Prosthetic Reconstruction, Rehabilitation & Surgical Planning —
Training activity: 3

Details

Plan, design and manufacture a custom fixation device (i.e. gunning splint) for the management of an elderly patient (dentate/edentulous, i.e. bone loss, osteoporosis) who suffer complex mandibular fractures and evaluate against treatment goals.

Type

Developmental training activity (DTA)

Evidence requirements

Evidence the activity has been undertaken by the trainee​.

Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.

An action plan to implement learning and/or to address skills or knowledge gaps identified.

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

What are the intended outcomes of the training activity?

• How will you define a successful outcome for the fixation device in terms of achieving stability for the complex mandibular fracture while ensuring it meets a safe clinical standard?
• In what ways will your design and manufacturing process demonstrate adherence to local and national health and safety policies, regulatory requirements, and the principles of your department’s Quality Management System (QMS)?
• How do you plan to align your treatment goals with the best interests of the patient, specifically considering the medical and physical requirements of an elderly patient with osteoporosis or significant bone loss?
• What are the intended outcomes for your communication strategy when discussing the integration of the splint into the broader surgical treatment plan with the multidisciplinary team (MDT)?
• How will you ensure the final device is evaluated effectively against the pre-defined treatment goals to ensure quality patient-centred care?

What do you anticipate you will learn from the experience?

• What specific insights do you hope to gain regarding the biomechanics and stability of fixation in edentulous or minimally dentate patients where traditional dental-borne fixation is not possible?
• How do you expect this activity to improve your ability to analyse and interpret multimodal imaging (e.g., OPGs, PA views, or CT data) when formulating surgical treatment plans for complex head and neck trauma?
• What do you already understand about the selection of biomedical materials and components that are appropriate for fragile elderly mucosa and the structural requirements of a fixation device?
• What do you anticipate learning about the social and psychological requirements of an elderly patient undergoing traumatic injury rehabilitation, and how will you assess and interpret these needs to customise the treatment?
• How will this experience enhance your understanding of the different roles within the MDT and their specific impact on the patient’s care pathway?

What actions will you take in preparation for the experience?

• Have you discussed the specific anatomical challenges of this case—such as poor bone quality/quality and displacement of facial fractures—with your Training Officer to gain clarity on the intended design?
• What potential challenges do you foresee in capturing accurate clinical information or impressions for an edentulous trauma patient, and how would these be handled?
• How have you prepared to work in partnership with clinical specialisms (e.g., Maxillofacial Surgeons) to ensure your design supports the intended surgical intervention and patient outcome?
• How do you feel about embarking on the manufacture of a critical fixation device for a high-risk elderly patient, and what steps have you taken to ensure you stay within your scope of practice?
• Have you reviewed the relevant regulatory requirements (such as the Medical Devices Directive) and clinical governance frameworks to ensure the custom-made device is compliant and safe?

In action

What are you doing?

• How are you approaching the analysis and interpretation of multimodal imaging (such as OPGs or CT data) to ensure the fixation device is designed to a safe clinical standard?
• What real-time decisions are you making as the manufacture progresses to ensure the splint accommodates the unique anatomical challenges of bone loss or osteoporosis?
• In what ways are you ensuring that your current actions in the laboratory or clinic align with the principles of your Quality Management System (QMS) and overall service governance?
• Which aspects of the design process for a complex mandibular fracture feel intuitive to you, and which parts require more conscious effort to ensure you are delivering quality patient-centred care?
• Why have you chosen a specific biomedical material or component at this moment, and how does it relate to the intended surgical treatment goal?

How are you progressing with the activity?

• How effective are your current actions in achieving a design that provides biomechanical stability in a minimally dentate or edentulous environment?
• What technical or clinical challenges are you facing as the activity unfolds, particularly regarding the patient’s medical or physical requirements?
• What are you learning about the interplay between the laboratory plan and the surgical treatment goals as you refine the device?
• How does this complex trauma case connect to your existing knowledge and skills in manufacturing simpler occlusal or fixation devices?
• Are you successfully practising in partnership with the multidisciplinary team (MDT), and how is their input influencing your progress in the moment?

How are you adapting to the situation?

• If you encounter a discrepancy between the imaging and the physical model, what alternative design approaches are you considering in real-time?
• What immediate support or guidance do you need from your Training Officer or a Consultant Surgeon to ensure the device remains in the best interests of the patient?
• How are you ensuring that your involvement in the planning and manufacturing process remains strictly within your scope of practice as a trainee?
• How are you adapting your communication style or technical approach to better address the social or psychological requirements of the elderly patient during this stressful rehabilitation process?
• Are you maintaining adherence to local and national health and safety policies even when you have to adjust your manufacturing techniques to handle unexpected complexities in the case?

On action

What did you notice?

• Summarise the key stages of the process, from the initial analysis and interpretation of multimodal imaging (such as OPGs, PA views, or CT data) to the final manufacture and evaluation of the device.
• What were the most significant clinical features of the complex mandibular fracture, and how did the patient’s medical and physical requirements—specifically bone loss and osteoporosis—impact your design choices?
• Did you observe specific challenges in achieving biomechanical stability for an edentulous or minimally dentate ridge compared to standard fixation cases?
• Identify any “reflect-in-action” moments where you had to adjust your manufacturing technique in response to the material properties or unexpected anatomical complexities revealed during the design phase.
• What did you notice about the interprofessional communication during the development of the surgical treatment plan, and how did the multidisciplinary team (MDT) provide input on the device’s intended goals?

What did you learn from the activity?

• What specific skills or knowledge did you develop regarding the management of mandibular fractures in high-risk elderly populations?
• How has this experience improved your ability to select appropriate biomedical materials and components that balance the need for surgical rigidity with the fragility of elderly oral mucosa?
• In what ways did you apply the principles of a quality management system (QMS) to ensure the custom-made medical device was manufactured to a safe clinical standard and met all regulatory requirements?
• What did you learn about the roles of different clinical specialisms within the MDT and how the Gunning splint fits into the broader patient care pathway for complex head and neck surgery?
• How did you evaluate the final device against the treatment goals? Were there any unexpected successes or challenges during this evaluation that changed your perspective on fixation mechanics?

What will you take from the experience moving forward?

• What areas for continued development have you identified, such as a need for further training in advanced CAD/CAM planning for trauma or a deeper understanding of bone quality assessment?
• How will you apply the learning from this activity to your routine practice, particularly in how you assess and interpret the psychological and social requirements of elderly patients undergoing traumatic rehabilitation?
• What immediate steps will you take to support the assimilation of your learning, such as following the patient’s post-operative progress to see how the splint performed in a clinical setting?
• What resources or support—such as peer-reviewed literature on geriatric trauma or guidance from a Consultant Surgeon/Restotertive dentist—would be beneficial for your future development in this area?
• How has this activity influenced your commitment to quality patient-centred care and your understanding of the legal and ethical frameworks governing custom-made medical devices?

Beyond action

Have you revisited the experiences?

• How has your understanding of the biomechanics of fixation in edentulous or osteoporotic bone evolved since you first reflected on this activity?
• When revisiting your Reflect-before, -in, and -on-action for this task, what new insights have you gained regarding the surgical treatment planning for complex head and neck trauma?
• Have you compared this experience with Observed Training Activities (OTAs) or clinical observations in theatre, and what specific clinical behaviours have you now assimilated into your routine practice?
• As part of your review of the module, how does this Gunning splint case act as a ‘building block’ for more advanced trauma management?
• Have you engaged in professional storytelling with senior prosthetists or surgeons regarding the challenges of managing complex mandibular fractures in the elderly, and how has this exchange transformed your view of patient-centred care?

How have these experiences impacted upon your current practice?

• How are you currently applying the principles of a quality management system (QMS) and regulatory requirements to the manufacture of other custom-made medical devices?
• In what ways has the learning from this activity helped you prepare for your in-person assessments such as the Observed Communication Events (OCE), discussing the design of intra-oral fixation for a trauma case with a surgeon?
• How has your ability to analyse and interpret multimodal imaging—such as OPGs or CT data for bone loss—improved since completing this task?
• How have you integrated the assessment of medical, physical, and psychological requirements into your routine new patient assessments?
• Can you identify specific instances where your selection of biomedical materials for current cases has been influenced by what you learned about material performance in elderly patients with fragile mucosa?

How might these experiences contribute towards your future practice?

• What transferable skills, such as multidisciplinary partnership or ethical decision-making in the patient’s best interests, have you developed that are essential for your future role as a Clinical Scientist?
• How will your experience in formulating surgical treatment plans for complex trauma inform your future involvement in head and neck oncology or craniofacial reconstruction cases?
• What clear actions for continued development have you identified, such as pursuing advanced training in CAD/CAM planning for complex fractures or deepening your knowledge of bone quality assessment?
• How has this activity shaped your professional identity regarding the maintenance of safe clinical standards while managing high-risk, vulnerable patient populations?
• In what ways will your understanding of local and national service governance contribute to your future leadership in clinical audit or service evaluation projects?

Relevant learning outcomes

#	Outcome
# 1	Outcome Deliver quality patient centred care with the best interests of patients in all elements of practice.
# 2	Outcome Practice in accordance with local and national health and safety policies, regulatory requirements and overall service governance.
# 3	Outcome Communicate effectively with patients, relatives, healthcare professionals and other stakeholders.
# 5	Outcome Analyse and interpret patient investigations, multimodal imaging and information.
# 6	Outcome Perform clinical investigations, formulate treatment plans and manufacture medical devices to a safe clinical standard.
# 7	Outcome Prepare surgical treatment plans for complex head and neck surgery.
# 8	Outcome Select appropriate biomedical materials and components/instrumentation used in the treatment of patients and the manufacture of custom-made medical devices.
# 9	Outcome Practice in partnership with other clinical specialisms as part of a multidisciplinary team and understand their roles and their impact on patient care and pathway.
# 10	Outcome Apply the principals of a quality management system to their professional practice.
# 12	Outcome Assess and interpret patients’ needs to provide customised treatment dependent on medical, physical, social and psychological requirements.