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Boroojeni HSH, Mohaghegh S, Khojasteh A. Application of CAD-CAM Technologies for Maxillofacial Bone Regeneration: A Narrative Review of the Clinical Studies. Curr Stem Cell Res Ther 2024; 19:461-472. [PMID: 36372914 DOI: 10.2174/1574888x18666221111154057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/24/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022]
Abstract
The application of regenerative methods in treating maxillofacial defects can be categorized as functional bone regeneration in which scaffolds without protection are used and in-situ bone regeneration in which a protected healing space is created to induce bone formation. It has been shown that functional bone regeneration can reduce surgical time and obviate the necessity of autogenous bone grafting. However, studies mainly focused on applying this method to reconstruct minor bone effects, and more investigation concerning the large defects is required. In terms of in situ maxillofacial bone regeneration with the help of CAD-CAM technologies, the present data have suggested feasible mesh rigidity, perseverance of the underlying space, and apt augmentative results with CAD-CAM-based individualized Ti meshes. However, complications, including dehiscence and mesh exposure, coupled with consequent graft loss, infection and impeded regenerative rates have also been reported.
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Affiliation(s)
- Helia Sadat Haeri Boroojeni
- Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sadra Mohaghegh
- Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Khojasteh
- Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Cranio-Maxillofacial Surgery/University Hospital, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
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Mohaghegh S, Sadat Haeri Boroojeni H, Nokhbatolfoghahaei H, Khojasteh A. Application of biodegradable Patient-specific scaffolds for maxillofacial bone regeneration: a scoping review of clinical studies. Br J Oral Maxillofac Surg 2023; 61:587-597. [PMID: 37845099 DOI: 10.1016/j.bjoms.2023.08.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/28/2023] [Accepted: 08/20/2023] [Indexed: 10/18/2023]
Abstract
This study aimed to systematically review clinical studies in which biodegradable patient-specific scaffolds were used for bone regeneration. Studies in which biodegradable scaffolds were fabricated through computer-assisted design and computer-assisted manufacturing (CAD-CAM) procedures were included. Those that applied non-biodegradable materials or used biodegradable materials in a condensable powder or block form were excluded. Among a total of 26 included studies, 11 used customised allogeneic bone blocks, five used polycaprolactone (PCL)-containing scaffolds, four used hydroxyapatite (HA) scaffolds, and four biphasic calcium phosphate (BCP). The majority of the studies applied scaffolds for minor intraoral defects. All the large defects were reconstructed with polymer-containing scaffolds. Results of the included studies showed partial to complete filling of the defect following the application of biodegradable scaffolds. However, limited graft exposure was reported when using PCL, BCP, and HA scaffolds. Tissue engineering can be considered a potential method for the treatment of maxillofacial bone defects. However, more evidence is required, especially for the application of biodegradable scaffolds in large defects.
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Affiliation(s)
- Sadra Mohaghegh
- Oral and Maxillofacial Surgery Department, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran 1983963113, Iran
| | - Helia Sadat Haeri Boroojeni
- Oral and Maxillofacial Surgery Department, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran 1983963113, Iran
| | - Hanieh Nokhbatolfoghahaei
- Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Khojasteh
- Oral and Maxillofacial Surgery Department, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran 1983963113, Iran.
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3
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Blume O, Back M, Dinya E, Palkovics D, Windisch P. Efficacy and volume stability of a customized allogeneic bone block for the reconstruction of advanced alveolar ridge deficiencies at the anterior maxillary region: a retrospective radiographic evaluation. Clin Oral Investig 2023:10.1007/s00784-023-05015-0. [PMID: 37055540 DOI: 10.1007/s00784-023-05015-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/02/2023] [Indexed: 04/15/2023]
Abstract
OBJECTIVES The aim of this retrospective case series was to evaluate the efficacy and volume stability of a customized allogeneic bone block (CABB) for the hard tissue reconstruction of severely atrophied anterior maxillary ridges. MATERIALS AND METHODS Hard tissue alterations between baseline (T1), 2-month follow-up (T2), and 6-month follow-up (T3) cone-beam computed tomography scans were evaluated with semi-automatic segmentation. Following automatic spatial alignment of the datasets, 3D subtraction analysis was performed. The volume stability of the inserted allogeneic bone block was determined on the basis of the ratio of the T3 and T2 hard tissue volumes. RESULTS The newly formed hard tissue volume at T2 averaged at of 0.75 cm3 ± 0.57 cm3, whereas at T3, an average of 0.52 cm3 ± 0.42 cm3 volumetric hard tissue gain could be detected. The T3/T2 ratio was found to be 67.83% ± 18.72% on average. The dice similarity coefficient between the T2 and T3 hard tissue models averaged at 0.73 ± 0.15. CONCLUSIONS Cancellous CABBs are a reliable option for the reconstruction of severely atrophied alveolar ridges. The resorption rates of these grafts are similar to those found in the literature; however, with precise manufacturing and proper intraoperative flap management, the resorption rates may be reduced. CLINICAL RELEVANCE With precise knowledge of the resorption patterns, the shape of blocks can be altered in the future to compensate for the volumetric loss.
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Affiliation(s)
- Oliver Blume
- Private Practice Dres. Back & Blume, Tal 13, 80331, Munich, Germany
| | - Michael Back
- Private Practice Dres. Back & Blume, Tal 13, 80331, Munich, Germany
| | - Elek Dinya
- Institute of Digital Health Sciences, Faculty of Public Services, Semmelweis University, Ferenc sqr. 15, Budapest, 1094, Hungary
| | - Daniel Palkovics
- Department of Periodontology, Semmelweis University, Szentkirályi str. 47, Budapest, 1088, Hungary.
| | - Peter Windisch
- Department of Periodontology, Semmelweis University, Szentkirályi str. 47, Budapest, 1088, Hungary
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Mangano C, Luongo G, Luongo F, Lerner H, Margiani B, Admakin O, Mangano F. Custom-made computer-aided-design/ computer-assisted-manufacturing (CAD/CAM) synthetic bone grafts for alveolar ridge augmentation: A retrospective clinical study with 3 years of follow-up. J Dent 2022; 127:104323. [PMID: 36241044 DOI: 10.1016/j.jdent.2022.104323] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/22/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To report on the results obtained with computer-aided-design/ computer-assisted-manufacturing (CAD/CAM) custom-made synthetic hydroxyapatite/beta-tricalcium-phosphate (HA/beta-TCP) bone grafts in alveolar ridge augmentation for dental implant placement. METHODS The procedure included: (1) cone-beam computed tomography (CBCT) of the bone defect; (2) virtual design of the custom-made onlay bone grafts; (3) milling of grafts from a pre-formed block of synthetic HA/beta-TCP; and (4) bone reconstructive surgery. Implants were placed 8 months later. The patients were followed for 3 years. The study outcomes were: (1) intra- and immediate post-operative complications; (2) 8-month vertical and horizontal bone gain; (3) implant survival; (4) implant-crown success; and (5) peri-implant marginal bone loss (MBL). RESULTS Twenty-six patients underwent ridge augmentation with custom-made CAD/CAM HA/beta-TCP onlay grafts. Eight months later, these patients were rehabilitated with dental implants. During surgery, 25/26 (96.1%) of the grafts adapted well to the bone defect. Immediate post-operative complications were pain and swelling (2/26 patients: 7.6%), and bone graft exposure (3/26: 11.5%); one exposure led to infection, removal of the graft, and failure of the procedure. Excellent integration of the other grafts was observed 8 months after the regenerative procedure, with mean vertical and horizontal bone gains of 2.10 mm (± 0.35) and 2.96 mm (± 0.45), respectively. Twenty-five implants were placed and restored with single crowns. Three years later, all implants were in function. The 3-year implant crown success rate and peri-implant MBL were 92.0% and 0.7 mm (±0.19), respectively. CONCLUSIONS With custom-made CAD/CAM synthetic HA/beta-TCP onlay grafts reconstruction of small vertical and/or horizontal defects of the alveolar ridge was obtained; this enabled implant placement, with high implant-crown success rate after 3 years. Further studies are needed to validate this technique. STATEMENT OF CLINICAL RELEVANCE Custom-made CAD/CAM synthetic HA/beta-TCP onlay grafts may represent an option for regeneration of small bone defects prior to implant placement.
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Affiliation(s)
| | | | | | - Henriette Lerner
- Academic Teaching and Research Institution of Johann Wolfgang Goethe University, Frankfurt, Germany.
| | - Bidzina Margiani
- Department of Department of Pediatric, Preventive Dentistry and Orthodontics, Sechenov First State Medical University, Moscow, Russia.
| | - Oleg Admakin
- Department of Department of Pediatric, Preventive Dentistry and Orthodontics, Sechenov First State Medical University, Moscow, Russia.
| | - Francesco Mangano
- Department of Department of Pediatric, Preventive Dentistry and Orthodontics, Sechenov First State Medical University, Moscow, Russia.
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5
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The use of 3D ceramic block graft compared with autogenous block graft for rehabilitation of the atrophic maxilla: a randomized controlled clinical trial. Trials 2022; 23:903. [DOI: 10.1186/s13063-022-06843-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/14/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Dental implant placement may require a bone graft for vertical and horizontal alveolar ridge augmentation. Due to its osteoconduction, osteoinductive, and osteogenesis, autogenous bone graft characteristics are considered the standard gold treatment. However, autografts can promote postoperative morbidity and implicate difficulties concerning the graft adaptation to the recipient's bone since it can eventually avoid gaps. To overcome these issues, this trial will compare the performance of Plenum® Oss 3Dβ fit, an alloplastic graft, and a 3D-printed patient-specific graft based on β-tricalcium phosphate to the autograft procedure.
Methods
This is a split-mouth randomized clinical study designed to evaluate the performance of personalized (patient-specific) bioceramic bone grafts (Plenum® Oss 3Dβ fit) for bone augmentation of the atrophic anterior maxilla in comparison to the autogenous bone graft. We hypothesize that the gain and maintenance of the grafted area volume and the quality of the newly formed bone tissue after eight months postoperative with the synthetic patient-specific graft will be superior to the autogenous bone graft. To assess the quantity and the quality of bone neoformation, volumetric and histological analyses will be performed.
Discussion
The fabrication of medical devices by additive manufacturing presents advantages over conventional manufacturing processes, mostly related to the precision of geometry and anatomy. Additionally, the osteoconductive proprieties of β-tricalcium phosphate enable this synthetic bone substitute as an alternative solution over autogenous graft for bone defect reconstruction. Thus, patient-specific bone grafts can potentially improve patient satisfaction, reducing the need for autogenous bone grafts, consequently avoiding implications related to this type of treatment, such as patient morbidity.
Trial registration
This study is registered in REBEC (Registro Brasileiro de Ensaios Clínicos): RBR-76wmm3q; UTN: U1111-1272-7773. Registration date: 14 September 2021.
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Pfaffeneder-Mantai F, Meller O, Schneider B, Bloch J, Bytyqi D, Sutter W, Turhani D. Specially designed and CAD/CAM manufactured allogeneic bone blocks using for augmentation of a highly atrophic maxilla show a stable base for an all-on-six treatment concept: a case report. Maxillofac Plast Reconstr Surg 2022; 44:21. [PMID: 35608728 PMCID: PMC9130375 DOI: 10.1186/s40902-022-00351-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/16/2022] [Indexed: 11/27/2022] Open
Abstract
Background In terms of a highly atrophic maxilla, bone augmentation still remains very challenging. With the introduction of computer-aided design/computer-aided manufacturing (CAD/CAM) for allogeneic bone blocks, a new method for the treatment of bone deficiencies was created. This case report demonstrates the successful use of two specially designed and CAD/CAM manufactured allogeneic bone blocks for a full arch reconstruction of a highly atrophic maxilla with an all-on-six concept. Case presentation We report the case of a 55-year-old male patient with a highly atrophic maxilla and severe bone volume deficiencies in horizontal and vertical lines. In order to treat the defects, the surgeon decided to use a combination of two allogeneic bone blocks and two sinus floor augmentations. The bone blocks were fabricated from the data of a cone beam computed tomography (CBCT) using CAD/CAM technology. After the insertion of the two bone blocks and a healing period of 7 months, six dental implants were placed in terms of an all-on-six concept. The loading of the implants took place after an additional healing time of 7 months with a screw-retained prosthetic construction and with a milled titanium framework with acrylic veneers. Conclusion The presented procedure shows the importance of the precise design of CAD/CAM manufactured allogeneic bone blocks for the successful treatment of a highly atrophic maxilla. Proper soft-tissue management is one of the key factors to apply this method successfully.
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Affiliation(s)
- Florian Pfaffeneder-Mantai
- Center for Oral and Maxillofacial Surgery, Department of Dentistry, Faculty of Medicine and Dentistry, Danube Private University, Steiner Landstraße 124, 3500, Krems, Austria.,Division for Chemistry and Physics of Materials, Department of Medicine, Faculty of Medicine and Dentistry, Danube Private University, Steiner Landstraße 124, 3500, Krems, Austria
| | - Oliver Meller
- Center for Oral and Maxillofacial Surgery, Department of Dentistry, Faculty of Medicine and Dentistry, Danube Private University, Steiner Landstraße 124, 3500, Krems, Austria
| | - Benedikt Schneider
- Center for Oral and Maxillofacial Surgery, Department of Dentistry, Faculty of Medicine and Dentistry, Danube Private University, Steiner Landstraße 124, 3500, Krems, Austria
| | - Julius Bloch
- Center for Oral and Maxillofacial Surgery, Department of Dentistry, Faculty of Medicine and Dentistry, Danube Private University, Steiner Landstraße 124, 3500, Krems, Austria
| | - Ditjon Bytyqi
- Center for Oral and Maxillofacial Surgery, Department of Dentistry, Faculty of Medicine and Dentistry, Danube Private University, Steiner Landstraße 124, 3500, Krems, Austria
| | - Walter Sutter
- Center for Oral and Maxillofacial Surgery, Department of Dentistry, Faculty of Medicine and Dentistry, Danube Private University, Steiner Landstraße 124, 3500, Krems, Austria
| | - Dritan Turhani
- Center for Oral and Maxillofacial Surgery, Department of Dentistry, Faculty of Medicine and Dentistry, Danube Private University, Steiner Landstraße 124, 3500, Krems, Austria.
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7
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Lizio G, Pellegrino G, Corinaldesi G, Ferri A, Marchetti C, Felice P. Guided Bone Regeneration using Titanium Mesh to Augment 3-dimensional alveolar defects prior to implant placement. A Pilot Study. Clin Oral Implants Res 2022; 33:607-621. [PMID: 35305283 PMCID: PMC9314996 DOI: 10.1111/clr.13922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/06/2022] [Accepted: 03/08/2022] [Indexed: 11/27/2022]
Abstract
Objectives To evaluate the outcomes of bone regeneration using a customized titanium mesh scaffold to cover a bone graft for reconstruction of complex defects of the jaws. Materials and Methods 19 large defects were digitally reconstructed using CT scans according to the prosthetic requirements. A titanium mesh scaffold was designed to cover the bone (autologous/bovine bone particulate) graft. At least 6 months after surgery, a new cone‐beam CT was taken. The pre‐ and postoperative CT datasets were then converted into three‐dimensional models and digitally aligned. The actual mesh position was compared to the virtual position to assess the reliability of the digital project. The reconstructed bone volumes (RBVs) were calculated according to the planned bone volumes (PBVs), outlining the areas under the mesh. These values were then correlated with the number of exposures, locations of atrophy, and virtually planned bone volume. Results The mean matching value between the planned position of the mesh and the actual one was 82 ± 13.4%. 52.3% (40% early and 60% late) exposures were observed, with 15.8% exhibiting infection. 26.3% resulted as failures. The amount of reconstructed bone volume (RBV) in respect to PBV was 65 ± 40.5%, including failures, and 88.2 ± 8.32% without considering the failures. The results of the exposure event were statistically significant (p = .006) in conditioning the bone volume regenerated. Conclusions This study obtained up to 88% of bone regeneration in 74% of the cases. The failures encountered (26%) should underline the operator's expertise relevance in conditioning the final result.
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Affiliation(s)
- Giuseppe Lizio
- Unit of Oral Surgery, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Italy
| | - Gerardo Pellegrino
- Unit of Oral Surgery, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Italy
| | - Giuseppe Corinaldesi
- Unit of Oral Surgery, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Italy
| | - Agnese Ferri
- Unit of Oral Surgery, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Italy
| | - Claudio Marchetti
- Unit of Maxillofacial Surgery, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Italy
| | - Pietro Felice
- Unit of Oral Surgery, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Italy
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8
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Blume O, Donkiewicz P, Palkovics D, Götz W, Windisch P. Volumetric Changes of a Customized Allogeneic Bone Block Measured by Two Image Matching Tools: Introduction of a Novel Assessment Technique for Graft Resorption. Acta Stomatol Croat 2022; 55:406-417. [PMID: 35001936 PMCID: PMC8734454 DOI: 10.15644/asc55/4/8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/04/2021] [Indexed: 12/13/2022] Open
Abstract
Objective The purpose of this case report was to present a method for the assessment of volumetric changes of bone blocks during healing and demonstrate its practicability by analysing the resorption of a pre-shaped allogeneic bone block used for the reconstruction of a complex maxillary defect. Materials and methods CBCT-scans of a 19-year-old male treated with an allogeneic bone block were recorded pre-OP, post-OP, and following six months of healing. Graft shrinkage was assessed via two image matching tools, namely coDiagnostiX® and Slicer. A biopsy specimen was harvested along the implant canal at the time of implantation. Results The osseous defect was successfully restored and advanced graft remodelling was found upon re-entry as confirmed by the histomorphometric and histologic analysis. The initial volumes of the graft determined via coDiagnostiX® and Slicer were 0.373 mL and 0.370 mL., respectively, while graft resorption after six months of healing was 0.011 mL (3.00%) and 0.016 mL (4.33%). Conclusions The avoidance of bone harvesting and reduction of invasiveness display an important issue in dentoalveolar restorations. However, before grafting materials can be considered a safe alternative, understanding their clinical performance, especially resorption stability, is pivotal. The present case report demonstrates a limited resorption of the allogeneic bone block and further emphasizes the practicability of determining bone resorption by the here introduced method. As our investigation comprises solely one subject, the results should be considered with care and substantiated by further studies.
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Affiliation(s)
- Oliver Blume
- Private Practice 'Dres. Back & Blume', Tal 13, 80331 Munich, Germany
| | - Phil Donkiewicz
- Department of Oral Surgery and Dental Emergency Care, Faculty of Health, School of Dentistry, Witten / Herdecke University, North RhineWestphalia, Germany
| | - Daniel Palkovics
- Department of Periodontology, Semmelweis University, Szentkirályi u. 47, 1088 Budapest, Hungary
| | - Werner Götz
- Department of Orthodontics, Laboratory for Basic Research in Oral Biology, University of Bonn, Germany
| | - Péter Windisch
- Department of Periodontology, Semmelweis University, Szentkirályi u. 47, 1088 Budapest, Hungary
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9
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Blume O, Back M, Martin K, Windisch P. A customized allogenic bone block for alveolar reconstruction quantitated by a 3D matching technique: A case report. Clin Case Rep 2021; 9:e04771. [PMID: 34532047 PMCID: PMC8435223 DOI: 10.1002/ccr3.4771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/17/2022] Open
Abstract
After initial resorption, the bone volume showed long-term stability following loading of the implant. Furthermore, 3D matching was a suitable quantification method to analyze the volume development of bone augmentation.
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Affiliation(s)
- Oliver Blume
- Private Practice (Dres. Back & Blume)MunichGermany
| | - Michael Back
- Private Practice (Dres. Back & Blume)MunichGermany
| | - Kim Martin
- Private Practice (Dres. Back & Blume)MunichGermany
| | - Péter Windisch
- Department of PeriodontologySemmelweis UniversityBudapestHungary
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10
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Ambrosio F, Azimi K, López-Torres A, Notice T, Khoshneviszadeh A, Neely A, Kinaia B. Custom allogeneic block graft for ridge augmentation: Case series. Clin Adv Periodontics 2021. [PMID: 34435754 DOI: 10.1002/cap.10183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/08/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Alveolar bone deficiency is a common postextraction sequela that adversely affects implant placement. Therefore, ridge augmentation is often required to obtain proper bone quantity and quality for restoratively driven implant placement. This case series describes the successful horizontal and vertical alveolar ridge augmentation using custom-fabricated allogeneic block bone grafts. CASE SERIES Two healthy partially edentulous patients presented to private practice seeking dental implant treatment. Initial clinical examination and cone-beam computed tomography (CBCT) radiographic analysis showed moderate to large horizontal ridge defects. Treatment options were discussed for alveolar ridge augmentation and the patients elected to undergo the custom allogeneic block graft procedure to regenerate the atrophied alveolar ridges. The CBCT scan in conjunction with computer-aided design/computer-aided manufacturing (CAD/CAM) technology was used to fabricate customized allogeneic block grafts based on alveolar ridge topography. The custom allogeneic block graft allowed less surgical time and decreased postoperative morbidity. The grafted area was allowed 6 months of healing time. Follow-up radiographs showed the stability of the graft followed by dental implant placement. The dental implants were functionally loaded, and successful implant esthetics and function achieved. CONCLUSION Custom allogeneic block grafts could provide a promising innovative method for optimal ridge augmentation. KEY POINTS Why are these cases new information? Less invasive procedure as an alternative conventional two-stage block augmentation. More predictable outcome due to customized block graft. What are the keys to successful management of these cases? It is important determining the type of bone defect. Vertical and horizontal bone loss. Primary closure. What are the primary limitations to success in these cases? Limited data from prospective clinical trials documenting the effectiveness of custom allogeneic block grafts. Limited data are available to confirm accuracy of the CAD/CAM process. Passive flap closure is needed.
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Affiliation(s)
| | - Khashayar Azimi
- Division of Graduate Periodontics, University of Detroit Mercy School of Dentistry, Detroit, Michigan, USA
| | - Andrea López-Torres
- Division of Graduate Periodontics, University of Detroit Mercy School of Dentistry, Detroit, Michigan, USA
| | - Tinisha Notice
- Division of Graduate Periodontics, University of Detroit Mercy School of Dentistry, Detroit, Michigan, USA
| | - Arash Khoshneviszadeh
- Division of Graduate Periodontics, University of Detroit Mercy School of Dentistry, Detroit, Michigan, USA
| | - Anthony Neely
- Division of Graduate Periodontics, University of Detroit Mercy School of Dentistry, Detroit, Michigan, USA.,Private practice, Southfield, Michigan, USA
| | - Bassam Kinaia
- Division of Graduate Periodontics, University of Detroit Mercy School of Dentistry, Detroit, Michigan, USA.,Private practice, Sterling Heights, Michigan, USA
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11
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Popov NV, Ippolitov AA, Trunin DA, Panin AM, Tsitsiashvili AM. [Experimental study of the bearing capacity of lyophilized allogeneic bone material]. STOMATOLOGII︠A︡ 2021; 100:7-11. [PMID: 33874653 DOI: 10.17116/stomat20211000217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
THE AIM OF THE STUDY Was to conduct an experimental study of the bearing capacity and determination of the Young's modulus of lyophilized allogeneic bone material. MATERIALS AND METHODS The study used 5 prototypes of lyophilized allogeneic bone blocks, which were alternately subjected to static loading by compressive force. The experimental values of Young's modulus of all bone samples were determined. When applying the Student's probability distribution in statistical processing of experimental data, the average indicators of the forces of destruction of the samples were obtained and Young's modulus was determined. RESULTS AND DISCUSSION As a result of the study, the indices of the maximum loading (6012H) and Young's modulus (147.2±0.228 MPa) of lyophilized allogeneic bone material were obtained. CONCLUSION The obtained Young's modulus of lyophilized allogeneic bone material is of great importance in scientific activity, providing the possibility of further investigation of the properties of lyophilized allogeneic bone tissue to form a preoperative forecast of the behavior of an osteoplastic material and a dental implant installed in it.
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Affiliation(s)
- N V Popov
- Samara State Medical University of the Ministry of Healthcare of the Russian Federation, Samara, Russia
| | - A A Ippolitov
- Samara State Medical University of the Ministry of Healthcare of the Russian Federation, Samara, Russia
| | - D A Trunin
- Samara State Medical University of the Ministry of Healthcare of the Russian Federation, Samara, Russia
| | - A M Panin
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - A M Tsitsiashvili
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
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12
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Oberdiek F, Vargas CI, Rider P, Batinic M, Görke O, Radenković M, Najman S, Baena JM, Jung O, Barbeck M. Ex Vivo and In Vivo Analyses of Novel 3D-Printed Bone Substitute Scaffolds Incorporating Biphasic Calcium Phosphate Granules for Bone Regeneration. Int J Mol Sci 2021; 22:3588. [PMID: 33808303 PMCID: PMC8037651 DOI: 10.3390/ijms22073588] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 12/12/2022] Open
Abstract
(1) Background: The aim of this study was examining the ex vivo and in vivo properties of a composite made from polycaprolactone (PCL) and biphasic calcium phosphate (BCP) (synprint, ScientiFY GmbH) fabricated via fused deposition modelling (FDM); (2) Methods: Scaffolds were tested ex vivo for their mechanical properties using porous and solid designs. Subcutaneous implantation model analyzed the biocompatibility of PCL + BCP and PCL scaffolds. Calvaria implantation model analyzed the osteoconductive properties of PCL and PCL + BCP scaffolds compared to BCP as control group. Established histological, histopathological and histomorphometrical methods were performed to evaluate new bone formation.; (3) Results Mechanical testing demonstrated no significant differences between PCL and PCL + BCP for both designs. Similar biocompatibility was observed subcutaneously for PCL and PCL + BCP scaffolds. In the calvaria model, new bone formation was observed for all groups with largest new bone formation in the BCP group, followed by the PCL + BCP group, and the PCL group. This finding was influenced by the initial volume of biomaterial implanted and remaining volume after 90 days. All materials showed osteoconductive properties and PCL + BCP tailored the tissue responses towards higher cellular biodegradability. Moreover, this material combination led to a reduced swelling in PCL + BCP; (4) Conclusions: Altogether, the results show that the newly developed composite is biocompatible and leads to successful osteoconductive bone regeneration. The new biomaterial combines the structural stability provided by PCL with bioactive characteristics of BCP-based BSM. 3D-printed BSM provides an integration behavior in accordance with the concept of guided bone regeneration (GBR) by directing new bone growth for proper function and restoration.
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Affiliation(s)
| | - Carlos Ivan Vargas
- Escuela Técnica Superior de Ingenieros Industriales, Universidad Politécnica de Madrid, Calle José Gutierrez Abascal, 2, 28006 Madrid, Spain
- REGEMAT 3D, Avenida del conocimiento 41, A-111, 18016 Granada, Spain;
| | | | - Milijana Batinic
- Research Department, BerlinAnalytix GmbH, 12109 Berlin, Germany;
- Department of Ceramic Materials, Chair of Advanced Ceramic Materials, Institute for Materials Science and Technologies, Technical University Berlin, 10623 Berlin, Germany;
| | - Oliver Görke
- Department of Ceramic Materials, Chair of Advanced Ceramic Materials, Institute for Materials Science and Technologies, Technical University Berlin, 10623 Berlin, Germany;
| | - Milena Radenković
- Scientific Research Center for Biomedicine, Department for Cell and Tissue Engineering, Faculty of Medicine, University of Niš, 18000 Niš, Serbia; (M.R.); (S.N.)
| | - Stevo Najman
- Scientific Research Center for Biomedicine, Department for Cell and Tissue Engineering, Faculty of Medicine, University of Niš, 18000 Niš, Serbia; (M.R.); (S.N.)
- Department of Biology and Human Genetics, Faculty of Medicine, University of Niš, 18000 Niš, Serbia
| | - Jose Manuel Baena
- REGEMAT 3D, Avenida del conocimiento 41, A-111, 18016 Granada, Spain;
| | - Ole Jung
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, 18057 Rostock, Germany;
| | - Mike Barbeck
- Department of Ceramic Materials, Chair of Advanced Ceramic Materials, Institute for Materials Science and Technologies, Technical University Berlin, 10623 Berlin, Germany;
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Tunkel J, de Stavola L, Kloss‐Brandstätter A. Alveolar ridge augmentation using the shell technique with allogeneic and autogenous bone plates in a split-mouth design-A retrospective case report from five patients. Clin Case Rep 2021; 9:947-959. [PMID: 33598278 PMCID: PMC7869406 DOI: 10.1002/ccr3.3626] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 12/29/2022] Open
Abstract
Atrophic alveolar ridges of five patients were augmented with allografts and autografts on opposite sites, followed by dental implantation. Both augmentation materials led to equivalent bone gains. Allografts did not compromise the clinical outcome.
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Affiliation(s)
- Jochen Tunkel
- private practice for oral surgeryBad OeynhausenGermany
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Li S, Zhang T, Zhou M, Zhang X, Gao Y, Cai X. A novel digital and visualized guided bone regeneration procedure and digital precise bone augmentation: A case series. Clin Implant Dent Relat Res 2020; 23:19-30. [PMID: 33079419 DOI: 10.1111/cid.12959] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/28/2020] [Accepted: 10/06/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Although the traditional bone augmentation technology can basically meet the clinical needs at present, the effect of bone augmentation in most cases is related to the experience of the operator. PROPOSE This study commits to providing a digital solution for precise bone augmentation in the field of oral implantology. MATERIALS AND METHODS After collecting the data of patients' intraoral scanning and DICOM (digital imaging and communications in medicine), the implant position is digitally designed, and the alveolar bone is digitally augmented around the ideal implant position. On the premise of ensuring that the thickness of labial bone is 2 mm, and there is sufficient alveolar bone 3 to 4 mm apically from the ideal gingival margin for implant placing, we carry out excessive augmentation of 0.5 and 1 mm on the labial bone and alveolar crest, respectively, to compensate for possible bone resorption after 6 months. After 3D printing the reconstructed alveolar bone model, the titanium mesh is trimmed and preformed on the alveolar bone model. Outcomes are reported in terms of mean values (5%-95% percentile values). RESULTS Thirty implant sites have accepted this novel virtually designed alveolar bone augmentation. Before the second-stage surgery, the average vertical bone gain was 2.48 mm (0.29-6.32), the average horizontal bone gain was 4.11 mm (1.19-8.74), the average height of the residual alveolar bone above the implant platform was 1.44 mm (0.59-2.92), the average thickness of the labial bone width at the implant platform was 2.00 mm (0.93-3.64), the average thickness of the labial bone width at 2 mm apically from the implant platform was 2.74 mm (1.40-5.46). The virtual augmentation of each tooth position was 349.41 mm3 (165.70-482.70), while the actual augmentation of each tooth position was 352.94 mm3 (159.24-501.78), the accuracy of the final actual augmentation reached 95.82% (range from 88.53% to 99.15%). CONCLUSION This case series suggests that a virtually digital guided bone regeneration (GBR) workflow is precise and controllable. The practicality, safety and effectiveness of this procedure needs to be compared to other bone augmentation procedures in randomized controlled trials.
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Affiliation(s)
- Songhang Li
- Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Tianxu Zhang
- Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Mi Zhou
- Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiaolin Zhang
- Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yang Gao
- Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiaoxiao Cai
- Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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15
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Integrated 3D Information for Custom-Made Bone Grafts: Focus on Biphasic Calcium Phosphate Bone Substitute Biomaterials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17144931. [PMID: 32650587 PMCID: PMC7399868 DOI: 10.3390/ijerph17144931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/02/2020] [Accepted: 07/05/2020] [Indexed: 12/24/2022]
Abstract
Purpose: Several studies showed that the sintering temperature of 1250 °C could affect the formation of α-Ca3(PO4)2, which is responsible for the reduction of the hardness value of biphasic calcium phosphate biocomposites, but they did not evaluate the inference of the sintering time at peak temperature on transition of β-Ca3(PO4)2 to α-Ca3(PO4)2. This analysis explored, in an innovative way, inferences and correlations between volumetric microstructure, mechanical properties, sintering temperature, and time at peak temperature in order to find the best sintering conditions for biphasic calcium phosphate composites grafted in severe alveolar bone defects. Methods: Sintered biphasic calcium phosphates (30%-hydroxyapatite/70%-tricalcium phosphate) were tested by microCT imaging for the 3D morphometric analysis, by compressive loading to find their mechanical parameters, and by X-ray diffraction to quantify the phases via Rietveld refinement for different sintering temperatures and times at the peak temperature. Data were analysed in terms of statistical inference using Pearson’s correlation coefficients. Results: All the studied scaffolds closely mimicked the alveolar organization of the jawbone, independently on the sintering temperatures and times; however, mechanical testing revealed that the group with peak temperature, which lasted for 2 hours at 1250 °C, showed the highest strength both at the ultimate point and at fracture point. Conclusion: The good mechanical performances of the group with peak temperature, which lasted for 2 hours at 1250 °C, is most likely due to the absence of the α-Ca3(PO4)2 phase, as revealed by X-ray diffraction. However, we detected its presence after sintering at the same peak temperature for longer times, showing the time-dependence, combined with the temperature-dependence, of the β-Ca3(PO4)2 to α-Ca3(PO4)2 transition.
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Pabst A, Ackermann M, Thiem D, Kämmerer P. Influence of Different Rehydration Protocols on Biomechanical Properties of Allogeneic Cortical Bone Plates: A Combined in-vitro/ in-vivo Study. J INVEST SURG 2020; 34:1158-1164. [PMID: 32441171 DOI: 10.1080/08941939.2020.1767735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: Allogeneic cortical bone plates (CP) are used for alveolar ridge augmentation. Since CP are freeze-dried and dehydrated during processing, the breaking strength (BS) and the flexibility (FX) are reduced, resulting in a relevant risk for plate fractures during insertion. The aim of this study was to evaluate the influence of rehydration time on the biomechanical properties (BS & FX) of CP in-vitro and in vivo.Material and Methods: 40 CP were randomly divided into four experimental groups. (A) untreated control (n = 10), rehydration for 10 (B), 30 (C) and 60 (D) minutes in 0.9% saline solution (n = 10 each). BS [Newton, N] and FX [mm] (force till fracture and distance of deflection to the breaking point) were analyzed. Besides, architectural features of all CP groups were visualized and examined by scanning electron microscopy (SEM). In addition, the frequency of CP fractures of rehydrated- vs. non-rehydrated CP was retrospectively analyzed in 6 patients.Results: Compared to the control group, significantly increased BS and FX were demonstrated after 10, 30 and 60 minutes of rehydration (p each ≤ 0.035). After a rehydration time of 10 minutes, no additional increase of BS and FX was seen when compared to30 and 60 minutes (p each = 1.0). SEM scans demonstrated that the CP fracture characteristics were influenced by the different rehydration protocols. The frequency of CP fractures was reduced in patients by CP rehydration.Conclusion: The biomechanical properties of CP can be significantly improved by 10 min of rehydration, resulting in an increased BS and FX, that might be clinically relevant.
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Affiliation(s)
- Andreas Pabst
- Department of Oral- and Maxillofacial Surgery, Federal Armed Forces Hospital, Koblenz, Germany
| | - Maximilian Ackermann
- Institute of Functional and Clinical Anatomy, University Medical Center, Mainz, Germany
| | - Daniel Thiem
- Department of Oral- and Maxillofacial Surgery, University Medical Center, Mainz, Germany
| | - Peer Kämmerer
- Department of Oral- and Maxillofacial Surgery, University Medical Center, Mainz, Germany
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17
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Kloss FR, Offermanns V, Donkiewicz P, Kloss‐Brandstätter A. Customized allogeneic bone grafts for maxillary horizontal augmentation: A 5-year follow-up radiographic and histologic evaluation. Clin Case Rep 2020; 8:886-893. [PMID: 32477540 PMCID: PMC7250966 DOI: 10.1002/ccr3.2777] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/20/2020] [Accepted: 02/06/2020] [Indexed: 12/14/2022] Open
Abstract
We report the histological evaluation of an individualized allogeneic bone block 5 years after alveolar ridge augmentation. The biopsy showed a well-vascularized lamellar bone with fatty incorporations without any avital allograft remnants. The presence of osteocytes, lining cells, macrophages, and blood vessels indicated a healthy and vital bone tissue.
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Affiliation(s)
| | - Vincent Offermanns
- Department of Cranio‐, Maxillofacial and Oral SurgeryMedical University InnsbruckInnsbruckAustria
| | - Phil Donkiewicz
- Department of Oral Surgery and Dental Emergency CareFaculty of HealthSchool of Dentistry Witten/Herdecke UniversityWittenNorth Rhine‐WestphaliaGermany
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18
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Malik R, Gupta A, Bansal P, Sharma R, Sharma S. Evaluation of Alveolar Ridge Height Gained by Vertical Ridge Augmentation Using Titanium Mesh and Novabone Putty in Posterior Mandible. J Maxillofac Oral Surg 2020; 19:32-39. [PMID: 31988560 DOI: 10.1007/s12663-019-01250-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 05/21/2019] [Indexed: 10/26/2022] Open
Abstract
Aim The purpose of this case series was to report the clinical and radiographical outcomes of vertical ridge augmentation in edentulous posterior mandible using a combination of titanium mesh with novabone putty. Material and Method Twenty patients were included, and grafting was done using alloplastic novabone putty supported by titanium mesh as the barrier for guided bone regeneration. Results Sixteen patients exhibited good soft tissue healing. Postoperative flap dehiscence occurred relatively early in the healing period in one patient followed by graft extrusion and delayed healing in other three patients. The mean vertical height of augmented bone was 4.825 ± 1.1387 mm. Conclusion This report demonstrates the remarkable efficacy of guided bone regeneration using a combination of titanium mesh and novabone putty for vertical ridge augmentation, thus expanding the indications for implant therapy and allowing recovery of the three-dimensional esthetic architecture in a severely resorbed alveolar ridge.
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Affiliation(s)
- Rahul Malik
- 1Department of Oral and Maxillofacial Surgery, Sudha Rustagi College of Dental Sciences and Research, Faridabad, India.,Gurgaon, India
| | - Ashish Gupta
- 1Department of Oral and Maxillofacial Surgery, Sudha Rustagi College of Dental Sciences and Research, Faridabad, India
| | - Pankaj Bansal
- 1Department of Oral and Maxillofacial Surgery, Sudha Rustagi College of Dental Sciences and Research, Faridabad, India
| | - Rahul Sharma
- 1Department of Oral and Maxillofacial Surgery, Sudha Rustagi College of Dental Sciences and Research, Faridabad, India
| | - Sneha Sharma
- 1Department of Oral and Maxillofacial Surgery, Sudha Rustagi College of Dental Sciences and Research, Faridabad, India
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Le Guéhennec L, Van Hede D, Plougonven E, Nolens G, Verlée B, De Pauw MC, Lambert F. In vitro and in vivo biocompatibility of calcium-phosphate scaffolds three-dimensional printed by stereolithography for bone regeneration. J Biomed Mater Res A 2019; 108:412-425. [PMID: 31654476 DOI: 10.1002/jbm.a.36823] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/08/2019] [Accepted: 10/11/2019] [Indexed: 12/11/2022]
Abstract
Stereolithography (SLA) is an interesting manufacturing technology to overcome limitations of commercially available particulated biomaterials dedicated to intra-oral bone regeneration applications. The purpose of this study was to evaluate the in vitro and in vivo biocompatibility and osteoinductive properties of two calcium-phosphate (CaP)-based scaffolds manufactured by SLA three-dimensional (3D) printing. Pellets and macro-porous scaffolds were manufactured in pure hydroxyapatite (HA) and in biphasic CaP (HA:60-TCP:40). Physico-chemical characterization was performed using micro X-ray fluorescence, scanning electron microscopy (SEM), optical interferometry, and microtomography (μCT) analyses. Osteoblast-like MG-63 cells were used to evaluate the biocompatibility of the pellets in vitro with MTS assay and the cell morphology and growth characterized by SEM and DAPI-actin staining showed similar early behavior. For in vivo biocompatibility, newly formed bone and biodegradability of the experimental scaffolds were evaluated in a subperiosteal cranial rat model using μCT and descriptive histology. The histological analysis has not indicated evidences of inflammation but highlighted close contacts between newly formed bone and the experimental biomaterials revealing an excellent scaffold osseointegration. This study emphasizes the relevance of SLA 3D printing of CaP-based biomaterials for intra-oral bone regeneration even if manufacturing accuracy has to be improved and further experiments using biomimetic scaffolds should be conducted.
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Affiliation(s)
- Laurent Le Guéhennec
- Department of Prosthetic Dentistry, Faculty of Dentistry, Nantes, France.,Department of Preclinical Biomedical Sciences, Mammalian Cell Culture Laboratory, GIGA-R, Faculty of Medicine, Liège, Belgium
| | - Dorien Van Hede
- Department of Periodontology and Oral Surgery, Faculty of Medicine, Liège, Belgium
| | - Erwan Plougonven
- Department of Chemical Engineering, Faculty of Applied Sciences, Liège, Belgium
| | - Grégory Nolens
- Department of Biomedical Sciences, Faculty of Medicine, Namur, Belgium
| | - Bruno Verlée
- Sirris, Additive Manufacturing Department, Seraing, Belgium
| | - Marie-Claire De Pauw
- Department of Preclinical Biomedical Sciences, Mammalian Cell Culture Laboratory, GIGA-R, Faculty of Medicine, Liège, Belgium
| | - France Lambert
- Department of Periodontology and Oral Surgery, Faculty of Medicine, Liège, Belgium
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Reconstruction of a Unilateral Alveolar Cleft Using a Customized Allogenic Bone Block and Subsequent Dental Implant Placement in an Adult Patient. J Oral Maxillofac Surg 2019; 77:2127.e1-2127.e11. [DOI: 10.1016/j.joms.2019.05.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 11/30/2022]
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21
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Gialain IO, Pinhata-Baptista OH, Cavalcanti MGP, Cortes ARG. Computer-Aided Design/Computer-Aided Manufacturing Milling of Allogeneic Blocks Following Three-Dimensional Maxillofacial Graft Planning. J Craniofac Surg 2019; 30:e413-e415. [PMID: 31299797 DOI: 10.1097/scs.0000000000005353] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Despite the advent of stereolithography in craniofacial surgery for creating surgical guides and custom synthetic scaffolds, little is known about the feasibility of computer-aided design/computer-aided manufacturing (CAD/CAM) milling of freeze-dried allogeneic bone blocks following previously designed volumetric graft plans. The aim of this technical report is to present a methodology for CAD/CAM milling to achieve the volume and shape of allogeneic bone blocks as estimated by using a virtual planning software. To perform the current methodology, an ex vivo simulation was performed. The milled allogeneic block presented satisfactory dimensional accuracy as compared with the respective three-dimensional virtual model.
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22
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Comparative Study between Laser Light Stereo-Lithography 3D-Printed and Traditionally Sintered Biphasic Calcium Phosphate Scaffolds by an Integrated Morphological, Morphometric and Mechanical Analysis. Int J Mol Sci 2019; 20:ijms20133118. [PMID: 31247936 PMCID: PMC6651383 DOI: 10.3390/ijms20133118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 06/24/2019] [Accepted: 06/24/2019] [Indexed: 01/05/2023] Open
Abstract
In dental districts, successful bone regeneration using biphasic calcium phosphate materials was recently explored. The present study aimed to perform a comparative study between 3D-printed scaffolds produced by laser light stereo-lithography (SLA) and traditionally sintered biphasic calcium phosphate scaffolds by an integrated morphological, morphometric and mechanical analysis. Methods: Biphasic calcium phosphate (30% HA/70% β-TCP) samples, produced by SLA-3D-printing or by traditional sintering methods, were tested. The experimental sequence included: (1) Microtomography (microCT) analyses, to serve as control-references for the 3D morphometric analysis; (2) loading tests in continuous mode, with compression up to fracture, to reconstruct their mechanical characteristics; and (3) microCT of the same samples after the loading tests, for the prediction of the morphometric changes induced by compressive loading of the selected materials. All the biomaterials were also studied by complementary scanning electron microscopy to evaluate fracture regions and surfaces. Results: The characterization of the 3D mineralized microarchitecture showed that the SLA-3D-printed biomaterials offer performances comparable to and in some cases better than the traditionally sintered ones, with higher mean thickness of struts and pores. Interestingly, the SLA-3D-printed samples had a higher ultimate strength than the sintered ones, with a smaller plastic region. Moreover, by SEM observation, it was observed that fractures in the SLA-3D-printed samples were localized in the structure nodes or on the external shells of the rods, while all the traditionally sintered samples revealed a ductile fracture surface. Conclusions: The reduction of the region of plastic deformation in the SLA-3D-printed samples with respect to traditionally sintered biomaterials is expected to positively influence, in vivo, the cell adhesion. Both microCT and SEM imaging revealed that the studied biomaterials exhibit a structure more similar to human jaw than the sintered biomaterials.
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Stoop CC, Chatzivasileiou K, Berkhout WER, Wismeijer D. Marginal and internal fit of 3D printed resin graft substitutes mimicking alveolar ridge augmentation: An in vitro pilot study. PLoS One 2019; 14:e0215092. [PMID: 30986268 PMCID: PMC6464328 DOI: 10.1371/journal.pone.0215092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 03/26/2019] [Indexed: 11/19/2022] Open
Abstract
Recent improvements in additive manufacturing technologies may facilitate the use of customized 3D printed grafts for horizontal and vertical augmentation of the atrophic alveolar ridge. The accurate fit of such grafts could reduce the clinical treatment time and contribute optimal bone regeneration. The aim of this in vitro study was to evaluate the marginal and internal fit of 3D printed resin grafts as they could be used for alveolar ridge augmentation. Alveolar ridge morphologic data were derived from the Cone Beam Computed Tomography (CBCT) scans of six patients with alveolar bone defects. These data were transferred to a segmentation program to produce virtual 3D reconstructions of the alveolar ridge models. Using a Computer Aided Design (CAD) program, the alveolar bone defects were defined and customized grafts were designed and both the defects as well as the grafts generated (CAM) as 3D projects. These projects were imported into a 3D printer and were manufactured in resin. Hereafter, the grafts were fitted to the defect sites of the corresponding models and new CBCT scans were performed. Based on these scans, measurements were made at the marginal and internal part of the fitted grafts to evaluate the marginal and internal fit, respectively. The statistical analysis revealed that the mean marginal fit was significantly better (P < 0.05) than the mean internal fit. The fit of the grafts was dependent on the shape and on the size of the grafts. Specifically, the total void surface between the fitted graft and the corresponding defect site was significantly larger in the large-defect grafts than the small-defect grafts (P < 0.05). Within the limitations of the study, it could be demonstrated that it is possible to fabricate 3D printed resin grafts with acceptable fit in customized shapes, when combining CBCT scans and computer aided design and 3D printing techniques.
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Affiliation(s)
- C. C. Stoop
- Department of Implant Dentistry and Prosthetic Dentistry, University of Amsterdam, ACTA, Amsterdam, The Netherlands
- * E-mail:
| | - K. Chatzivasileiou
- Department of Implant Dentistry and Prosthetic Dentistry, University of Amsterdam, ACTA, Amsterdam, The Netherlands
| | - W. E. R. Berkhout
- Department of Oral and Maxillofacial Radiology, University of Amsterdam, ACTA, Amsterdam, The Netherlands
| | - D. Wismeijer
- Department of Implant Dentistry and Prosthetic Dentistry, University of Amsterdam, ACTA, Amsterdam, The Netherlands
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Blume O, Donkiewicz P, Back M, Born T. Bilateral maxillary augmentation using CAD/CAM manufactured allogenic bone blocks for restoration of congenitally missing teeth: A case report. J ESTHET RESTOR DENT 2019; 31:171-178. [PMID: 30756449 DOI: 10.1111/jerd.12454] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/18/2018] [Accepted: 12/11/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Various biomaterials have been successfully applied in alveolar bone regeneration, however, the reconstruction of extensive osseous defects remains challenging and is often unfeasible with granular grafting materials. Several studies have outlined allogenic bone blocks as valid alternative to autologous block grafting. CLINICAL CONSIDERATIONS In this report, we demonstrate the regeneration of two large osseous defects in the maxilla with allogenic bone blocks made from human donor bone. The bone blocks were customized using the CAD/CAM technology in order to enable the insertion of four dental implants. CONCLUSIONS Both blocks perfectly matched the defect geometry, showed limited resorption, led to the formation of sufficient amounts of mineralized bone in both horizontal and vertical dimensions and enabled the installation of implants according to the treatment plan. The implementation of innovative technologies for individualization of allogenic bone blocks simplifies the restoration of complex and extensive osseous defects and poses great benefits for both practitioners and patients. CLINICAL SIGNIFICANCE The here presented procedure demonstrates the successful regeneration of two extensive osseous defects in a patient suffering from hypodontia using two CAD/CAM manufactured allogenic bone blocks, rendering the procedure far less invasive as compared to guided bone regeneration carried out with autologous transplants. Furthermore, to the best of our knowledge, this is the first case report that radiographically demonstrates the new formation of a cortical bone layer following block grafting with solely cancellous bone blocks.
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Affiliation(s)
| | - Phil Donkiewicz
- Department of Oral Surgery and Dental Emergency Care, Faculty of Health, School of Dentistry Witten/Herdecke University, North Rhine-Westphalia, Germany
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25
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Blume O, Back M, Born T, Smeets R, Jung O, Barbeck M. Treatment of a bilaterally severely resorbed posterior mandible due to early tooth loss by Guided Bone Regeneration using customized allogeneic bone blocks: A case report with 24 months follow-up data. J ESTHET RESTOR DENT 2018; 30:474-479. [PMID: 29920915 DOI: 10.1111/jerd.12388] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The use of allogeneic bone grafts for alveolar ridge reconstruction has become an often-discussed alternative to augmentation procedures using autografts. Nevertheless, there still is a lack of literature concerning long-time experiences of allografts for alveolar ridge reconstruction. Especially the results of the use of allogeneic bone blocks for mandible reconstructions need to be further investigated. CLINICAL CONSIDERATIONS In this case report, we present the use of customized allogenic bone blocks in Guided Bone Regeneration (GBR) procedures for severely deficient mandibulary bones, the implantation after a healing period of 5 month and the 24-month follow-up data. CONCLUSIONS Customized allogeneic bone blocks seem to be a successful alternative to augmentations with autologous bone blocks reconstructing highly resorbed mandibulary alveolar ridges, showing highest volume stability and no signs of bone resorption after implant loading. CLINICAL SIGNIFICANCE The application of customized allogeneic bone blocks has shown to be a successful augmentation technique even compared with with autologous bone blocks reconstructing highly resorbed mandibulary alveolar ridges demonstrating no compromises regarding clinical outcome, functionality and esthetics.
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Affiliation(s)
| | | | | | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, University Hospital Hamburg- Eppendorf, Hamburg, Germany
| | - Ole Jung
- Department of Oral and Maxillofacial Surgery, University Hospital Hamburg- Eppendorf, Hamburg, Germany
| | - Mike Barbeck
- Department of Oral and Maxillofacial Surgery, University Hospital Hamburg- Eppendorf, Hamburg, Germany
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Venet L, Perriat M, Mangano FG, Fortin T. Horizontal ridge reconstruction of the anterior maxilla using customized allogeneic bone blocks with a minimally invasive technique - a case series. BMC Oral Health 2017; 17:146. [PMID: 29216869 PMCID: PMC5721474 DOI: 10.1186/s12903-017-0423-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/12/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Different surgical procedures have been proposed to achieve horizontal ridge reconstruction of the anterior maxilla; all these procedures, however, require bone replacement materials to be adapted to the bone defect at the time of implantation, resulting in complex and time-consuming procedures. The purpose of this study was to describe how to use a 3D printed hardcopy model of the maxilla to prepare customized milled bone blocks, to be adapted on the bone defect areas using a minimally invasive subperiosteal tunneling technique. METHODS Cone beam computed tomography (CBCT) images of the atrophic maxilla of six patients were acquired and modified into 3D reconstruction models. Data were transferred to a 3D printer and solid models were fabricated using autoclavable nylon polyamide. Before the surgery, freeze-dried cortico-cancellous blocks were manually milled and adapted on the 3D printed hardcopy models of the maxillary bone, in order to obtain customized allogeneic bone blocks. RESULTS In total, eleven onlay customized allogeneic bone grafts were prepared and implanted in 6 patients, using a minimally invasive subperiosteal tunneling technique. The scaffolds closely matched the shape of the defects: this reduced the operation time and contributed to good healing. The patients did not demonstrate adverse events such as inflammation, dehiscence or flap re-opening during the recovery period; however, one patient experienced scaffold resorption, which was likely caused by uncontrolled motion of the removable provisional prosthesis. Following a 6 month healing period, CBCT was used to assess graft integration, which was followed by insertion of implants into the augmented areas. Prosthetic restorations were placed 4 months later. CONCLUSIONS These observations suggest that customized bone allografts can be successfully used for horizontal ridge reconstruction of the anterior maxilla: patients demonstrated reduced morbidity and decreased total surgery time. Further studies on a larger sample of patients, with histologic evaluation and longer follow-up are needed to confirm the present observations.
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Affiliation(s)
- Laurent Venet
- Department of oral surgery, Hospices Civils de Lyon, Lyon, France
| | - Michel Perriat
- Department of oral surgery, Hospices Civils de Lyon, Lyon, France
| | | | - Thomas Fortin
- Department of Oral Surgery, Dental School of Lyon, University Claude Bernard, Lyon 1, 6-8 rue Guillaume Paradin, 69007, Lyon, France. .,UJF-Grenoble 1 / CNRS / TIMC-IMAG UMR 5525, F-38041, Grenoble, France.
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Treatment of Severely Resorbed Maxilla Due to Peri-Implantitis by Guided Bone Regeneration Using a Customized Allogenic Bone Block: A Case Report. MATERIALS 2017; 10:ma10101213. [PMID: 29065477 PMCID: PMC5667019 DOI: 10.3390/ma10101213] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 10/18/2017] [Accepted: 10/19/2017] [Indexed: 11/17/2022]
Abstract
The objective of this case report is to introduce a customized CAD/CAM freeze-dried bone allograft (FDBA) block for its use in Guided Bone Regeneration (GBR) procedures for severely deficient maxillary bones. Additionally, a special newly developed remote incision technique is presented to avoid wound dehiscence. The results show optimal integration behavior of the FDBA block after six months and the formation of new vital bone. Thus, the results of the present case report confirm the use of the customized CAD/CAM bone block for augmentation of complex defects in the maxillary aesthetic zone as a successful treatment concept.
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Custom-milled individual allogeneic bone grafts for alveolar cleft osteoplasty-A technical note. J Craniomaxillofac Surg 2017; 45:1955-1961. [PMID: 29066039 DOI: 10.1016/j.jcms.2017.09.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 09/11/2017] [Accepted: 09/13/2017] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Bone grafts from the iliac crest are most commonly used for osteoplasties of the cleft alveolus. To preclude undue donoresite morbidity custom-milled allogeneic bone grafts might be an appropriate choice. MATERIAL AND METHODS This technical note showcases the repair of an alveolar cleft using an individualized allogeneic bone graft in a 36-year old female patient. She was asking for an alternative to the iliac crest bone grafting. Her alveolus was successfully build up by a custom-milled cancellous bone block allograft (maxgraft® 80 bonebuilder). RESULTS Custom-milled cancellous bone block allografts can greatly facilitate alveolar cleft repair and may present an effective treatment option under the premise that resorption resistance corresponds to autografts. CONCLUSION Further clinical studies are needed to explore the potential of bone block allografts for alveolar cleft osteoplasty.
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Luongo F, Mangano FG, Macchi A, Luongo G, Mangano C. Custom-Made Synthetic Scaffolds for Bone Reconstruction: A Retrospective, Multicenter Clinical Study on 15 Patients. BIOMED RESEARCH INTERNATIONAL 2016; 2016:5862586. [PMID: 28070512 PMCID: PMC5192311 DOI: 10.1155/2016/5862586] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/23/2016] [Indexed: 02/07/2023]
Abstract
Purpose. To present a computer-assisted-design/computer-assisted-manufacturing (CAD/CAM) technique for the design, fabrication, and clinical application of custom-made synthetic scaffolds, for alveolar ridge augmentation. Methods. The CAD/CAM procedure consisted of (1) virtual planning/design of the custom-made scaffold; (2) milling of the scaffold into the exact size/shape from a preformed synthetic bone block; (3) reconstructive surgery. The main clinical/radiographic outcomes were vertical/horizontal bone gain, any biological complication, and implant survival. Results. Fifteen patients were selected who had been treated with a custom-made synthetic scaffold for ridge augmentation. The scaffolds closely matched the shape of the defects: this reduced the operation time and contributed to good healing. A few patients experienced biological complications, such as pain/swelling (2/15: 13.3%) and exposure of the scaffold (3/15: 20.0%); one of these had infection and complete graft loss. In all other patients, 8 months after reconstruction, a well-integrated newly formed bone was clinically available, and the radiographic evaluation revealed a mean vertical and horizontal bone gain of 2.1 ± 0.9 mm and 3.0 ± 1.0 mm, respectively. Fourteen implants were placed and restored with single crowns. The implant survival rate was 100%. Conclusions. Although positive outcomes have been found with custom-made synthetic scaffolds in alveolar ridge augmentation, further studies are needed to validate this technique.
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Affiliation(s)
| | - Francesco Guido Mangano
- Department of Surgical and Morphological Science, Dental School, Insubria University, 21100 Varese, Italy
| | - Aldo Macchi
- Department of Surgical and Morphological Science, Dental School, Insubria University, 21100 Varese, Italy
| | - Giuseppe Luongo
- Department of Oral and Maxillofacial Surgery, Federico II University, 80131 Naples, Italy
| | - Carlo Mangano
- Department of Dental Sciences, Vita Salute San Raffaele University, 20132 Milan, Italy
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Custom-Made Computer-Aided-Design/Computer-Aided-Manufacturing Biphasic Calcium-Phosphate Scaffold for Augmentation of an Atrophic Mandibular Anterior Ridge. Case Rep Dent 2015; 2015:941265. [PMID: 26064701 PMCID: PMC4442008 DOI: 10.1155/2015/941265] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 04/21/2015] [Indexed: 12/20/2022] Open
Abstract
This report documents the clinical, radiographic, and histologic outcome of a custom-made computer-aided-design/computer-aided-manufactured (CAD/CAM) scaffold used for the alveolar ridge augmentation of a severely atrophic anterior mandible. Computed tomographic (CT) images of an atrophic anterior mandible were acquired and modified into a 3-dimensional (3D) reconstruction model; this was transferred to a CAD program, where a custom-made scaffold was designed. CAM software generated a set of tool-paths for the manufacture of the scaffold on a computer-numerical-control milling machine into the exact shape of the 3D design. A custom-made scaffold was milled from a synthetic micromacroporous biphasic calcium phosphate (BCP) block. The scaffold closely matched the shape of the defect: this helped to reduce the time for the surgery and contributed to good healing. One year later, newly formed and well-integrated bone was clinically available, and two implants (AnyRidge, MegaGen, Gyeongbuk, South Korea) were placed. The histologic samples retrieved from the implant sites revealed compact mature bone undergoing remodelling, marrow spaces, and newly formed trabecular bone surrounded by residual BCP particles. This study demonstrates that custom-made scaffolds can be fabricated by combining CT scans and CAD/CAM techniques. Further studies on a larger sample of patients are needed to confirm these results.
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