A CAD-Based Workflow for Structured Mid-Sagittal Plane Definition in Contralateral Mandibular Mirroring: A Technical Note.

OBJECTIVES

To describe a structured CAD-based workflow for defining the mandibular mid-sagittal plane during contralateral mirroring for unilateral mandibular defects and to demonstrate its clinical applicability in reconstructive planning.

METHODS

DICOM data were segmented to generate a mandibular STL model. In CAD software, a mid-sagittal splitting plane was constructed using convergent geometric references, including a best-fit plane, principal inertia axis, and centre-of-gravity point, combined with pogonion as the anterior midline reference. The unaffected hemimandible was mirrored across this plane, exported as an STL file, and used for biomodel fabrication, guide planning, and reconstruction plate pre-contouring. A representative ameloblastoma case was used to illustrate the workflow.

RESULTS

The workflow produced a mirrored mandibular template suitable for digital-to-physical transfer. In the representative case, the template supported preoperative reconstruction plate adaptation and intraoperative contour planning. At 12-month follow-up, facial contour and occlusion were clinically acceptable on qualitative assessment.

CONCLUSIONS

A convergent reference CAD workflow offers a practical method for standardising mid-sagittal plane definition in mandibular contralateral mirroring. The workflow may reduce reliance on subjective landmark selection in unilateral pathology; however, quantitative validation against established midplane methods is required.

CLINICAL SIGNIFICANCE: This technique provides a stepwise digital planning workflow for unilateral mandibular reconstruction, helping surgeons define the mid-sagittal plane, create mirrored templates, fabricate biomodels, and pre-contour reconstruction plates when tumour-related distortion limits reliable anatomical reference points.

LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .