Office-Based Digital Workflow for Managing Old Mandibular Fracture Malunion: Use of Short-Segment Drilling and Osteotomy Guides With Predictive Holes.

Treating old mandibular fractures with malunion is challenging due to the need for osteotomy and interference between bone segments, complicating occlusal restoration. This technical note introduces a novel office-based digital workflow utilizing surgical guides. Preoperative computed tomography (CT) data were imported into MIMICS software for virtual surgical planning to precisely realign bone fragments based on anatomical and occlusal relationships. A pre-bent reconstruction plate was adapted to a 3-dimensional-printed mandible model, and cone beam CT scans captured detailed screw path data. This information was used in 3-matic software to design short-segment drilling guides (SSDGs), and osteotomy guides with predictive holes. These guides facilitated accurate bone osteotomy and realignment during surgery. This workflow addresses the limitations of previous SSDGs, offering a reliable solution for managing malunion in old mandibular fractures. The approach reduces surgical complexity, enhances precision, and streamlines treatment, providing an innovative method for challenging mandibular fractures.