Comparing the importance of implant customization vs. usage of a fibular graft using a novel mandibular implant for improved reconstruction: a finite element study.

This study proposes and analyses a novel standard conformal implant (SCI) design, combining the benefits of standard implants (SI) and custom implants (CI) for mandibular defect reconstruction. Using finite element analysis, the performance of all three implant types was compared during unilateral clenching tasks, both with and without fibular graft. The analysis focused on stress and strain distribution in implants and fixation screws. Without fibular graft, CI exhibited lower maximum stress compared to SI and SCI. Reconstruction with fibular graft significantly reduced stress and strain values across all implants, suggesting a lower probability of implant fracture and screw loosening. While SCI seemed promising, reconstruction with SI also resulted in the stress values within failure limits of the implant and screw material and strain values within the threshold for bone resorption, suggesting that implant choice may be less critical with graft support. The study concluded that fibular grafts play a more crucial role in mandibular reconstruction compared to implant customization. However, the custom implant could be a suitable option for patients unable to receive fibular grafts due to comorbidities. Further improvements in the computational model and experimental validation are needed to assess the clinical viability and long-term performance of the implants.