Mandibular reconstruction with a manually fabricated acrylic resin positioning guide: report of two clinical cases

Abstract

This case report describes the use of manually fabricated acrylic resin positioning guides for mandibular reconstruction in two patients undergoing revision surgery after initial oral squamous cell carcinoma ablation. Rapid prototyping (RP) models were created preoperatively using cone-beam CT data, enabling reconstruction plate (R-plate) prebending. An acrylic resin positioning guide was then fabricated on the RP model to preserve the prebent configuration. Revision surgery presented technical challenges for conventional intraoperative manual bending due to scarring, limited surgical exposure, and unpredictable resection margins. The positioning guide enabled precise intraoperative transfer and fixation of the prebent R-plate, achieving accurate anatomical restoration, improved surgical efficiency, and stable functional recovery. Compared to patient-specific implants and fully customized 3D-printed plates, this technique offers significant advantages in cost-effectiveness, preparation time, and accessibility while maintaining satisfactory surgical outcomes. The acrylic resin positioning guide represents a practical, adaptable alternative particularly suitable for revision cases and resource-limited settings.