Cutting Guides in Jaw – Chin Recontouring

The Impact of Virtual Planning in Modern Surgery

We live in the technological era. Obviously this has also affected the world of surgery. Virtual planning is so widespread that, nowadays, what should attract attention is to find any professional who does not previously plan his cases in specific software. Also those who does not take advantage of the facilities provided by the cutting guides or the material made to measure for each patient. 

It is true that this universalization of technology has meant better assistance to our patients. But we must not forget that behind every advance there are companies investing and hoping to profit from these efforts. For this reason, it is the most frequent procedures that tend to benefit from the greatest advances, leaving behind those procedures that are less frequently performed. 

Redefining Mandibular – Mentonian Contouring with our Cutting-Edge Technology

Since 2016 we have been working in our team to implement existing technology for mandibular contouring surgery, a very small “niche” to which few professionals dedicate their day to day. And we managed to develop and validate cutting guides perfectly designed for this purpose. 

Until then, no guides had been used, or what had been used to modify the shape of the angles or chin were inherited from guides used for other more popular surgeries, such as orthognathic surgery. 

Thanks to the collaboration with the industry, we were able to design the mandibular basal mandibular cutting guide with ideal characteristics:

• the smallest possible size, to be able to introduce them through the smallest possible approach
• a certain flexibility, to allow their introduction in the field where they are needed
• resistance, so as not to break during placement or the demarcation phase
• biocompatibility

Previously designed guides were too large in size and needed to be introduced through more extensive approaches and did not rest on the mandibular basal, but on the teeth, generating more complex structures that made their use difficult.

As shown on the image above, with our guide , we can modify the mandibular basal in all its extension, from angle to angle; or adapt it to the needs of each patient: angles, mandibular body and chin or only the chin.

Due to the type of design, it is possible to modify mainly the height of the mandible. In terms of definitive width and shape, we usually have to resort to shaving or bone milling techniques using a high-speed micromotor, with the consequent component of experience for a correct result. 

The guides are particularly useful to us, since with 3D design we can: 

1. Locate the inferior dental nerve in its intramandibular path. 
2. Detect anomalies in the mandibular anatomy. 
3. Generate differentiated cuts according to the proportions we are looking for, since they can be measured and analyzed directly in the virtual 3D model.
4. Correct asymmetries. 
5. Combine this design with other types of mandibular cuts for other purposes (orthognathic surgery, mentoplasty, etc).

The Game-Changing Role of Intraoperative Guides in Surgery

Intraoperatively, they have saved us time, since previously making similar cuts on both sides of the jaw used to take much more time (between 45 and 60 minutes more, in a surgery lasting 2-3 hours). And the quality and precision of the result of the cuts in the bone cannot be compared to what we are able to achieve without them. 

However, we have to say that the use of guides does not guarantee a perfect result. This, to a large extent, depends on the surgeon’s criteria, since it will be he who will have to make the design on the computer. If this design does not follow the adequate beauty patterns or the results that the patient is looking for, the surgery will not have achieved its objective. We will have, therefore, a bad result, “perfectly planned”.

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