Case Report: Virtual surgery and 3D printing in a medication-related osteonecrosis of the jaws (MRONJ) pathological mandibular fracture

Introduction: The use of anatomical models, guides, and surgical templates allows for increased precision of interventions and reduced operative times. Thanks to computer-aided design (CAD) and computer-aided manufacturing (CAM) technologies and rapid prototyping through 3D printing, it is possible to obtain accurate models, which are useful to defining surgical planning in the maxillofacial district. Methods: We present the case of a patient with a pathological fracture of the mandibular body affected by medication-related osteonecrosis of the jaws (MRONJ) in stage III. Through the manipulation of virtual models obtained from thin-layer Computed Tomography (CT), a virtual surgical intervention of sequestrectomy and debridement of necrotic bone tissue, reduction and containment of the fracture was performed. The resulting mandibular model was used as a template for the preoperative modeling of the titanium reconstruction plate used for fracture containment. Results: The intraoperative result and follow-up demonstrated good accuracy of the model with respect to post-operative mandibular dynamics, condylar-fossa position and a reduced surgical time. Discussion: Virtual surgery and 3D-printed prototyping represent a feasible technique in MRONJ patients, allowing increased precision of interventions, reduced risks associated with the operation, and improved operative and recovery times for the patient.