2 Indications and current treatments
2.1 Complex orofacial reconstruction involving multiple surfaces, including bony and cartilaginous structures, without the expectation of substantial soft tissue cover is most frequently needed after severe orofacial trauma or removal of orofacial tumours, but may also be used to treat congenital facial abnormalities. Various materials are used including autologous grafts; tissue-engineered bone; alloplastic materials such as silicone, titanium or hydroxyapatite; and composites (for example, titanium mesh embedded in porous polyethylene).
2.2 The traditional method of forming titanium implants for complex orofacial reconstruction is to bend and cut titanium mesh during the operation. Positioning the implant in the appropriate site requires an accurate assessment of shape and fit, and a number of insertion attempts may be necessary before correct implant shape is achieved. In this procedure, computer-aided design and computer-aided manufacturing (CAD‑CAM) techniques are used to create a customised implant before the operation to insert the implant. The aim is to improve both functional and cosmetic outcomes.