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

Abstract

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.