200 according to embodiments of the present invention. With reference to Fig. Surgical system 1200, as shown in Figure 12A, comprises a left section 1210, a middle section 1220, and a right section 1230. Sections 1210, 1220, and 1230 may be connected by joints or other devices, as shown, or may not be connected at all. Fig. Figure 12B illustrates aspects of a surgical system 1200 according to embodiments of the present invention. As shown here, the surgical system 1200 includes fibular grafts 1241, 1243, a sagittal saw blade 1250, and temporary fixation screws 1211, 1213. In some embodiments, a cutting / alignment guide can be designed to cut bone grafts ranging in size from 20 to 100 millimeters in length, although sizes in the range of 30 to 50 millimeters may be more common. Exemplary cutting guides can accommodate blades with a cutting edge length of 25 to 45 millimeters and a blade thickness of up to 0.5 millimeters.

[0045] Fig. 13A and Fig. Figure 13B represents aspects of a cutting / alignment guide assembly according to embodiments of the present invention. This embodiment provides a (straight) parasymphyse-to-pharosymphyse cutting guide. As shown in Fig. As shown in Figure 13A, a cutting / alignment guide assembly 1300A can include a rigid rod 1310 of a cutting / alignment guide. The sections of the cutting / alignment guide assembly 1300A can be connected by joints or other devices, as shown, or not connected at all. As shown in Fig. As shown in Figure 13B, a cutting / alignment guide assembly 1300B (curved alignment) can include a cutting / alignment guide spring 1320. The sections of the cutting / alignment guide assembly 1300B can be connected by joints or other devices, as shown, or not connected at all. Fig. Figure 14A provides a cross-sectional view of aspects of a surgical system 1400, which includes a patient-specific triangular plate 1470, according to embodiments of the present invention. The system 1400 also includes an upper fibular graft 1442 and a lower fibular graft 1444. As shown in Figure 14A, the system 1400 includes an upper fibular graft 1442 and a lower fibular graft 1444. Fig. As shown in Figure 14B, the surgical system 1400 can also include a dental implant 1480 and one or more monocortical screws 1482A, 1482B. In some cases, a patient-specific triangular plate can be inserted between two rows of fibular grafts to provide the jaw structure while also allowing the screws inserted into the fibular grafts to be countersunk. Two rows of fibular grafts can be used on a case-by-case basis to build up bone height for positioning dental implants, which are to be inserted simultaneously. In some cases, a triangular cross-sectional plate or a dental implant can include one or more countersunk holes to receive one or more screws each.

[0046] Fig. Figure 15 presents aspects of a cutting / alignment guide assembly 1500 in a curved orientation according to embodiments of the present invention. With reference to Fig. 15 The surgical system 1500 includes a left section 1510, a middle section 1520 and a right section 1530.

[0047] Fig. Figure 16 represents aspects of a surgical system 1600 according to embodiments of the present invention. The system 1600 also includes an upper fibular graft 1642 and a lower fibular graft 1644.

[0048] Fig. Figure 17 illustrates aspects of a surgical system 1700 according to embodiments of the present invention. As shown in this general view, the fibular grafts are inserted into a natural mandible or into a natural mandibular defect 1701. This image shows the three screws on the natural symphysis, with two stacked on top of each other. It is understood that in exemplary embodiments, this can be done with all three screws positioned in a row.

[0049] Fig. Figure 18 presents aspects of a double-row neomandibular design. The surgical system 1800 includes an upper fibular graft row 1810, a triangular plate 1820, and a lower fibular graft row 1830. In some cases, a patient-specific triangular plate can be inserted between two rows of fibular grafts to provide jaw structure while also allowing the screws inserted into the fibular grafts to be countersunk. Two rows of fibular grafts can be used on a case-by-case basis to build up bone height for positioning dental implants, which are to be inserted simultaneously.

[0050] Fig. Figure 19 represents aspects of a surgical system 1900 according to embodiments of the present invention. As shown in this lateral view, the fibular grafts are inserted into a natural mandible or into a natural mandibular defect 1901. Fig. 20A and Fig. Figure 20B represents aspects of a triangular plate 2000 according to embodiments of the present invention.

[0051] Fig. 21A and Fig. Figure 21B represents aspects of a monocortical fixation screw 2100 according to embodiments of the present invention. In some cases, the screw 2100 can be a hexalobe screw with HA 2 x 7 mm T10.

[0052] Fig. Figure 22A represents aspects of a surgical system 2200A according to embodiments of the present invention. As shown in this lateral view, three fibular grafts 2212A, 2214A, and 2216A are inserted into a natural mandible 2201A. In this figure, the surgical system 2200A is provided as an embodiment with a single row of fibular grafts and engages a pressure bench 2202A in two of the three segments, while the third segment remains free.

[0053] Fig. Figure 22B represents aspects of a surgical system 2200B according to embodiments of the present invention. As shown in this lateral view, three fibular grafts 2212B, 2214B, and 2216B are inserted into a natural mandible 2201B. In this figure, the surgical system 2200B is provided as an embodiment with a single row of fibular grafts, and a pressure bench 2202B engages each of the three segments. Thus, in contrast to Fig. 22A in Fig. 22B shows that a traction plate can be pulled out to form an interface with the third fibular graft 2216B.

[0054] Fig. Figure 22C presents another view of aspects of a surgical system 2200B. In this view, embodiments of the present invention enclose a single-row neomandible comprising three fibular grafts 2212B, 2214B, and 2216B with a tension band 2202B connected to the third graft 2216B by monocortical screws. Thus, the tension band 2202B can encompass all segments, and the screws on the tension band 2202B can simply be monocortical screws in the non-implant position. When the tension band 2202B is inserted across all segments, the fibular grafts 2212B, 2214B, and 2216B can accordingly maintain their 3D relationship throughout the reconstruction, which is one of the main advantages of this system.In this image, which shows a single fibular graft row with a rectangular plate and a 2202B dental traction band, there is little or no space between the plate and the upper ramus portion of the neomandible.

[0055] Fig. Figure 23 illustrates aspects of a traction device 2300 according to embodiments of the present invention. In some cases, a rectangular plate in the mid-mandibular position can be used with the traction device for dental implantation. It is understood that embodiments of the present invention encompass two reconstruction configurations with the single-barrel configuration. In one reconstruction configuration with a triangular plate, the fibular parts are held in place as in the double-barrel configuration, and the fixation plate is placed on the fibula to create the neomandible. In another reconstruction configuration with a rectangular plate, the traction device is placed, the temporary screws and the temporary fixation holding the fibular parts are removed, and the rectangular plate is applied.

[0056] Fig. 24A, Fig. 24B, Fig. 24C and Fig. Figure 24D represents certain optional aspects of preoperative planning cutting planes according to some embodiments of the present invention. In some embodiments, incisions can be made uniformly around the orthogonal axis. In some cases, uneven incisions can lead to a lateral displacement. In some embodiments, fibular incisions can be made uniformly around the orthogonal axis. In some cases, unevenly angled incisions can lead to a lateral displacement of the graft. Notwithstanding the foregoing, it is understood that in some embodiments, configurations may not be as shown here. In some cases, the diameter of the fibula varies, and the osteotomies are therefore intentionally not designed exactly around the orthogonal axis to compensate for this, which would otherwise result in a mismatch.

[0057] Fig. Figure 25 describes aspects of a surgical system 2500 according to embodiments of the present invention. As shown here, a system 2500 may include a dental clamping plate 2510 placed on a neomandible 2520. In some embodiments, the neomandible assembly 2520 includes one or more sections coupled to one or more respective bone graft segments. A single bone graft segment may, for example, be a fibular node graft segment. Fig. Figure 26 represents aspects of a surgical system 2600 according to embodiments of the present invention. As shown here, a system 2600 can include a dental clamping plate 2610 placed on a neomandibular assembly 2620.

[0058] Fig. 27 presents aspects of a surgical system 2700 according to embodiments of the present invention. With reference to Fig. Figure 27 shows that System 2700 includes an upper fibular graft 2742 and a lower fibular graft 2744. As shown here, System 2700 can include a snap-lock bearing 2710, a dental clamping plate 2720, a dental screw 2730, and a triangular plate 2740. As illustrated in this figure, Surgical System 2700 can be provided in both dental plate and orthopedic dental implant configurations. In some cases, a patient-specific triangular plate can be inserted between two rows of fibular grafts to provide jawbone structure while also allowing the screws inserted into the fibular grafts to countersink. Two rows of fibular grafts can be used on a case-by-case basis to build up bone height for positioning dental implants to be inserted simultaneously.

[0059] Fig. Figure 28 describes aspects of a screw 2800 according to embodiments of the present invention. In some cases, the screw 2800 can be a monocortical dental screw. In some cases, the screw 2800 can include a cortical fixation thread 2810 and a cancellous fixation thread 2820. In some embodiments, surface treatments or a surface coating (porous structure) can be used to increase osseointegration. Fig. 29A and Fig. 29B represent aspects of a dental clamping plate 2900 according to embodiments of the present invention. Fig. Figure 30 represents aspects of a dental localizer mounting 3000 according to embodiments of the present invention.

[0060] Fig. Figure 31 presents aspects of a surgical system 3100 according to embodiments of the present invention. With reference to Fig. The system 3100 includes an upper fibular graft 3142 and a lower fibular graft 3144. As shown here, a system 3100 can include a lag screw 3110 that passes through both rows of fibula. Fig. Figure 32 represents aspects of a dental lag screw 3200 according to embodiments of the present invention. Fig. Figure 33 illustrates a cross-sectional view of an embodiment with a threaded plate and a dental locking screw. As shown here, the surgical system 3300 includes a screw 3310 having a three-turn metric thread 3320, a cortical fixation thread 3330, and a cancellous fixation thread 3340. In some cases, all threads may have the same inclination. Fig. Figure 34 presents aspects of an embodiment with a threaded plate 3410 and a dental locking screw 3420.

[0061] Fig. 35A and Fig. 35B represent aspects of an angle locking 3500 of the right joint according to embodiments of the present invention. Fig. 36A and Fig. 36B represent aspects of an angle locking 3600 of the left joint according to embodiments of the present invention. Fig. 37A and Fig. Figure 37B represents aspects of an adjusting screw 3700 according to embodiments of the present invention. In some cases, an adjusting screw 3700 can be an adjusting screw with M 2.5 x 3 mm. Fig. Figure 38 represents aspects of a rigid rod 3800 of a cutting / alignment guide according to embodiments of the present invention. Fig. 39A and Fig. 39B represent aspects of a cutting / alignment guide spring 3900 according to embodiments of the present invention.

[0062] Fig. Figure 40 represents aspects of a surgical system 4000 according to embodiments of the present invention. As shown here, a system 4000 can comprise a neomandibular construct consisting of a single row of three fibular grafts 4012, 4014 and 4016 with a non-protruding plate and non-protruding dental implants. Fig. Figure 41 represents aspects of a surgical system 4100 according to embodiments of the present invention. As shown in this cross-sectional view, a system 4100 may include a single-barrel neomandibular prosthesis with a non-protruding plate. Fig. Figure 42 presents aspects of a surgical system 4200 according to embodiments of the present invention. As shown here, a system 4200 can include a non-protruding plate and dental implant locator.

[0063] Embodiments of the present invention include various techniques for achieving the double-barrel conformation. The cutting guide can be fixed to the fibula, the fibula is cut, and the lower and upper rows can come together. This can be achieved with an all-in-one system design that incorporates rotation around a joint. Alternatively, this can be achieved with a two-part system design that allows the two barrels to move independently.

[0064] Fig. Figures 43A-E illustrate a “recessed fixation” of the neomandible to the natural mandible according to some embodiments of the disclosed techniques. Fig. Figure 43A illustrates the natural mandible 4300 and the first section 4302 according to some embodiments of the disclosed techniques. The first section 4302 may include two or more round flanges 4304 extending from the first section 4302 towards the natural mandible 4300. In the embodiment shown Fig. In 43A, the first section 4302 has a triangular cross-section. In other embodiments, the first section 4302 may have cross-sections of other shapes.

[0065] Fig. Figure 43B illustrates the natural mandible 4300 with an attached drill guide 4306 according to some embodiments of the disclosed techniques. The drill guide 4306 can be attached to the natural mandible 4300 in any manner. For example, the drill guide 4306 can be attached to the natural mandible 4300 with one or more screws. The drill guide 4306 can be wrapped around two surfaces of the natural mandible, for example as shown in Figure 43B. Fig. 43B shown. The drill guide 4306 can include two or more tubes to guide the drill bit to prevent the driller from tilting the drill bit away from the axis.

[0066] Fig. Figure 43C illustrates the natural mandible 4300 and the first section 4302 after drilling holes 4312 into the natural mandible 4300 according to some embodiments of the disclosed techniques. After drilling the holes 4312, the natural mandible 4300 and the first section 4302 can be joined by inserting the flanges 4304 into the holes 4312, as indicated by the horizontal arrow in Figure 43C. Fig. 43C shown.

[0067] Fig. Figure 43D illustrates the natural mandible 4300 after it has been connected to the first section 4302 according to some embodiments of the disclosed techniques. A first upper bone graft section 4308 and a first lower bone graft section 4310 are also shown attached to the first section 4302. Fig. Figure 43D also illustrates a K-wire 4316 being inserted through the first lower bone graft segment 4310 and into the natural mandible 4300.

[0068] Fig. Figure 43E illustrates the connected natural mandible 4300 and the first section 4302 with a pressure screw 4318, which is guided via the K-wire 4314 into the first lower bone graft section 4310 and into the natural mandible 4300, according to some embodiments of the disclosed techniques. In other embodiments, other methods of fixation may be used.

[0069] Fig. Figures 44-48 further illustrate a “recessed fixation” of the neomandible to the natural mandible according to some embodiments of the disclosed techniques.

[0070] Fig. Figure 44 illustrates a neomandibular prosthesis 4400 according to some embodiments of the disclosed techniques. With reference to Fig. The neomandible 4400 can include three sections 4402A, B, and C. The neomandible 4400 can also include upper bone graft sections 4408A and B and lower bone graft sections 4410A, B, and C. The upper bone graft sections 4408A and B can each be attached to sections 4402A and B, while the lower bone graft sections 4410A, B, and C can each be attached to sections 4402A, B, and C. The first section 4402A can include two or more flanges 4404 for insertion into the natural mandible. Other embodiments can have more or fewer sections.

[0071] Fig. 45 is a left-sided view of the neomandible 4400 from Fig. 44 according to some embodiments of the disclosed techniques. With reference to Fig. Figure 45 shows the first section 4402A, the flanges 4404 and the first upper and lower bone graft sections 4408A, 4410A.

[0072] Fig. Figure 46 illustrates the natural mandible with an inserted bore guide 4606 according to some embodiments of the disclosed techniques. The fixation can be at least monocortical and thus lie on a buccal surface of the mandible.

[0073] Fig. Figure 47 illustrates the natural mandible after drilling holes 4712 into the natural mandible using the drilling guide 4606 according to some embodiments of the disclosed techniques.

[0074] Fig. Figure 48 illustrates the natural mandible, wherein the neomandible 4400 is inserted into the natural mandible, according to some embodiments of the disclosed techniques.

[0075] Fig. Figure 49 is a flowchart illustrating a process 4900 for implanting a neomandibular assembly into a mandibular defect region of a patient using a countersunk fixation, according to some embodiments of the disclosed techniques. The process elements described in this disclosure are shown in an arrangement. However, it is understood that one or more elements of each process may be performed in a different order, in parallel, omitted entirely, or the like. Furthermore, each process may include other elements in addition to those shown.

[0076] With reference to Fig. 49 can involve process 4900 at 4902 providing a neomandibular assembly. For example, the neomandibular assembly 4400 can consist of Fig. 44. The neomandibular assembly may include a first section, a first upper bone graft section, a first lower bone graft section, a first upper fixation mechanism securing the first section to the first upper bone graft section, a first lower fixation mechanism securing the first section to the first lower bone graft section, and a variety of flanges extending from the first section and arranged to mate with corresponding holes in the natural mandible, for example, as in Fig. 43A-E and Fig. 44 illustrated.

[0077] With renewed reference to Fig. 49. The process 4900 at 4904 can involve inserting a bore guide into the natural mandible. For example, the bore guide can be as in Fig. 43B and Fig. 46 are shown and described with reference to them.

[0078] With renewed reference to Fig. 49. The process 4900 at 4906 can involve drilling a large number of holes into the natural mandible using the drill guide. For example, the holes can be as in Fig. 43C and Fig. 47 will be shown and described with reference to them. With renewed reference to Fig. 49, the process 4900 at 4908 can involve placing the multitude of flanges into the multitude of holes.

[0079] Procedure 4900 may involve inserting a K-wire through the first lower bone graft segment and into the natural mandible at 4910. For example, the K-wire may be inserted as shown in Fig. 43D shown and described with reference to it.

[0080] With renewed reference to Fig. 49. The process 4900 at 4912 may involve inserting a pressure screw over the K-wire to connect the first lower bone segment to the natural mandible. For example, the pressure screw may be as shown in Fig. Figure 43E is shown and described with reference to it. In other embodiments, other methods of fixation may be used.

[0081] Fig. Figures 50A-E illustrate an “embedded fixation” of the neomandible to the natural mandible according to some embodiments of the disclosed techniques. Fig. Figure 50A illustrates the natural mandible 5000 and the first section 5002 according to some embodiments of the disclosed techniques. The first section 5002 may include a flange 5004 extending from the first section 5002 toward the natural mandible 5000. The flange 5004 may include a plurality of through holes, as shown. For example, the flange 5004 may include three or four through holes, although other numbers of holes may be used instead. In the embodiment shown in Fig. In 50A, the first section 5002 has a rectangular cross-section. In other embodiments, the first section 5002 may have cross-sections of other shapes.

[0082] Fig. Figure 50B illustrates the natural mandible 5000 with an attached cutting guide 5006 according to some embodiments of the disclosed techniques. The cutting guide 5006 can be attached to the natural mandible 5000 in any desired manner. For example, the cutting guide 5006 can be attached to the natural mandible 5000 with two or more screws for torsional stability, as shown. The cutting guide 5006 can be wrapped around two surfaces of the natural mandible, for example, as shown in Figure 50B. Fig. 50B shown.

[0083] Fig. Figure 50C illustrates the natural mandible 5000 and the first section 5002 after cutting a channel 5012 into the natural mandible 5000 according to some embodiments of the disclosed techniques. After cutting the channel 5012, the natural mandible 5000 and the first section 5002 can be joined by inserting the flange 5004 into the channel 5012, as indicated by the horizontal arrow in Figure 50C. Fig. 50°C shown.

[0084] Fig. Figure 50D illustrates the natural mandible 5000 after it has been connected to the first section 5002 according to some embodiments of the disclosed techniques. A first upper bone graft section 5008 and a first lower bone graft section 5010 are also shown attached to the first section 5002.

[0085] Fig. Figure 50E illustrates a K-wire 5016 being inserted through the first lower bone graft segment 5010 and into the natural mandible 5000, according to some embodiments of the disclosed techniques. Fig. Figure 50F illustrates the connected natural mandible 5000 and the first section 5002 with a pressure screw 5018 which is guided over the K-wire into the first lower bone graft section 5010 and into the natural mandible 5000, according to some embodiments of the disclosed techniques.

[0086] Fig. Figures 51-54 further illustrate an “embedded fixation” of the neomandible to the natural mandible according to some embodiments of the disclosed techniques.

[0087] Fig. Figure 51 illustrates a neomandibular prosthesis 5100 according to some embodiments of the disclosed techniques. With reference to Fig. The neomandibular prosthesis 5100 can include three sections 5102A, B, and C. The neomandibular prosthesis 5100 can also include upper bone graft sections 5108A and B and lower bone graft sections 5110A, B, and C. The upper bone graft sections 5108A and B can each be attached to sections 5102A and B, while the lower bone graft sections 5110A, B, and C are each attached to sections 5102A, B, and C. The first section 5102A can include a flange 5104 for insertion into the natural mandible.

[0088] Fig. Figure 52 illustrates the natural mandible with an inserted cutting guide 5206 according to some embodiments of the disclosed techniques. With reference to Fig. 52 The cutting guide 5206 can be held to the natural mandible with two or more screws.

[0089] Fig. Figure 53 illustrates the natural mandible after cutting a channel 5312 into the natural mandible according to some embodiments of the disclosed techniques.

[0090] Fig. Figure 54 illustrates the natural mandible, wherein the neomandible 5100 is inserted into the natural mandible using the cutting guide 5206, according to some embodiments of the disclosed techniques.

[0091] Fig. Figure 55 is a flowchart illustrating a process 5500 for implanting a neomandibular assembly at a mandibular defect region of a patient using an embedded fixation, according to some embodiments of the disclosed techniques.

[0092] With reference to Fig. Process 5500 can involve providing a neomandibular assembly in process 5502. For example, the neomandibular assembly 5100 can consist of... Fig. 51. The neomandibular assembly may include a first section, a first upper bone graft section, a first lower bone graft section, a first upper fixation mechanism securing the first section to the first upper bone graft section, a first lower fixation mechanism securing the first section to the first lower bone graft section, and a flange extending from the first section and arranged to mate with a corresponding channel in the natural mandible. The flange may have at least one through-hole and preferably three or more, for example as shown in Fig. 43A-E illustrated.

[0093] With renewed reference to Fig. 55, process 5500 at 5504 may involve inserting a cutting guide into the natural mandible. For example, the cutting guide may be as in Fig. 50B and Fig. 52 will be shown and described with reference to them.

[0094] With renewed reference to Fig. 55 The process 5500 at 5506 may involve cutting a channel through the outer cortex of the natural mandible using the cutting guide. For example, the channel may be as in Fig. 50C and Fig. 53 will be shown and described with reference to them. With further reference to Fig. 55 The process 5500 at 5508 may involve placing the flange in the channel and securing the flange to the natural mandible by placing a respective screw through each of the through holes in the flange and into the inner cortex of the natural mandible.

[0095] Procedure 5500 may involve, at 5510, the insertion of a K-wire through the first inferior segment of the bone and into the natural mandible. For example, the K-wire may be inserted as shown in Fig. 50E shown and described as being used with reference to these.

[0096] With renewed reference to Fig. 55 The process 5500 at 5512 may involve inserting a pressure screw over the K-wire to connect the first lower bone segment to the natural mandible. For example, the pressure screw may be as shown in Fig. The components shown in Figure 50F are inserted as described with reference to them. In other embodiments, other methods of fixation may be used.

[0097] Embodiments of the present invention comprise kits comprising the mandibular reconstruction system disclosed herein. In some embodiments, the kit includes one or more mandibular reconstruction system components together with instructions for using the device(s), for example, according to any of the methods disclosed herein.

[0098] All features of the described systems and devices are applicable mutatis mutandis and vice versa to the described methods.

[0099] Fig. Figures 56-63 illustrate a mandibular single-barrel reconstruction technique using a temporary fixation plate according to some embodiments of the disclosed techniques. Features of these embodiments can be combined with features of other embodiments described in this document.

[0100] Fig. Figure 56 illustrates a section of a natural bone 5600. For example, the bone could be a fibula.

[0101] Fig. Figure 57 illustrates the natural fibula segment 5600 with labeled bone graft segments 5702A, 5702B, and 5702C according to some embodiments of the disclosed technique. At this point, a cutting guide (not shown) can be attached to the bone graft segments 5702 using temporary fixation screws 5704. As described above, the cutting guide may have multiple segments that are connected by joints or other devices, or may not be connected at all. For example, the articulated cutting guide may be the articulated cutting guide 1100 made of Fig. 11 or the articulated cutting guides 1300A and 1300B made of Fig. 13A and Fig. 13B.

[0102] Fig. Figure 58 illustrates the bone graft sections 5702A, 5702B and 5702C after they have been cut from the natural fibula section 5600, according to some embodiments of the disclosed technique.

[0103] Fig. Figure 59 illustrates the bone graft sections 5702A, 5702B, and 5702C arranged in a neomandibular position, as well as a temporary fixation plate 5900 configured to hold the bone graft sections 5702 in the neomandibular position, according to some embodiments of the disclosed techniques. The temporary fixation plate 5900 is patient-specific and can be manufactured by 3D printing or similar techniques.

[0104] Fig. Figure 60 illustrates the temporary fixation plate 5900, which is attached to the bone graft sections 5702A, 5702B, and 5702C using screws 6000, according to some embodiments of the disclosed technique. In the drawings, the temporary fixation plate is attached to cephalic surfaces of the multiple bone graft sections. However, other surfaces of the multiple bone graft sections can be used. In the drawings, two screws 6000 are used for each bone graft section 5700. However, other numbers of screws 6000 can be used. The screws 6000 can be monocortical fixation screws.

[0105] Fig. Figure 61 illustrates the bone graft sections 5702A, 5702B, and 5702C with the attached temporary fixation plate 5900 according to some embodiments of the disclosed techniques. The bone graft sections 5702 are now held in place by the temporary fixation plate 5900. At this point, the multiple bone graft sections are attached to both the temporary fixation plate 5900 and the cutting guide. At this point, the cutting guide can be removed.

[0106] Fig. Figure 62 illustrates the bone graft sections 5702A, 5702B, and 5702C, wherein the temporary fixation plate 5900 is attached using screws 6000 and the final fixation plate 6200 is attached, for example, using screws, according to some embodiments of the disclosed techniques. At this point, the multiple bone graft sections are attached to both the temporary fixation plate 5900 and the final fixation plate 6200.

[0107] Fig. Figure 63 illustrates the removal of the temporary fixation plate 5900 and screws 6000 from the bone graft sections 5702A, 5702B, and 5702C according to some embodiments of the disclosed techniques. The bone graft sections 5702 are now held in place by the final fixation plate 6200.

[0108] Fig. Figure 64 is a flowchart illustrating a process 6400 for constructing a neomandibular assembly according to some embodiments of the disclosed techniques. The process elements described in this disclosure are shown in an arrangement. However, it is understood that one or more elements of each process may be performed in a different order, in parallel, omitted entirely, or the like. Furthermore, each process may include other elements in addition to those shown.

[0109] With reference to Fig. Process 6400 can involve providing a bone segment at 6402. For example, the bone segment can be bone segment 5600 from Fig. 56.

[0110] With renewed reference to Fig. 64, process 6400 at 6404 can involve attaching a cutting guide to the bone segment. For example, the cutting guide could be the articulated cutting guide 1100 made of Fig. 11 or the articulated cutting guides 1300A and 1300B made of Fig. 13A and Fig. 13B. In some embodiments, the sections of the cutting guide may not be connected at all.

[0111] With reference to Fig. 64 The process 6400 at 6406 can involve cutting the bone section into multiple bone graft sections using the cutting guide. For example, the multiple bone graft sections can be as in Fig. 58 will be shown.

[0112] With renewed reference to Fig. 64 The process 6400 at 6408 can involve arranging the multiple bone graft segments in a neomandibular position. For example, the multiple bone graft segments can be arranged as in Fig. 59 are shown arranged.

[0113] With renewed reference to Fig. 64 The process 6400 at 6410 can involve attaching a temporary fixation plate to the multiple bone graft segments. For example, the multiple bone graft segments can be as in Fig. 58. For example, the temporary fixation plate can be used as shown in Fig. 59-61 shown on the multiple bone graft sections.

[0114] With renewed reference to Fig. 64, the process 6400 at 6412 may involve removal of the cutting guide from the multiple bone graft sections.

[0115] Process 6400 may involve the application of a final fixation plate to the multiple bone graft segments at step 6414. For example, the final fixation plate may be as shown in Fig. 62 shown on the several bone graft sections.

[0116] With renewed reference to Fig. 64. Process 6400 at 6416 may involve removing the temporary fixation plate from the multiple bone graft segments to create a single-barrel neomandible. Process 6400 at 6418 may involve implanting the single-barrel neomandible into a mandibular defect region of a patient. Process 6400 at 6420 may involve placing dental implants at predetermined locations on the neomandible. The dental implants may be commercially available dental implants. Fig. Figures 65-69 illustrate a mandibular double-barrel reconstruction technique using temporary fixation plates according to some embodiments of the disclosed techniques. Features of these embodiments can be combined with features of other embodiments described in this document.

[0117] The technique can begin with a section of natural bone, for example as in Fig. Figure 56 illustrates this. For example, the bone could be a fibula.

[0118] A cutting guide can be attached to the bone graft sections using temporary fixation screws, for example as described in relation to Fig. 57. While illustrated and described for a single-barrel neomandibular graft, this technique can be used to form both barrels of a double-barrel neomandibular graft by using one or more cutting guides. Each barrel can incorporate multiple bone graft segments after being cut from the natural fibular segment, for example, as described in relation to Fig. 58 illustrated and described.

[0119] Fig. Figure 65 illustrates articulated cutting guides that are curved to position the bone graft segments in an upper neomandibular position and a lower neomandibular position, according to some embodiments of the disclosed techniques. With reference to Fig. Figure 65 shows the bone graft sections 6502 arranged in a lower neomandibular position and the bone graft sections 6504 arranged in an upper neomandibular position, together with an articulated cutting guide 6506.

[0120] Fig. Figure 66 illustrates the temporary fixation plates attached to the bone graft segments according to some embodiments of the disclosed techniques. During this process, the cutting guide (not shown) remains attached. With reference to Fig. 66 A lower temporary fixation plate 6602 can be attached to the bone graft sections 6502 located in the lower neomandibular position, and an upper temporary fixation plate 6604 can be attached to the bone graft sections 6504 located in the upper neomandibular position. In some embodiments, the temporary fixation plates 6602, 6604 can be attached to cephalic surfaces of the bone graft sections using screws 6606. However, other surfaces of the multiple bone graft sections can be used. The screws 6606 can be monocortical fixation screws. The temporary fixation plates 6602, 6604 can be patient-specific and can be manufactured by 3D printing or similar techniques.

[0121] Fig. Figure 67 illustrates bending the articulated cutting guide 6506 to align the bone graft sections 6502, which are arranged in the upper neomandibular position, with the bone graft sections 6504, which are arranged in the lower neomandibular position, according to some embodiments of the disclosed technique. In this embodiment, the cutting guide is also angled at 6702 between the upper and lower sections. During the process, the temporary fixation plates 6502, 6504 remain in place.

[0122] In other embodiments, two separate articulated cutting guides can be used: one for the superior neomandible and another for the inferior neomandible. After cutting the natural bone segments, each articulated cutting guide can be bent at the joints to form the respective neomandible. Once bent, the cutting / alignment guide springs can be attached to the angled cutting guides to bend them into the appropriate position. The cutting / alignment guide springs can be in Fig. 13A and Fig. Figure 13B will be shown and described in relation to it. After the holes for the jaw plate 6802 have been drilled using the articulated cutting guides (with the attached cutting / alignment guide springs), the upper and lower neomandibular prostheses can be manually aligned for insertion of the jaw plate 6802 using the holes.

[0123] Fig. Figure 68 illustrates the placement of a jaw plate 6802 between the bone graft sections 6504 arranged in the upper neomandibular position and the bone graft sections 6502 arranged in the lower neomandibular position to create a double-barrel neomandibular 6800, according to some embodiments of the disclosed technique. At this point, the multiple bone graft sections are attached to the temporary fixation plates 6502, 6504, and the jaw plate 6802. In this embodiment, the articulated cutting guide 6506 can be removed before the jaw plate 6802 is attached.

[0124] In other embodiments, the jaw plate can be attached while the cutting guide is being attached. After the jaw plate is attached, the cutting guide can be removed. In these embodiments, the temporary fixing plates are not required.

[0125] Fig. Figure 69 illustrates the Double-Barrel Neomandibula 6800 from Fig. 68, which is attached to the natural mandible 6902, according to some embodiments of the disclosed techniques. Any attachment process may be used, for example, including those described elsewhere in this document.

[0126] Fig. Figure 70 is a flowchart illustrating a process 7000 for constructing a double-barrel neomandibular assembly according to some embodiments of the disclosed techniques. The process elements described in this disclosure are shown in an arrangement. However, it is understood that one or more elements of each process may be performed in a different order, in parallel, omitted entirely, or the like. Furthermore, each process may include other elements in addition to those shown.

[0127] With reference to Fig. The process 7000 can involve providing at least one bone segment at 7002. For example, the bone segment can be bone segment 5600 from Fig. 56.

[0128] With renewed reference to Fig. 70, process 7000 at 7004 can involve attaching at least one cutting guide to the bone segment. For example, the cutting guide can be the articulated cutting guide 1100. Fig. 11 or the articulated cutting guides 1300A and 1300B made of Fig. 13A and Fig. 13B. In some embodiments, the sections of the cutting guide may not be connected at all.

[0129] With renewed reference to Fig. 70, the process 7000 at 7006 can involve cutting at least one bone segment into multiple bone graft segments using the cutting guide. For example, the multiple bone graft segments can be as in Fig. 58 will be shown.

[0130] With renewed reference to Fig. 70 The process 7000 at 7008 can involve arranging the multiple bone graft segments in an upper neomandibular position and a lower neomandibular position. For example, the multiple bone graft segments can be arranged as in Fig. 59. In embodiments using an articulated cutting guide comprising two cutting guides connected by a joint, the multiple bone graft sections can be aligned by rotating the cutting guides around the joint.

[0131] With renewed reference to Fig. 70 The process 7000 at 7010 can involve attaching an upper and lower temporary fixation plate to the multiple bone graft segments. For example, the upper and lower fixation plates can be as shown in Fig. 66 shown and described with reference to these, they are attached to the several bone graft sections.

[0132] With renewed reference to Fig. 70 The process 7000 at 7012 may involve aligning the bone graft segments located in the upper neomandibular position with the bone graft segments located in the lower neomandibular position. For example, the at least one articulated cutting guide as in Fig. 67 shown bent. In embodiments that use an articulated cutting guide, the bone graft sections can be arranged by bending the articulated cutting guide around the joints.

[0133] With renewed reference to Fig. 70, the process 7000 at 7014 may involve the removal of at least one cutting guide from the multiple bone graft sections.

[0134] Process 7000 may involve, in 7014, the application of a jaw plate between the bone graft segments located in the upper neomandibular position and the bone graft segments located in the lower neomandibular position. For example, the jaw plate may be as shown in Fig. 68 shown on the several bone graft sections.

[0135] With renewed reference to Fig. Process 7000 may involve removing the temporary fixation plates from the multiple bone graft segments at step 7018 to create a single-barrel neomandible. Process 7000 may involve implanting the double-barrel neomandible at step 7020 into a patient's mandibular defect region. Process 7200 may involve placing dental implants at predetermined locations on the neomandible at step 7022. The dental implants may be commercially available dental implants.

[0136] Although the preceding invention has been described in detail by means of illustrations and examples for the purpose of clarity, a person skilled in the art will understand that certain changes, modifications, altered designs, and / or equivalents may be made or employed as desired and are within the scope of the appended claims. Furthermore, every reference provided in this document is fully incorporated by reference to the same extent as if each reference were incorporated individually by reference.By reference to this, all publications, patents, patent applications, journal articles, books, technical references and the like mentioned in this description are incorporated in this document by reference to the same extent as if each individual publication, patent, patent application, journal article, book, technical reference or the like were specifically and individually indicated as incorporated by reference.

Claims

[1] Procedure, encompassing: Providing a section of bone; Attaching a cutting guide to the bone section; Cutting the bone section into several bone graft sections using the cutting guide; Arranging the multiple bone graft segments in a neomandibular position; Attaching a temporary fixation plate to the multiple bone graft sections after arranging the multiple bone graft sections in the neomandibular position; Removing the cutting guide from the multiple bone graft sections after applying the temporary fixation plate; Attaching a final fixation plate to the multiple bone graft segments after removal of the cutting guide; and Removing the temporary fixation plate from the multiple bone graft sections after applying the final fixation plate to create a neomandibular assembly. [2] Method according to claim 1, wherein: the cutting guide is an articulated cutting guide comprising several cutting guide sections connected by at least one joint; and The arrangement of the multiple bone graft sections in a neomandibular position involves bending the sections around at least one joint. [3] Method according to claim 1, wherein the application of the temporary fixation plate to the multiple bone graft sections comprises: Attachment of the temporary fixation plate to the cephalic surfaces of the multiple bone graft segments. [4] Method according to claim 1, wherein the application of the temporary fixation plate to the multiple bone graft sections comprises: Attaching the temporary fixation plate to the multiple bone graft sections with several screws. [5] Method according to claim 1, wherein the application of the temporary fixation plate to the multiple bone graft sections comprises: Attaching the temporary fixation plate to the multiple bone graft sections using multiple monocortical fixation screws. [6] The method of claim 1, further comprising: Implanting the neomandibular assembly in a mandibular defect region of a patient. [7] Method according to claim 6, further comprising: Placing dental implants at predetermined locations on the neomandibular assembly. [8] Neomandibula, comprising: several bone graft segments arranged in a neomandibular position; a cutting guide attached to the multiple bone graft sections; and a temporary fixation plate that is attached to the multiple bone graft sections. [9] Neomandibula according to claim 8, wherein the cutting guide is an articulated cutting guide comprising several cutting guide sections connected by at least one joint. [10] Neomandibula according to claim 9, further comprising: an alignment guide; wherein the cutting guide comprises several cutting guide sections; and the alignment guide is attached to the several cutting guide sections. [11] Neomandibula according to claim 8, wherein the temporary fixation plate is attached to cephalic surfaces of the multiple bone graft segments. [12] Neomandibula according to claim 8, wherein the temporary fixation plate is attached to the multiple bone graft sections by means of several screws. [13] Neomandibula according to claim 8, wherein the temporary fixation plate is attached to the multiple bone graft sections by means of several monocortical fixation screws. [14] Procedures, including: Provide at least one bone segment; Attaching a first cutting guide and a second cutting guide to the at least one bone segment; Cutting the at least one bone section into several bone graft sections using the first and second cutting guides; Arranging the multiple bone graft segments in an upper neomandibular position and a lower neomandibular position using the first and second cutting guides; Attaching an upper temporary fixation plate to the bone graft segments located in the upper neomandibular position; Attaching a lower temporary fixation plate to the bone graft segments located in the lower neomandibular position; Removal of the first and second cutting guides from the multiple bone graft sections after application of the upper temporary fixation plate and the lower temporary fixation plate; Placing a jaw plate between the bone graft sections located in the upper neomandibular position and the bone graft sections located in the lower neomandibular position; and Removal of the temporary fixation plates from the multiple bone graft sections after application of the jaw plate to create a neomandibular assembly. [15] The method of claim 14, further comprising: Aligning the bone graft sections located in the upper neomandibular position with the bone graft sections located in the lower neomandibular position. [16] Method according to claim 15, wherein: the first and second cutting guides are connected by another joint; and Aligning the bone graft sections involves rotating the first and second cutting guides around the further joint. [17] Method according to claim 15, wherein: the first cutting guide is an articulated cutting guide comprising several cutting guide sections connected by at least one joint; and the arrangement of the multiple bone graft sections in at least one of the upper neomandibular positions, bending of the multiple cutting guide sections around the at least one joint. [18] Method according to claim 14, wherein: the first cutting guide comprises several cutting guide sections; and The method further includes attaching an alignment guide to the several cutting guide sections of the first cutting guide. [19] Method according to claim 14, wherein: The procedure includes attaching the upper temporary fixation plate to the bone graft segments located in the upper neomandibular position, and attaching the upper temporary fixation plate to the cephalic surfaces of the bone graft segments located in the upper neomandibular position; and This includes attaching the lower temporary fixation plate to the bone graft segments located in the lower neomandibular position, and attaching the lower temporary fixation plate to the cephalic surfaces of the bone graft segments located in the lower neomandibular position. [20] Method according to claim 14, wherein the application of the upper and lower temporary fixing plate comprises: Attach the upper and lower temporary fixing plates with several screws. [21] Method according to claim 20, wherein the multiple screws are monocortical fixation screws. [22] The method of claim 14, further comprising: Implanting the neomandibular assembly in a mandibular defect region of a patient. [23] The method of claim 22, further comprising: Placing dental implants at predetermined locations on the neomandibular assembly.

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