Use of Custom Surgical Stents for Facial Bone Contouring- A New Technique

Custom computer software and computer-generated surgical drill guides are widely used in the planning and placement of osseointegrated dental implants. Manipulation and interaction with facial CT data in three dimensions (3D) permits the experienced operator to predictably place implants into predetermined sites both intra- and extra-orally. Similar technology allows manipulation of the 3D data in cases of pathological bony deformity in order to determine a surgical plan. However, whilst on screen planning may be straight forward, translating the ‘virtual’ plan into reality is far from straightforward.

We present a novel method of designing and using surgical drill guides of variable thickness to permit accurate drilling to pre-determined depths using a single drill bit. This allows the operating surgeon to quickly and accurately contour bone, of particular benefit when normal anatomy is significantly altered by pathology. From our careful search of the literature we believe that this is the first time that such a technique has been used in the facial skeleton.

We will illustrate the usefulness of this technique with a case of hemifacial recontouring performed for massive, stable polyostic fibrous dysplasia. We will demonstrate how the 3D computer modelling and drill guides manufactured by rapid prototyping significantly facilitated the recontouring procedure. This reduced both surgical time and morbidity, and allowed delivery of the optimal post-operative symmetrisation.