Development of an Automatic Computer Program to Determine the Optimal Dental Implant Size and Position in Fibula Free Flap

Computer-assisted surgery (CAS) and virtual surgical planning (VSP) have transformed jaw reconstruction, allowing immediate insertion of dental implants during surgery for better rehabilitation of occlusal function. However, traditional planning for optimal location and angulation of dental implants and fibula relies on experience and can be time-consuming. This study aimed to propose a function-driven workflow and develop an automatic computer program for optimal positioning of simultaneous dental implants and fibula segments. A customized computer program was developed using MATLAB. Computed tomography (CT) of lower limbs of ninety-one Southern Chinese individuals were retrieved and cross-section of 3-dimensional (3D) fibula models were comprehensively investigated for implant installation. Our research has proved that the accuracy of the program in identifying the anatomical orientation of fibula was 92%. The ideal location, angulation and length of implant could be automatically generated based on any selected implant diameter, with surgical feasibility of 94%. To the best of our knowledge, this is the first study to develop and validate a customized automatic computer program for osseointegrated implant design in fibula flap. This program can be incorporated to the current workflow of CAS to push forward the frontier of reliable and efficient surgical planning for function-driven jaw reconstruction.