## 4 Discussion  
Various modalities of use of load bearing plates during reconstruction of mandibular defects have been discussed in the literature. The most common of them are: (i) manual bending of straight reconstruction plates as per the defect; (ii) commercially available preformed plates; (iii) reconstruction plates that are prebend over a template obtained from 3D printing; and (iv) use of patient-specific 3D printed reconstruction plates aided with cutting guide, drill guide and positioning guide. Bending of plate on the table as per defect may sound simple but can pose difficulty in accurately conforming the plates when defects are long. Factory manufactured preformed plates do ease the job of manual bending but may not always perfectly match the individualized mandibular contours [13; 14; 15; 16]. Patient specific implants have been viewed as a promising modality for primary bone defects and benign conditions [17; 18; 19]. Theoretically, this approach has the maximum accuracy of the reconstruction. However, they do not offer any room for surgical flexibility [1; 2]. Any change in the surgical plan or resection margins during intraoperative period would simply discards their usage. This not only adds cost to the patients but also frustration to the surgeon. The goal of computer assisted planning in head and neck tumor surgery is to increase surgical accuracy, to achieve better aesthetic and functional outcomes, decreased intraoperative and graft ischemia duration, and to make the overall learning curve easy, producing consistent results [20; 21; 22]. There is definitely an advantage of CAD/CAM planning over conventional surgical methods. However, translating the accurate virtual planning to operating table is a still a big challenge. This issue becomes more crucial when we talk about \begin{table}
\begin{tabular}{c c c c c c c} \hline \hline \multirow{2}{*}{**S. No.**} & **Age** & **Defect** & **Anatomical Parts** & **Diagrammatic** & **Diagnosis** & **Design** \\  & **(Years)** & **Gender** & **Type** & **Involved** & **Illustration** & **Diagnosis** & **Category** \\ \hline
8 & 59.5 & M & LC & \
\begin{tabular}{c} Canine to canine, \\ right body, angle, \\ ramus \\ \end{tabular} &
\begin{tabular}{c} Secondary \\ reconstruction \\ \end{tabular} & II \\ \hline
9 & 50.3 & M & LC & \
\begin{tabular}{c} Canine to canine, left \\ body, angle, ramus \\ \end{tabular} &
\begin{tabular}{c} Secondary \\ reconstruction \\ \end{tabular} & III \\ \hline
10 & 59.2 & M & LCL & \
\begin{tabular}{c} Right ramus to left \\ ramus \\ \end{tabular} &
\begin{tabular}{c} Secondary \\ reconstruction \\ \end{tabular} & III \\ \hline
11 & 63.4 & M & LCL & \
\begin{tabular}{c} Right angle to left \\ ramus \\ \end{tabular} &
\begin{tabular}{c} Secondary \\ reconstruction \\ \end{tabular} & III \\ \hline \hline \end{tabular}
\end{table} 
Table 1: _Cont._reconstruction of complex craniofacial defects, especially secondary bone defects after radiotherapy or extensive lesion crossing the midline [4,12]. The authors have discussed the use of CAD-CAM technology to design and manufacture mandibular template in various secondary defect configurations for the purpose of patient-specific manual plate bending. To the best of the authors knowledge, this is the first attempt to propose an algorithm to virtually design a defect template in various defect configurations and clinical scenarios by use of Brainlab CMF software (iPlan). [PERSON] et al. had performed anatomical measurements in 100 CT scans and suggested that development of a mandibular reconstruction template tool would benefit mandibular reconstruction patients due to a constant mandibular arch angle and symphysis segment length throughout the general patient population, allowing the mimicking of a mandibular arch with up to three fibula segments [23]. The standard protocol devised by the authors and discussed here, attempts to fabricate model templates as close as possible to the patient's native mandible in various defect scenarios.