Three-dimensional printed Patient-specific Implants for Reconstruction after Post-mucormycosis Maxillofacial Defects - A Systematic Review and Meta-analysis.

BACKGROUND

Post-mucormycosis maxillary, mid-facial and mandibular defects are often extensive, multi-planar and occur in medically compromised patients, making conventional obturators, free flaps and standard implant protocols challenging.

OBJECTIVES

Three-dimensional (3D)-printed patient-specific implants (PSIs) have emerged as a digitally planned, titanium-based alternative, but clinical evidence remains fragmented.

DATA SOURCES: A systematic search of electronic databases and manual sources was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020.

STUDY ELIGIBILITY CRITERIA: Studies reporting clinical outcomes of 3D-printed PSIs in patients with post-mucormycosis maxillary/mid-facial defects were included. Data on patient/defect characteristics, PSI design, complications, functional and aesthetic outcomes were extracted. Risk of bias was assessed using Joanna Briggs Institute checklists for cohort/case series and case reports.

PARTICIPANTS AND INTERVENTIONS: Eleven studies met the inclusion criteria. Defects were predominantly Brown Class II-III maxillectomy and complex mid-facial/orbital defects treated with computed tomography/cone-beam computed tomography-guided, additively manufactured titanium PSIs, often integrated with zygomatic anchorage.

STUDY APPRAISAL: Pooled analysis of five multi-patient cohorts (n = 67) showed a PSI survival proportion of 0.96 (95% confidence interval = 0.91-1.00) at 6-24 months, with negligible heterogeneity (I 2 = 0%). Complications were mostly minor and true PSI loss was rare.

RESULTS

Functional (mastication, speech and leakage control) and aesthetic outcomes, where reported, were generally favourable with high patient satisfaction.

CONCLUSIONS

3D-printed PSIs show excellent short-term survival and promising functional and aesthetic rehabilitation in extensive post-mucormycosis defects, but current evidence is limited to small, high-bias observational studies.

LIMITATIONS: Robust prospective and comparative research is needed before routine adoption can be recommended.