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Park DH, Jun JH, Yun SH, Choi BS, Fiorellini JP, Tallarico M, Hwang KG, Park CJ. Semi-customized three-dimensional ultra-fine titanium meshes in guided bone regeneration for implant therapy in severe alveolar bone defect: a case report. Int J Implant Dent 2024; 10:17. [PMID: 38551730 PMCID: PMC10980665 DOI: 10.1186/s40729-024-00535-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/18/2024] [Indexed: 04/01/2024] Open
Abstract
This case report provides a detailed description of a simple and fast bone regeneration procedure using a semi-customized three-dimensional ultra-fine titanium mesh. A 50-year-old male with a severe vertical and horizontal bone defect in the anterior mandible underwent implant treatment in a staged approach. The autologous bone was combined with a xenograft, and the mixture was grafted to augment the bone defect and covered with semi-customized ultra-fine titanium meshes, which were selected among its various types according to size and configuration of the bone defect, directly connected and immobilized on the tenting screws with minimal shaping. In a postoperative 6 months re-entry surgery, the performed titanium meshes were removed, implants were placed, and a bone core biopsy was obtained that demonstrated satisfactory new bone formation. Finally, two months later, the definitive prosthesis was installed. This semi-customized ultra-fine titanium mesh could help an implant clinician obtain more predictable results in the guided bone regeneration (GBR).
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Affiliation(s)
- Dae-Ho Park
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Jong-Hun Jun
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Seo-Hyoung Yun
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Baek-Sun Choi
- Tissue Regeneration Institute, Osstem Implant Co. Ltd., Seoul, Republic of Korea
| | - Joseph P Fiorellini
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marco Tallarico
- Department of Medicine, Surgery, and Pharmacy, University of Sassari, Sassari, Italy
| | - Kyung-Gyun Hwang
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Chang-Joo Park
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
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Wang Y, Zhang X, Zhang S, Yang G, Li Y, Mao Y, Yang L, Chen J, Wang J. Development of a rapid-shaping and user-friendly membrane with long-lasting space maintenance for guided bone regeneration. J Mater Chem B 2024; 12:1495-1511. [PMID: 38223916 DOI: 10.1039/d3tb02137h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
The success of guided bone regeneration (GBR) surgery depends largely on the use of GBR membranes to maintain space for bone regeneration and prevent soft tissue ingrowth. However, currently available commercial degradable GBR membranes are often limited by poor space maintenance ability and require additional suture or nail for fixation. To overcome these limitations, we developed a rapid-shaping, adhesive, and user-friendly GBR membrane (PLGA film-PGN) with long-lasting space maintenance by immersing an electrospun poly(lactide-co-glycolic acid) film in a photo-crosslinkable hydrogel composed of polyethylene glycol diacrylate, gelatin methacryloyl, and nanosilicate (PGN). The PGN hydrogel significantly improved the mechanical strength of the PLGA film-PGN and endowed it with plasticity and adhesive properties, making it more maneuverable. The maximum bending force that the PLGA film-PGN could withstand was over 55 times higher than that of the HEAL ALL film (a commonly used commercial GBR membrane). PLGA film-PGN also promoted the proliferation and osteogenic differentiation of rBMSCs. According to a critical-size rat calvarial defect model, PLGA film-PGN maintained the space within the defect area and significantly enhanced bone formation 4 weeks after the surgery. To conclude, the study provided a novel perspective on GBR membrane design and the multifunctional PLGA film-PGN membrane demonstrated great potential for bone defect reconstruction.
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Affiliation(s)
- Yuting Wang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
| | - Xin Zhang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
| | - Shu Zhang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
| | - Guangmei Yang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
| | - Yuanyuan Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
| | - Yilin Mao
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
| | - Linxin Yang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
| | - Junyu Chen
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
| | - Jian Wang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
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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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Bokobza A, Nicot R, Raoul G, Afota F, Choukroun J, Savoldelli C. Management of postoperative outcomes of polytetrafluoroethylene membranes in alveolar ridge reconstruction: a systematic review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101641. [PMID: 37739223 DOI: 10.1016/j.jormas.2023.101641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 09/24/2023]
Abstract
Guided bone regeneration (GBR) is a validated technique with satisfactory outcomes during 30 years of follow-up. The use of polytetrafluoroethylene (PTFE) membrane for vertical augmentation has been studied extensively. However, studies have reported exposure rates of up to 31%, there is no consensus on the management of postoperative exposure. The objective of this study was to propose a management approach for postoperative exposure of polytetrafluoroethylene (PTFE) membranes in alveolar ridge reconstruction. MATERIAL AND METHOD An electronic search in PubMed Central's and additional electronic databases was performed. The search strategy was limited to human studies, full-text English or French articles published from 1990 until april 2023. The extracted data included defect location, membrane type, biomaterials, time to postoperative exposure, and Fontana classification stage. Protocol bias assessment was performed using an adaptation of the QUADAS-2 tool. This review has been registered on PROSPERO (ID: CRD42023445497). RESULTS A total of 43 articles were found to be eligible, and 11 of these met the predefined inclusion and exclusion criteria. Based on the results of this systematic review, an algorithm for the management of PTFE membrane exposure is proposed. CONCLUSION Postoperative membrane exposure is not a determining factor for the success of bone grafting. In cases with postoperative complications, the majority of cases still achieved adequate implant-prosthetic rehabilitation. Lastly, this series of 11 articles was insufficient to draw conclusions regarding good practice recommendations. A larger series is required to validate the specific management approaches.
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Affiliation(s)
- Allan Bokobza
- Univ. Lille, CHU Lille, Department of Oral and Maxillofacial Surgery, F-59000 Lille, France.
| | - Romain Nicot
- Univ. Lille, CHU Lille, Inserm, Department of Oral and Maxillofacial Surgery, U1008 - Advanced Drug Delivery Systems, F-59000 Lille, France
| | - Gwénaël Raoul
- Univ. Lille, CHU Lille, Inserm, Department of Oral and Maxillofacial Surgery, U1008 - Advanced Drug Delivery Systems, F-59000 Lille, France
| | - Franck Afota
- Head and Neck Institute, University Hospital of Nice, 31 avenue de Valombrose, 06100 Nice, France
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Nassar HI, Fateen A. Accuracy of fit for cobaltchromium bar over two implants fabricated with different manufacturing techniques: an in-vitro study. BMC Oral Health 2023; 23:946. [PMID: 38031111 PMCID: PMC10688085 DOI: 10.1186/s12903-023-03700-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 11/22/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE The purpose of the invitro research was to compare the fit of Cobalt Chromium customized bar fabricated with different manufacturing processes cast metal bar, milled bar and 3D printed bar using scanning electron microscope. MATERIALS AND METHODS Clear epoxy resin molds were prepared. In each mold two parallel implants with a 14 mm distance from each other were embedded. Thirty Co-Cr custom bars were constructed and were divided equally into three groups: Group (I) (Co-Cr conv), group (II) milled bar (Co-Cr milled), and group (III) printed bar (Co-Cr print). The marginal fit at implant-abutment interface was scanned using scanning electron microscope (SEM). RESULTS There was a significant difference between the three studied groups regarding marginal misfit the between implant and fabricated bars with p-value < 0.001. The highest value of micro-gap distance was found in Co-Cr conventional group (7.95 ± 2.21 μm) followed by Co-Cr 3D printed group (4.98 ± 1.73) and the lower value were found in Co-Cr milled (3.22 ± 0.75). CONCLUSION The marginal fit of milled, 3D printed and conventional cast for Co-Cr alloy were within the clinically acceptable range of misfit. CAD/CAM milled Co-Cr bar revealed a superior internal fit at the implant-abutment interface. This was followed by selective laser melting (SLM) 3D printed bar and the least fit was shown for customized bar with the conventional lost wax technique.
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Affiliation(s)
- Hossam I Nassar
- Faculty of Oral and Dental Medicine, Future University in Egypt, Cairo, Egypt.
| | - Ayman Fateen
- Faculty of Oral and Dental Medicine, Future University in Egypt, Cairo, Egypt
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Ivanovski S, Breik O, Carluccio D, Alayan J, Staples R, Vaquette C. 3D printing for bone regeneration: challenges and opportunities for achieving predictability. Periodontol 2000 2023; 93:358-384. [PMID: 37823472 DOI: 10.1111/prd.12525] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/18/2023] [Accepted: 08/26/2023] [Indexed: 10/13/2023]
Abstract
3D printing offers attractive opportunities for large-volume bone regeneration in the oro-dental and craniofacial regions. This is enabled by the development of CAD-CAM technologies that support the design and manufacturing of anatomically accurate meshes and scaffolds. This review describes the main 3D-printing technologies utilized for the fabrication of these patient-matched devices, and reports on their pre-clinical and clinical performance including the occurrence of complications for vertical bone augmentation and craniofacial applications. Furthermore, the regulatory pathway for approval of these devices is discussed, highlighting the main hurdles and obstacles. Finally, the review elaborates on a variety of strategies for increasing bone regeneration capacity and explores the future of 4D bioprinting and biodegradable metal 3D printing.
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Affiliation(s)
- Saso Ivanovski
- School of Dentistry, Centre for Orofacial Regeneration, Reconstruction and Rehabilitation (COR3), The University of Queensland, Queensland, Herston, Australia
| | - Omar Breik
- Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Danilo Carluccio
- Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Jamil Alayan
- School of Dentistry, Centre for Orofacial Regeneration, Reconstruction and Rehabilitation (COR3), The University of Queensland, Queensland, Herston, Australia
| | - Ruben Staples
- School of Dentistry, Centre for Orofacial Regeneration, Reconstruction and Rehabilitation (COR3), The University of Queensland, Queensland, Herston, Australia
| | - Cedryck Vaquette
- School of Dentistry, Centre for Orofacial Regeneration, Reconstruction and Rehabilitation (COR3), The University of Queensland, Queensland, Herston, Australia
- Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
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Kämmerer PW, Al-Nawas B. Bone reconstruction of extensive maxillomandibular defects in adults. Periodontol 2000 2023; 93:340-357. [PMID: 37650475 DOI: 10.1111/prd.12499] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/21/2023] [Accepted: 05/26/2023] [Indexed: 09/01/2023]
Abstract
Reconstruction of significant maxillomandibular defects is a challenge that has been much discussed over the last few decades. Fundamental principles were developed decades ago (bone bed viability, graft immobilization). Clinical decision-making criteria are highly relevant, including local/systemic factors and incision designs, the choice of material, grafting technique, and donor site morbidity. Stabilizing particulated grafts for defined defects-that is, via meshes or shells-might allow significant horizontal and vertical augmentation; the alternatives are onlay and inlay techniques. More significant defects might require extra orally harvested autologous bone blocks. The anterior iliac crest is often used for nonvascularized augmentation, whereas more extensive defects often require microvascular reconstruction. In those cases, the free fibula flap has become the standard of care. The development of alternatives is still ongoing (i.e., alloplastic reconstruction, zygomatic implants, obturators, distraction osteogenesis). Especially for these complex procedures, three-dimensional planning tools enable facilitated planning and a surgical workflow.
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Affiliation(s)
- Peer W Kämmerer
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Mainz, Germany
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Mainz, Germany
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Kan D, He X, Liu B, Yang C, Zou Y. Full-thickness skin regeneration beneath the exposed titanium mesh in cranioplasty: Two cases report. Medicine (Baltimore) 2023; 102:e34821. [PMID: 37603526 PMCID: PMC10443770 DOI: 10.1097/md.0000000000034821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/28/2023] [Indexed: 08/23/2023] Open
Abstract
RATIONALE Titanium mesh is one of the most widely used implant materials applied in cranioplasty; however, it has been reported to encounter the risk of progressive scalp thinning and implant exposure over time. Here we present 2 cases of exposed titanium mesh (TM) and unusual phenomena of full-thickness skin regeneration beneath the mesh. PATIENT CONCERNS Two patients, 1 with an 8-year and 1 with a 2-year history of implant exposure after cranial TM implantation. DIAGNOSES The patients were diagnosed with scalp ulcers and cranial TM exposure. INTERVENTION The exposed part of the implant was removed, and the full-thickness skin beneath the mesh was directly used as functional soft tissue coverage to repair the scalp defect. OUTCOMES Full recovery for both patients with cosmetic satisfaction. LESSONS Though the exact mechanism of this epithelisation phenomenon beneath the TM remains to be elucidated, it provided a feasible choice for clinicians to reconstruct the scalp's integrity without exerting complicated procedures when dealing with similar cases.
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Affiliation(s)
- Daohong Kan
- Department of Burn and Plastic Surgery, The Second People’s Hospital of Yibin (The Yibin Hospital of West China Hospital, Sichuan University), Sichuan, China
| | - Xuefeng He
- Department of Burns and Wound Repair, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Bing Liu
- Department of Burn and Plastic Surgery, The Second People’s Hospital of Yibin (The Yibin Hospital of West China Hospital, Sichuan University), Sichuan, China
| | - Chaokun Yang
- Department of Cardio Thoracic Surgery, The Second People’s Hospital of Yibin (The Yibin Hospital of West China Hospital, Sichuan University), Sichuan, China
| | - Yong Zou
- Department of Burn and Plastic Surgery, The Second People’s Hospital of Yibin (The Yibin Hospital of West China Hospital, Sichuan University), Sichuan, China
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Shi X, Li X, Tian Y, Qu X, Zhai S, Liu Y, Jia W, Cui Y, Chu S. Physical, mechanical, and biological properties of collagen membranes for guided bone regeneration: a comparative in vitro study. BMC Oral Health 2023; 23:510. [PMID: 37481548 PMCID: PMC10362553 DOI: 10.1186/s12903-023-03223-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 07/11/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND To provide a reference for clinical selection of collagen membranes by analyzing the properties of three kinds of collagen membranes widely used in clinics: Bio-Gide membrane from porcine dermis (PD), Heal-All membrane from bovine dermis (BD), and Lyoplant membrane from bovine pericardium (BP). METHODS The barrier function of three kinds of collagen membranes were evaluated by testing the surface morphology, mechanical properties, hydrophilicity, and degradation rate of collagen membranes in collagenase and artificial saliva. In addition, the bioactivity of each collagen membrane as well as the proliferation and osteogenesis of MC3T3-E1 cells were evaluated. Mass spectrometry was also used to analyze the degradation products. RESULTS The BP membrane had the highest tensile strength and Young's modulus as well as the largest water contact angle. The PD membrane exhibited the highest elongation at break, the smallest water contact angle, and the lowest degradation weight loss. The BD membrane had the highest degradation weight loss, the highest number of proteins in its degradation product, the strongest effect on the proliferation of MC3T3-E1 cells, and the highest expression level of osteogenic genes. CONCLUSIONS The PD membrane is the best choice for shaping and maintenance time, while the BD membrane is good for osteogenesis, and the BP membrane is suitable for spatial maintenance. To meet the clinical requirements of guided bone regeneration, using two different kinds of collagen membranes concurrently to exert their respective advantages is an option worth considering.
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Affiliation(s)
- Xiaolu Shi
- Department of Implantology, Hospital of Stomatology, Jilin University, Changchun, China
| | - Xianjing Li
- Department of Implantology, Hospital of Stomatology, Jilin University, Changchun, China
| | - Ye Tian
- Department of Implantology, Hospital of Stomatology, Jilin University, Changchun, China
| | - Xinyao Qu
- Department of Drug Clinical Trial, the Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China
| | - Shaobo Zhai
- Department of Implantology, Hospital of Stomatology, Jilin University, Changchun, China
| | - Yang Liu
- Department of Implantology, Hospital of Stomatology, Jilin University, Changchun, China
| | - Wei Jia
- Yongchang Community Health Service Center of Chaoyang District, Changchun, China
| | - Yan Cui
- Department of Dermatology and Venereology, First Hospital of Jilin University, Jilin University, Changchun, China.
| | - Shunli Chu
- Department of Implantology, Hospital of Stomatology, Jilin University, Changchun, China.
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Scribante A, Ghizzoni M, Pellegrini M, Pulicari F, Manfredini M, Poli PP, Maiorana C, Spadari F. Full-Digital Customized Meshes in Guided Bone Regeneration Procedures: A Scoping Review. PROSTHESIS 2023; 5:480-495. [DOI: 10.3390/prosthesis5020033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Meshes, especially titanium ones, are being widely applied in oral surgery. In guided bone regeneration (GBR) procedures, their use is often paired with membranes, being resorbable or non-resorbable. However, they present some limitations, such as difficulty in the treatment of severe bone defects, alongside frequent mesh exposure. Customized meshes, produced by a full-digital process, have been recently introduced in GBR procedures. Therefore, the focus of the present review is to describe the main findings in recent years of clinical trials regarding patient-specific mesh produced by CAD/CAM and 3D printing workflow, made in titanium or even PEEK, applied to GBR surgeries. The purpose is to analyze their clinical management, advantages, and complications. This scoping review considered randomized clinical trials, observational studies, cohort studies, and case series/case reports studies. Studies that did not meet inclusion criteria were excluded. The preferred reporting items for scoping reviews (PRISMA-ScR) consensus was followed. A total of 15 studies were selected for this review. Based on the studies included, the literature suggests that meshes produced by a digital process are used to restore complex and severe bone defects. Moreover, they give satisfactory aesthetic results and fit the defects, counteracting grid exposure. However, more clinical trials should be conducted to evaluate long-term results, the rate of complications, and new materials for mesh manufacturing.
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Affiliation(s)
- Andrea Scribante
- Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Martina Ghizzoni
- Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Matteo Pellegrini
- Maxillofacial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
| | - Federica Pulicari
- Maxillofacial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
| | - Mattia Manfredini
- Maxillofacial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
| | - Pier Paolo Poli
- Maxillofacial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
| | - Carlo Maiorana
- Maxillofacial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
| | - Francesco Spadari
- Maxillofacial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
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De Angelis N, Amaroli A, Sabbieti MG, Cappelli A, Lagazzo A, Pasquale C, Barberis F, Agas D. Tackling Inequalities in Oral Health: Bone Augmentation in Dental Surgery through the 3D Printing of Poly(ε-caprolactone) Combined with 20% Tricalcium Phosphate. BIOLOGY 2023; 12:biology12040536. [PMID: 37106737 PMCID: PMC10135550 DOI: 10.3390/biology12040536] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/25/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023]
Abstract
The concept of personalized medicine and overcoming healthcare inequalities have become extremely popular in recent decades. Polymers can support cost reductions, the simplicity of customized printing processes, and possible future wide-scale expansion. Polymers with β-tricalcium phosphate (TCP) are well known for their synergy with oral tissues and their ability to induce osteoconductivity. However, poor information exists concerning their properties after the printing process and whether they can maintain an unaffected biological role. Poly(ε-caprolactone) (PCL) polymer and PCL compounded with TCP 20% composite were printed with a Prusa Mini-LCD-®3D printer. Samples were sterilised by immersion in a 2% peracetic acid solution. Sample analyses were performed using infrared-spectroscopy and statical mechanical tests. Biocompatibility tests, such as cell adhesion on the substrate, evaluations of the metabolic activity of viable cells on substrates, and F-actin labelling, followed by FilaQuant-Software were performed using a MC3T3-E1 pre-osteoblasts line. PCL+β-TCP-20% composite is satisfactory for commercial 3D printing and appears suitable to sustain an ISO14937:200937 sterilization procedure. In addition, the proper actin cytoskeleton rearrangement clearly shows their biocompatibility as well as their ability to favour osteoblast adhesion, which is a pivotal condition for cell proliferation and differentiation.
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Affiliation(s)
- Nicola De Angelis
- Department of Surgical and Diagnostic Sciences (DISC), University of Genoa, 16132 Genoa, Italy
- Department of Civil, Chemical and Environmental Engineering (DICCA), University of Genoa, 16100 Genoa, Italy
- Faculty of Dentistry Department of Periodontology, Trisakti University, Jakarta 11440, Indonesia
| | - Andrea Amaroli
- Department of Earth, Environmental and Life Sciences (DISTAV) University of Genoa, 16132 Genoa, Italy
| | - Maria Giovanna Sabbieti
- School of Biosciences and Veterinary Medicine, University of Camerino, 62032 Camerino (MC), Italy
| | - Alessia Cappelli
- School of Biosciences and Veterinary Medicine, University of Camerino, 62032 Camerino (MC), Italy
| | - Alberto Lagazzo
- Department of Civil, Chemical and Environmental Engineering (DICCA), University of Genoa, 16100 Genoa, Italy
| | - Claudio Pasquale
- Department of Surgical and Diagnostic Sciences (DISC), University of Genoa, 16132 Genoa, Italy
- Department of Civil, Chemical and Environmental Engineering (DICCA), University of Genoa, 16100 Genoa, Italy
| | - Fabrizio Barberis
- Department of Civil, Chemical and Environmental Engineering (DICCA), University of Genoa, 16100 Genoa, Italy
| | - Dimitrios Agas
- School of Biosciences and Veterinary Medicine, University of Camerino, 62032 Camerino (MC), Italy
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12
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De Angelis N, Kassim ZH, Mohd Yusof E, Yumang C, Menini M. Bone Augmentation Techniques with Customized Titanium Meshes: A Systematic Review of Randomized Clinical Trials. Open Dent J 2023. [DOI: 10.2174/18742106-v17-230228-2022-172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
Background:
A correct tridimensional implant placement requires a sufficient amount of bone to completely satisfy the prosthetic reconstruction. Several techniques can be used to recreate the bone quantity. Among them, titanium meshes have shown great potential in space maintenance and fewer complications in case of exposure. Recently, 3D CAD, CAM technology, and specifically SLM have been used to produce customized meshes in titanium alloy. The aim Purpose of this systematic review is to evaluate new customized meshes compared to traditional ones in terms of new volume of generated bone and the incidence of complications.
Materials and Methods:
A MEDLINE/PubMed literature search was performed to find relevant randomized controlled clinical trials published in English up to and including December 2022. The Cochrane Database of Systematic Reviews and SCOPUS were also searched. The main keywords used in the search were: titanium meshe(s), customized titanium meshe(s), combined with AND/OR as Boolean operators, and bone augmentation with/and/or titanium mesh.
Results:
The electronic search identified 1002 papers in total, and after duplicate removal, 500 articles were screened. After a manual screening of the title and abstract, 488 studies were excluded, and 12 articles' full text of 12 articles was analyzed. Further analysis was performed to make sure that the articles matched the inclusion/exclusion criteria of the present review. Six additional articles were excluded in this phase. No meta-analysis was performed due to the heterogeneity of the data.
Conclusion:
By using traditional or customized devices with the newly generated bone volume allowed the implant placement in all cases. Complications were mainly reported as exposure during the healing phase, but the conclusions of whether customized or conventional systems perform one better than the other are still inconclusive.
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13
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Sehgal V, Ruangsawasdi N, Kiattavorncharoen S, Bencharit S, Thanasrisuebwong P. Occlusive and Proliferative Properties of Different Collagen Membranes-An In Vitro Study. MATERIALS (BASEL, SWITZERLAND) 2023; 16:1657. [PMID: 36837285 PMCID: PMC9964610 DOI: 10.3390/ma16041657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
Different collagen barrier membranes come in various sources and crosslinking that may affect barrier function and tissue integration. This study investigated barrier function and tissue integration of the three different collagen membranes (Jason®: porcine pericardium, GENOSS: bovine tendon, and BioMend® Extend: cross-linked bovine tendon) with human gingival fibroblasts. The barrier function and tissue integration properties were determined under confocal microscopy. Morphological characteristics were observed using scanning electron microscopy. Our results showed that all collagen membranes allowed a small number of cells to migrate, and the difference in barrier function ability was not significant. The cross-linked characteristics did not improve barrier ability. The native collagen membrane surfaces allowed evenly scattered proliferation of HGF, while the cross-linked collagen membrane induced patchy proliferation. Statistically significant differences in cell proliferation were found between Jason and BioMend Extend membranes (p = 0.04). Scanning electron microscope showed a compact membrane surface at the top, while the bottom surfaces displayed interwoven collagen fibers, which were denser in the crosslinked collagen membranes. Within the limitations of this study, collagen membranes of different origins and physical properties can adequately prevent the invasion of unwanted cells. Native collagen membranes may provide a better surface for gingival cell attachment and proliferation.
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Affiliation(s)
- Vishal Sehgal
- Master of Science Program in Implant Dentistry, Faculty of Dentistry, Mahidol University, Bangkok 10400, Thailand
| | - Nisarat Ruangsawasdi
- Department of Pharmacology, Faculty of Dentistry, Mahidol University, Bangkok 10400, Thailand
| | - Sirichai Kiattavorncharoen
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok 10400, Thailand
| | - Sompop Bencharit
- Office of Oral Health Innovation, Department of Oral Rehabilitation, The James B. Edwards College of Dental Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
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14
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Huang P, Xu J, Xie L, Gao G, Chen S, Gong Z, Lao X, Shan Z, Shi J, Zhou Z, Chen Z, Cao Y, Wang Y, Chen Z. Improving hard metal implant and soft tissue integration by modulating the “inflammatory-fibrous complex” response. Bioact Mater 2023; 20:42-52. [PMID: 35633873 PMCID: PMC9127122 DOI: 10.1016/j.bioactmat.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/23/2022] [Accepted: 05/08/2022] [Indexed: 11/29/2022] Open
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15
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Huang S, Wei H, Li D. Additive manufacturing technologies in the oral implant clinic: A review of current applications and progress. Front Bioeng Biotechnol 2023; 11:1100155. [PMID: 36741746 PMCID: PMC9895117 DOI: 10.3389/fbioe.2023.1100155] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/11/2023] [Indexed: 01/21/2023] Open
Abstract
Additive manufacturing (AM) technologies can enable the direct fabrication of customized physical objects with complex shapes, based on computer-aided design models. This technology is changing the digital manufacturing industry and has become a subject of considerable interest in digital implant dentistry. Personalized dentistry implant treatments for individual patients can be achieved through Additive manufacturing. Herein, we review the applications of Additive manufacturing technologies in oral implantology, including implant surgery, and implant and restoration products, such as surgical guides for implantation, custom titanium meshes for bone augmentation, personalized or non-personalized dental implants, custom trays, implant casts, and implant-support frameworks, among others. In addition, this review also focuses on Additive manufacturing technologies commonly used in oral implantology. Stereolithography, digital light processing, and fused deposition modeling are often used to construct surgical guides and implant casts, whereas direct metal laser sintering, selective laser melting, and electron beam melting can be applied to fabricate dental implants, personalized titanium meshes, and denture frameworks. Moreover, it is sometimes required to combine Additive manufacturing technology with milling and other cutting and finishing techniques to ensure that the product is suitable for its final application.
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Affiliation(s)
| | - Hongbo Wei
- *Correspondence: Hongbo Wei, ; Dehua Li,
| | - Dehua Li
- *Correspondence: Hongbo Wei, ; Dehua Li,
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16
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Wang CX, Rong QG, Zhu N, Ma T, Zhang Y, Lin Y. Finite element analysis of stress in oral mucosa and titanium mesh interface. BMC Oral Health 2023; 23:25. [PMID: 36650512 PMCID: PMC9843863 DOI: 10.1186/s12903-022-02703-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/28/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The stiffness of titanium mesh is a double-blade sword to repair larger alveolar ridges defect with excellent space maintenance ability, while invade the surrounding soft tissue and lead to higher mesh exposure rates. Understanding the mechanical of oral mucosa/titanium mesh/bone interface is clinically meaningful. In this study, the above relationship was analyzed by finite elements and verified by setting different keratinized tissue width in oral mucosa. METHODS Two three-dimensional finite element models were constructed with 5 mm keratinized tissue in labial mucosa (KM cases) and 0 mm keratinized tissue in labial mucosa (LM cases). Each model was composed of titanium mesh, titanium screws, graft materials, bone, teeth and oral mucosa. After that, a vertical (30 N) loadings were applied from both alveolar ridges direction and labial mucosa direction to stimulate the force from masticatory system. The displacements and von Mises stress of each element at the interfaces were analyzed. RESULTS Little displacements were found for titanium mesh, titanium screws, graft materials, bone and teeth in both LM and KM cases under different loading conditions. The maximum von Mises stress was found around the lingual titanium screw insertion place for those elements in all cases. The keratinized tissue decreased the displacement of oral mucosa, decreased the maximum von Mises stress generated by an alveolar ridges direction load, while increased those stress from labial mucosa direction load. Only the von Mises stress of the KM cases was all lower than the tensile strength of the oral mucosa. CONCLUSION The mucosa was vulnerable under the increasing stress generated by the force from masticatory system. The adequate buccal keratinized mucosa width are critical factors in reducing the stress beyond the titanium mesh, which might reduce the titanium exposure rate.
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Affiliation(s)
- Chen-Xi Wang
- grid.11135.370000 0001 2256 9319Department of Oral Implantology, Peking University School and Hospital of Stomatology and National Clinical Research Center for Oral Diseases and National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, 100081 China
| | - Qi-Guo Rong
- grid.11135.370000 0001 2256 9319College of Engineering, Peking University, Beijing, 100871 China
| | - Ning Zhu
- grid.11135.370000 0001 2256 9319Department of Oral Implantology, Peking University School and Hospital of Stomatology and National Clinical Research Center for Oral Diseases and National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, 100081 China
| | - Ting Ma
- grid.11135.370000 0001 2256 9319Department of Oral Implantology, Peking University School and Hospital of Stomatology and National Clinical Research Center for Oral Diseases and National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, 100081 China
| | - Yu Zhang
- grid.11135.370000 0001 2256 9319Department of Oral Implantology, Peking University School and Hospital of Stomatology and National Clinical Research Center for Oral Diseases and National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, 100081 China
| | - Ye Lin
- grid.11135.370000 0001 2256 9319Department of Oral Implantology, Peking University School and Hospital of Stomatology and National Clinical Research Center for Oral Diseases and National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, 100081 China
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17
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Customized Titanium Mesh for Guided Bone Regeneration in the Posterior Mandible in a Patient Previously Treated with Bisphosphonates. Case Rep Dent 2022; 2022:5174075. [PMID: 36317050 PMCID: PMC9617713 DOI: 10.1155/2022/5174075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/12/2022] [Accepted: 09/21/2022] [Indexed: 11/18/2022] Open
Abstract
We describe the restorative treatment of an 86-year-old female patient who was referred to our specialist prosthodontics clinic. Due to secondary osteoporosis, she underwent oral antiresorptive therapy with ibandronic acid for 10 years. Although she was classified as a patient at increased risk of drug-induced osteonecrosis of the jaw, she eventually signed a consent form for fixed implant-supported prosthetic rehabilitation in her 4th sextant. However, after tooth extraction, the bone ridge was too small at the intended implant positions. Therefore, guided bone regeneration was performed with a computer-aided design/computer-aided manufacturing three-dimensional printed titanium mesh. Finally, a continuous augmented hard tissue ridge above 7 mm was found, and three implants were inserted. Eventually, after four months of submerged healing, the implants were loaded with single crowns. Now, the patient is seen regularly for supportive peri-implant therapy.
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18
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Shi Y, Liu J, Du M, Zhang S, Liu Y, Yang H, Shi R, Guo Y, Song F, Zhao Y, Lan J. Customized Barrier Membrane (Titanium Alloy, Poly Ether-Ether Ketone and Unsintered Hydroxyapatite/Poly-l-Lactide) for Guided Bone Regeneration. Front Bioeng Biotechnol 2022; 10:916967. [PMID: 35837554 PMCID: PMC9273899 DOI: 10.3389/fbioe.2022.916967] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/09/2022] [Indexed: 12/15/2022] Open
Abstract
Sufficient bone volume is indispensable to achieve functional and aesthetic results in the fields of oral oncology, trauma, and implantology. Currently, guided bone regeneration (GBR) is widely used in reconstructing the alveolar ridge and repairing bone defects owing to its low technical sensitivity and considerable osteogenic effect. However, traditional barrier membranes such as collagen membranes or commercial titanium mesh cannot meet clinical requirements, such as lack of space-preserving ability, or may lead to more complications. With the development of digitalization and three-dimensional printing technology, the above problems can be addressed by employing customized barrier membranes to achieve space maintenance, precise predictability of bone graft, and optimization of patient-specific strategies. The article reviews the processes and advantages of three-dimensional computer-assisted surgery with GBR in maxillofacial reconstruction and alveolar bone augmentation; the properties of materials used in fabricating customized bone regeneration sheets; the promising bone regeneration potency of customized barrier membranes in clinical applications; and up-to-date achievements. This review aims to present a reference on the clinical aspects and future applications of customized barrier membranes.
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Affiliation(s)
- Yilin Shi
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University, Jinan, China
- Shandong Key Laboratory of Oral Tissue Regeneration, Jinan, China
- Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Jin Liu
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University, Jinan, China
- Shandong Key Laboratory of Oral Tissue Regeneration, Jinan, China
- Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Mi Du
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University, Jinan, China
- Shandong Key Laboratory of Oral Tissue Regeneration, Jinan, China
- Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Shengben Zhang
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University, Jinan, China
- Shandong Key Laboratory of Oral Tissue Regeneration, Jinan, China
- Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Yue Liu
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University, Jinan, China
- Shandong Key Laboratory of Oral Tissue Regeneration, Jinan, China
- Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Hu Yang
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University, Jinan, China
- Shandong Key Laboratory of Oral Tissue Regeneration, Jinan, China
- Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Ruiwen Shi
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University, Jinan, China
- Shandong Key Laboratory of Oral Tissue Regeneration, Jinan, China
- Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Yuanyuan Guo
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University, Jinan, China
- Shandong Key Laboratory of Oral Tissue Regeneration, Jinan, China
- Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Feng Song
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University, Jinan, China
- Shandong Key Laboratory of Oral Tissue Regeneration, Jinan, China
- Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
| | - Yajun Zhao
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University, Jinan, China
- Shandong Key Laboratory of Oral Tissue Regeneration, Jinan, China
- Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
- *Correspondence: Jing Lan, ; Yajun Zhao,
| | - Jing Lan
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University, Jinan, China
- Shandong Key Laboratory of Oral Tissue Regeneration, Jinan, China
- Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, China
- *Correspondence: Jing Lan, ; Yajun Zhao,
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19
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Hartmann A, Kämmerer P, Ortolano LC, Sagheb K, Seiler M. Customised products for orbital wall reconstruction: a systematic review. Br J Oral Maxillofac Surg 2022; 60:e702-e711. [PMID: 35219519 DOI: 10.1016/j.bjoms.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 10/18/2021] [Indexed: 12/14/2022]
Abstract
The purpose of this systematic review was to critically analyse the recent literature and present the state of the art in customised reconstruction of orbital fractures. Three electronic databases and manual search approaches were used to identify relevant articles. Only controlled clinical studies were included. Primary outcome was defined as the status of recovery (complete/partial functional, and aesthetic disturbances). The benefit of intrasurgical navigation should be described. The secondary outcome was defined as the time of surgery, post-surgical events, and hospitalisation. Of the 552 records identified, eight met the inclusion criteria. Post-surgical results regarding recovery were superior in the customised group, and were comparable to the control group in five studies. The time of surgery was shorter in the customised groups, and liquid infusion and time of hospitalisation were reduced. Four studies documented more accurate reconstruction with the use of navigation. All the studies presented at least one bias, and considerable heterogeneity was evaluated. This review found that the use of customised meshes in combination with surgical navigation resulted in more accurate reconstruction. A significant reduction in surgical time was revealed.
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Affiliation(s)
- Amely Hartmann
- Echterdinger Straße 7, 70794 Filderstadt, Germany; Department of Oral and Maxillofacial Surgery, University Medical Centre of the Johannes Gutenberg University of Mainz, Augustusplatz 2, 55131 Mainz, Germany.
| | - Peer Kämmerer
- Department of Oral and Maxillofacial Surgery, University Medical Centre of the Johannes Gutenberg University of Mainz, Augustusplatz 2, 55131 Mainz, Germany
| | - Lorena Cascant Ortolano
- Departmental Library for the University Medical Centre, University of the Johannes Gutenberg University of Mainz, Langenbeckstr.1, 55131 Mainz, Germany
| | - Kawe Sagheb
- Department of Prosthetic Dentistry, University Medical Centre of the Johannes Gutenberg University of Mainz, Augustusplatz 2, 55131 Mainz, Germany
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20
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Vaquette C, Mitchell J, Ivanovski S. Recent Advances in Vertical Alveolar Bone Augmentation Using Additive Manufacturing Technologies. Front Bioeng Biotechnol 2022; 9:798393. [PMID: 35198550 PMCID: PMC8858982 DOI: 10.3389/fbioe.2021.798393] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/13/2021] [Indexed: 11/26/2022] Open
Abstract
Vertical bone augmentation is aimed at regenerating bone extraskeletally (outside the skeletal envelope) in order to increase bone height. It is generally required in the case of moderate to severe atrophy of bone in the oral cavity due to tooth loss, trauma, or surgical resection. Currently utilized surgical techniques, such as autologous bone blocks, distraction osteogenesis, and Guided Bone Regeneration (GBR), have various limitations, including morbidity, compromised dimensional stability due to suboptimal resorption rates, poor structural integrity, challenging handling properties, and/or high failure rates. Additive manufacturing (3D printing) facilitates the creation of highly porous, interconnected 3-dimensional scaffolds that promote vascularization and subsequent osteogenesis, while providing excellent handling and space maintaining properties. This review describes and critically assesses the recent progress in additive manufacturing technologies for scaffold, membrane or mesh fabrication directed at vertical bone augmentation and Guided Bone Regeneration and their in vivo application.
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21
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Azhar I, Ayulita D, Laksono H, Margaretha T. The efficiency of PRF, PTFE, and titanium mesh with collagen membranes for vertical alveolar bone addition in dental implant therapy: A narrative review. J Int Oral Health 2022. [DOI: 10.4103/jioh.jioh_7_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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22
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Hard tissue stability after guided bone regeneration: a comparison between digital titanium mesh and resorbable membrane. Int J Oral Sci 2021; 13:37. [PMID: 34782595 PMCID: PMC8594427 DOI: 10.1038/s41368-021-00143-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/28/2021] [Accepted: 10/27/2021] [Indexed: 02/05/2023] Open
Abstract
Guided bone regeneration (GBR) uses resorbable and non-resorbable membranes as biological barriers. This study compared the differences in hard tissue stability between GBR using evidence-based digital titanium mesh and resorbable collagen membranes during implant placement. A total of 40 patients (65 implant sites) were enrolled and divided into two groups: resorbable membrane and digital titanium mesh groups. The alveolar bone was analyzed at two- and three-dimensional levels using cone-beam computed tomography and by reconstructing and superimposing the hard tissues at four time points: preoperatively, postoperatively, before second-stage surgery, and 1 year after loading. The use of digital titanium mesh showed less alveolar bone resorption in vertical and horizontal directions two-dimensionally before the second-stage surgery and 1 year after loading. Regarding volumetric stability, the percentage of resorption after 6 months of healing with resorbable membrane coverage reached 37.5%. However, it was only 23.4% with titanium mesh. Although postoperative bone volume was greater at all labial sites with resorbable membrane than with digital titanium mesh, after substantial bone resorption within 1 year of loading, the labial bone thickness at the upper part of implants was thinner with resorbable membrane than with digital titanium mesh. Furthermore, digital titanium meshes made according to ideal bone arch contour reduced soft tissue irritation, and the exposure rate was only 10%. Therefore, although both resorbable membrane and digital titanium mesh in GBR were able to successfully reconstruct the bone defect, digital titanium meshes were better at maintaining the hard tissue volume in the osteogenic space.
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23
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Hard Tissue Volume Stability Effect beyond the Bony Envelope of a Three-Dimensional Preformed Titanium Mesh with Two Different Collagen Barrier Membranes on Peri-Implant Dehiscence Defects in the Anterior Maxilla: A Randomized Clinical Trial. MATERIALS 2021; 14:ma14195618. [PMID: 34640019 PMCID: PMC8510212 DOI: 10.3390/ma14195618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 11/28/2022]
Abstract
This single-blinded, randomized, controlled study aimed to clinically and radiographically evaluate hard tissue volume stability beyond the bony envelope using three-dimensional preformed titanium mesh (3D-PFTM) for peri-implant dehiscence defects in the anterior maxilla. A total of 28 patients who wished to undergo implant surgery combined with guided bone regeneration (GBR) after extraction of a single maxillary anterior tooth were randomly assigned to two groups depending on the type of collagen membrane used, additionally with the 3D-PFTM—test (n = 14, cross-linked collagen membrane; CCM) and control (n = 14, non-cross-linked collagen membrane; NCCM) groups. Each implant was evaluated radiographically using CBCT at baseline, immediately after surgery, and at 6 months postoperatively. The relative position and distances from the bony envelope to the outlines of the augmented ridge were further determined immediately after GBR and 6 months after healing. At the platform level, the mean horizontal hard tissue gain (HG) at all the sites was 2.35 ± 0.68 mm at 6 months postoperatively. The mean HG rate was 84.25% ± 14.19% in the CCM group and 82.56% ± 13.04% in the NCCM group, but the difference was not significant between the groups. In all cases, HG was maintained beyond the bony envelope even after 6 months of GBR. This study suggests that 3D-PFTM should be considered a valuable option for GBR for peri-implant dehiscence defects in the anterior maxilla. In addition, 3D-PFTM may confer predictable hard tissue volume stability even after the healing period of hard tissue augmented outside the bony envelope by GBR.
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24
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Cucchi A, Vignudelli E, Franceschi D, Randellini E, Lizio G, Fiorino A, Corinaldesi G. Vertical and horizontal ridge augmentation using customized CAD/CAM titanium mesh with versus without resorbable membranes. A randomized clinical trial. Clin Oral Implants Res 2021; 32:1411-1424. [PMID: 34551168 PMCID: PMC9293224 DOI: 10.1111/clr.13841] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 01/03/2023]
Abstract
Objectives The aim was to evaluate the role of resorbable membranes applied over customized titanium meshes related to soft tissue healing and bone regeneration after vertical/horizontal bone augmentation. Materials and Methods Thirty patients with partial edentulism of the maxilla/mandible, with vertical/horizontal reabsorption of the alveolar bone, and needing implant‐supported restorations, were randomly divided into two groups: Group A was treated using only custom‐made meshes (Mesh‐) and Group B using custom‐made meshes with cross‐linked collagen membranes (Mesh+). Data collection included surgical/technical and healing complications, “pseudo‐periosteum” thickness, bone density, planned bone volume (PBV), regenerated bone volume (RBV), regeneration rate (RR), vertical bone gain (VBG), and implant survival in regenerated areas. Statistical analysis was performed between the two study groups using a significance level of α = .05. Results Regarding the healing complications, the noninferiority analysis proved to be inconclusive, despite the better results of group Mesh+ (13%) compared to group Mesh‐ (33%): estimated value −1.13 CI‐95% from −0.44 to 0.17. Superiority approach confirmed the absence of significant differences (p = .39). RBV was 803.27 mm3 and 843.13 mm3, respectively, and higher RR was observed in group Mesh+ (82.3%) compared to Mesh‐ (74.3%), although this value did not reach a statistical significance (p = .44). All 30 patients completed the study, receiving 71 implants; 68 out of them were clinically stable and in function. Conclusion The results showed that customized meshes alone do not appear to be inferior to customized meshes covered by cross‐linked collagen membranes in terms of healing complication rates and regeneration rates, although superior results were observed in group Mesh+compared to group Mesh‐ for all variables.
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Affiliation(s)
| | - Elisabetta Vignudelli
- Department of Biomedical and Neuromotor Science (DIBINEM), University of Bologna, Bologna, Italy
| | - Debora Franceschi
- Department of Experimental and clinical Medicine, University of Florence, Florence, Italy
| | | | - Giuseppe Lizio
- Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Trans-plant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonino Fiorino
- Catholic University of Sacred Heart, University Polyclinic Foundation A. Gemelli (IRCCS), Rome, Italy
| | - Giuseppe Corinaldesi
- Department of Biomedical and Neuromotor Science (DIBINEM), University of Bologna, Bologna, Italy
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25
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Mandelli F, Traini T, Ghensi P. Customized-3D zirconia barriers for guided bone regeneration (GBR): clinical and histological findings from a proof-of-concept case series. J Dent 2021; 114:103780. [PMID: 34400253 DOI: 10.1016/j.jdent.2021.103780] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 08/03/2021] [Accepted: 08/06/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The aim of this case series was to evaluate, clinically and histologically, customized-3D zirconia barriers manufactured for guided bone regeneration (GBR) procedures. METHODS Seven healthy consecutive patients with severe bone atrophy (two of them with a bilateral atrophy) were selected for a GBR procedure with a zirconia barrier. In a 3D software (DentalCad, Exocad GmbH, Germany), a virtual bone graft was designed and a shell was designed covering the graft; a standard tessellation language (.STL) file was obtained and milled (M1, Zirkonzahn, Italy) using a 1200 MPa zirconia (Prettau, Zirkonzahn, Italy). Nine GBR surgeries (8 upper-posterior jaw, 1 lower-posterior jaw) were performed using autogenous bone chips mixed with xenograft (SmartBone, IBI-SA, Switzerland / BioOss, Geistlich, Switzerland) covered with a zirconia barrier, fixed by means of screws. After healing, implant sites were prepared with a trephine bur, collecting a bone biopsy, and dental implants were inserted (Neodent, Straumann Group, Switzerland). Specimens were histologically analyzed. RESULTS Eight successful surgeries were recorded; one zirconia barrier got exposed after one month of healing but no signs of infection were present till the barrier was removed. In all cases it was possible to insert implants with no additional bone augmentation procedures. Histological evaluations showed the presence of intense deposition of new bone. CONCLUSIONS Within the limitations of the present case series, the tested customized-3D zirconia barriers confirmed good clinical and histological performances, and, even in case of premature exposure, did not show signs of infection. Preliminary results suggest they are effective for GBR procedures. Further research is necessary with a larger sample size. CLINICAL SIGNIFICANCE The presented barriers could be a viable alternative to titanium-reinforced polytetrafluoroethylene membranes and customized meshes.
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Affiliation(s)
- Federico Mandelli
- DDS, Oral Surgery Spec. - Private practice, Via Padana Superiore 15, Milan, Italy.
| | - Tonino Traini
- CDT-MDT, DDS, Oral Surgery Spec., PhD - Department Innovative Technologies in Medicine & Dentistry, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy.
| | - Paolo Ghensi
- DDS, Oral Surgery Spec., Clin MSc, PhD - Department CIBIO, University of Trento, Trento, Italy.
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Mechanical Properties and Corrosion Resistance of TiAl6V4 Alloy Produced with SLM Technique and Used for Customized Mesh in Bone Augmentations. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11125622] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Bone augmentation procedures represent a real clinical challenge. One option is the use of titanium meshes. Additive manufacturing techniques can provide custom-made devices in titanium alloy. The purpose of this study was to investigate the material used, which can influence the outcomes of the bone augmentation procedure. Specific test samples were obtained from two different manufacturers with two different shapes: surfaces without perforations and with calibrated perforations. Three-point bending tests were run as well as internal friction tests to verify the Young’s modulus. Test samples were placed in two different buffered solutions and analyzed with optical microscopy. A further SEM analysis was done to observe any microstructural modification. Three-point flexural tests were conducted on 12 specimens. Initial bending was observed at lower applied stresses for the perforated samples (503 MPa) compared to non-perforated ones (900 MPa); the ultimate flexural strength was registered at 513 MPa and 1145 MPa for perforated and non-perforated samples, respectively. Both microscopic analyses (optical and SEM) showed no significant alterations. Conclusions: A normal masticatory load cannot modify the device. Chemical action in the case of exposure does not create macroscopic and microscopic alterations of the surface.
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Zhou L, Su Y, Wang J, Wang J, Wang X, Liu Q. Effect of Exposure Rates with Customized versus Conventional Titanium Mesh on Guided Bone Regeneration: A Systematic Review and Meta-Analysis. J ORAL IMPLANTOL 2021; 48:339-346. [PMID: 34091682 DOI: 10.1563/aaid-joi-d-20-00200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Titanium mesh exposure is the main complication of bone regeneration. In this study, a meta-analysis and performed to clarify the effect of customized titanium mesh versus conventional titanium mesh complications and the time of mesh exposure on edentulous alveolar ridge GBR. Databases, including PubMed, EMBASE, Web of Science and Cochrane Central Register Controlled Trials, were searched by two independent reviewers to retrieve articles published from January 2010 to March 2020, regarding the incidence of complications after GBR surgery, with language limited to English articles. A total of 705 articles were found, and 9 articles were quantitatively analyzed. A funnel plot was made for 10 comprehensive datasets. The combined value of the total exposure rate of titanium mesh was 0.44 (44%, 95% CI=0.30~0.58). The results of subgroup analysis showed that the combined value of the customized titanium mesh exposure rate was 0.31 (31%, 95% CI=0.15~0.51), and the combined value of the conventional titanium mesh exposure rate was 0.51 (51%, 95% CI=0.33~0.69). Based on the findings of the present study, the exposure rate of customized titanium mesh is lower than that of conventional titanium mesh. The design of 3D printing customized titanium mesh avoids nerves and blood vessels, which is of great significance to improve the accurate reconstruction of GBR and provides enough space for implantation and reducing the exposure rate. Soft tissue management (i.e., technical sensitivity) is also an important factor to avoid soft tissue fractures.
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Affiliation(s)
| | - Yucheng Su
- Chinese Academy of Medical Sciences & Peking Union Medical College Institute of Hospital Dental Department Dongcheng District CHINA Beijing Beijing 100032 Chinese Academy of Medical Sciences & Peking Union Medical College Institute of Hospital
| | - Jing Wang
- Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University
| | | | | | - Qian Liu
- Beijing Citident Stomatology Hospital
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Hartmann A, Peetz M, Al-Nawas B, Seiler M. Patient-specific titanium meshes: Future trend or current technology? Clin Implant Dent Relat Res 2021; 23:3-4. [PMID: 33620778 DOI: 10.1111/cid.12981] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Amely Hartmann
- Private Practice for Oral and Maxillofacial Surgery, Private Practice Dr. Seiler and Colleagues, Filderstadt, Germany.,Department of Oral and Maxillofacial Surgery, University Medical Centre of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | | | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery, University Medical Centre of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Marcus Seiler
- Private Practice for Oral and Maxillofacial Surgery, Private Practice Dr. Seiler and Colleagues, Filderstadt, Germany
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Sun Q, Soh HY, Zhang WB, Yu Y, Wang Y, Mao C, Guo CB, Yu GY, Peng X. Long-term Effect of Individualized Titanium Mesh in Orbital Floor Reconstruction After Maxillectomy. Laryngoscope 2021; 131:2231-2237. [PMID: 33847391 DOI: 10.1002/lary.29569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/05/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The aim of this study was to determine the clinical outcomes and long-term stability of individualized titanium mesh combined with free flap for orbital floor reconstruction after maxillectomy and to identify the risk factors for titanium mesh exposure. MATERIAL AND METHODS The data of 66 patients who underwent maxillectomy and orbital floor defect reconstruction by individualized titanium mesh in Peking University School and Hospital of Stomatology between 2011 and 2019 were retrospectively reviewed. Postoperative ophthalmic function and success of aesthetic restoration were assessed. Titanium mesh exposure was recorded and the risk factors were identified. RESULTS Mean follow-up was for 24.8 months (range, 6-92 months). Ophthalmic function was successfully restored in 63/66 patients. Aesthetic restoration was not considered satisfactory by 10 patients. Titanium mesh exposure occurred in six patients (exposure rate, 9.1%). Preoperative radiotherapy was identified as an independent risk factor for mesh exposure (OR = 28.8, P = 0.006). Previous surgery, postoperative radiotherapy, pathological type of the primary lesion, the type of tissue flap applied, and the use of intraoperative navigation were not significant risk factors. Six patients with titanium mesh exposure underwent second surgery, but mesh exposure recurred in two patients due to insufficient soft tissue coverage. CONCLUSION Individualized titanium mesh with free flap can effectively restore maxilla-orbital defects. Preoperative radiotherapy is an independent predictor of postoperative titanium mesh exposure. Adequate soft tissue coverage of the mesh may reduce the risk of mesh exposure. LEVEL OF EVIDENCE Level 4 (case-control study) Laryngoscope, 2021.
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Affiliation(s)
- Qian Sun
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Hui-Yuh Soh
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Wen-Bo Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yao Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yang Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Chi Mao
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Chuan-Bin Guo
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Guang-Yan Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xin Peng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
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Xie Y, Li S, Zhang T, Wang C, Cai X. Titanium mesh for bone augmentation in oral implantology: current application and progress. Int J Oral Sci 2020; 12:37. [PMID: 33380722 PMCID: PMC7773733 DOI: 10.1038/s41368-020-00107-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 02/05/2023] Open
Abstract
Guided bone regeneration (GBR) is an effective and simple method for bone augmentation, which is often used to reconstruct the alveolar ridge when the bone defect occurs in the implant area. Titanium mesh has expanded the indications of GBR technology due to its excellent mechanical properties and biocompatibility, so that the GBR technology can be used to repair alveolar ridges with larger bone defects, and can obtain excellent and stable bone augmentation results. Currently, GBR with titanium mesh has various clinical applications, including different clinical procedures. Bone graft materials, titanium mesh covering methods, and titanium mesh fixing methods are also optional. Moreover, the research of GBR with titanium mesh has led to multifarious progresses in digitalization and material modification. This article reviews the properties of titanium mesh and the difference of titanium mesh with other barrier membranes; the current clinical application of titanium mesh in bone augmentation; common complications and management and prevention methods in the application of titanium mesh; and research progress of titanium mesh in digitization and material modification. Hoping to provide a reference for further improvement of titanium mesh in clinical application and related research of titanium mesh.
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Affiliation(s)
- Yu Xie
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Head and Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Songhang Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Head and Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Tianxu Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Head and Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Chao Wang
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
| | - Xiaoxiao Cai
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Head and Department of Implant Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Li L, Wang C, Li X, Fu G, Chen D, Huang Y. Research on the dimensional accuracy of customized bone augmentation combined with 3D-printing individualized titanium mesh: A retrospective case series study. Clin Implant Dent Relat Res 2020; 23:5-18. [PMID: 33336492 DOI: 10.1111/cid.12966] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Few studies have focused on the dimensional accuracy of customized bone grafting by means of guided bone regeneration (GBR) with 3D-Printed Individual Titanium Mesh (3D-PITM). PURPOSE Digital technologies were applied to evaluate the dimensional accuracy of customized bone augmentation with 3D-PITM with a two-stage technique. MATERIALS AND METHODS Sixteen patients were included in this study. The CBCT data of post-GBR (immediate post-GBR) and post-implantation (immediate post-implant placement) were 3D reconstructed and compared with the pre-surgical planned bone augmentation. The dimensional differences were evaluated by superimposition using the Materialize 3-matic software. RESULTS The superimposition analysis showed that the maximum deviations of contour between were 3.4 mm, and the average differences of the augmentation contour were 0.5 ± 0.4 and 0.6 ± 0.5 mm respectively. The planned volume of bone regeneration was approximately equal to the amount of regenerated bone present 6 to 9 months after the surgical procedure. On average, the vertical gain in bone height was about 0.5 mm less than planned. And, the horizontal bone gain on the straight buccal of the dental implants and 2 to 4 mm apical of the platform fell also about a 0.5 mm short on average. Statistically significant differences were observed between the augmented volume of virtual and post-GBR, and the horizontal bone gain of post-implantation on the level of 4 mm apical to the implant platform (P < .05). CONCLUSIONS The dimensional accuracy of customized bone augmentation with the 3D-PITM approach needs further improvement and compared to other surgical approaches of bone augmentation.
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Affiliation(s)
- Linzhi Li
- Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Chao Wang
- Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China.,Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing 100083, China
| | - Xian Li
- Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Gang Fu
- Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Dan Chen
- Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Yuanding Huang
- Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
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Guided bone regeneration in staged vertical and horizontal bone augmentation using platelet-rich fibrin associated with bone grafts: a retrospective clinical study. Int J Implant Dent 2020; 6:72. [PMID: 33067730 PMCID: PMC7567776 DOI: 10.1186/s40729-020-00266-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/17/2020] [Indexed: 12/21/2022] Open
Abstract
Background The use of guided bone regeneration (GBR) for vertical and horizontal bone gain is a predictable approach to correct the bone defects before implant installation; however, the use of different protocols is associated with different clinical results. It is suggested that platelet-rich fibrin (PRF) could improve the outcomes of regenerative procedures. Thus, this study aimed to describe the bone gain associated with GBR procedures combining membranes, bone grafts, and PRF for vertical and horizontal bone augmentation. Materials and methods Eighteen patients who needed vertical or horizontal bone regeneration before installing dental implants were included in the study. The horizontal bone defects were treated with a GBR protocol that includes the use of a mixture of particulate autogenous and xenogenous grafts in the proportion of 1:1, injectable form of PRF (i-PRF) to agglutinate the graft, an absorbable collagen membrane covering the regenerated region, and leukocyte PRF (L-PRF) membrane covering the GBR membrane. The vertical bone defects were treated with the same grafted mixture protected by a titanium-reinforced non-resorbable high-density polytetrafluoroethylene (d-PTFE-Ti) membrane and covered by L-PRF. The bone gain was measured using a cone-beam computed tomography at baseline and after a period of 7.5 (± 1.0) months. Results All patients underwent surgery to install implants after this regenerative protocol. The GBR produces an increase in bone thickness (p < 0.001) and height (p < 0.005) after treatment, with a bone gain of 5.9 ± 2.4 for horizontal defects and 5.6 ± 2.6 for vertical defects. In horizontal defects, the gain was higher in the maxilla than in mandible (p = 0.014) and in anterior than the posterior region (p = 0.033). No differences related to GBR location were observed in vertical defects (p > 0.05). Conclusion GBR associated with a mixture of particulate autogenous and xenogenous grafts and i-PRF is effective for vertical and horizontal bone augmentation in maxillary and mandibular regions, permitting sufficient bone gain to future implant placement. Trial registration REBEC, RBR-3CSG3J. Date of registration—19 July 2019, retrospectively registered. http://www.ensaiosclinicos.gov.br/rg/RBR-3csg3j/
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Cucchi A, Bianchi A, Calamai P, Rinaldi L, Mangano F, Vignudelli E, Corinaldesi G. Clinical and volumetric outcomes after vertical ridge augmentation using computer-aided-design/computer-aided manufacturing (CAD/CAM) customized titanium meshes: a pilot study. BMC Oral Health 2020; 20:219. [PMID: 32758217 PMCID: PMC7409710 DOI: 10.1186/s12903-020-01205-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022] Open
Abstract
Background One of the most recent innovations in bone augmentation surgery is represented by computer-aided-design/computer-aided-manufacturing (CAD/CAM) customized titanium meshes, which can be used to restore vertical bone defects before implant-prosthetic rehabilitations. The aim of this study was to evaluate the effectiveness/reliability of this technique in a consecutive series of cases. Methods Ten patients in need of bone augmentation before implant therapy were treated using CAD/CAM customized titanium meshes. A digital workflow was adopted to design virtual meshes on 3D bone models. Then, Direct Metal Laser Sintering (DMLS) technology was used to produce the titanium meshes, and vertical ridge augmentation was performed according to an established surgical protocol. Surgical complications, healing complications, vertical bone gain (VBG), planned bone volume (PBV), lacking bone volume (LBV), regenerated bone volume (RBV), average regeneration rate (RR) and implant success rate were evaluated. Results All augmented sites were successfully restored with definitive implant-supported fixed partial dentures. Measurements showed an average VBG of 4.5 ± 1.8 mm at surgical re-entry. Surgical and healing complications occurred in 30% and 10% of cases, respectively. Mean values of PBV, LBV, and RBV were 984, 92, and 892 mm3, respectively. The average RR achieved was 89%. All 26 implants were successfully in function after 1 year of follow-up. Conclusions The results of this study suggest that the bone augmentation by means of DMLS custom-made titanium meshes can be considered a reliable and effective technique in restoring vertical bone defects.
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Affiliation(s)
- Alessandro Cucchi
- Unit of Oral and Maxillofacial Surgery, Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy.
| | - Alessandro Bianchi
- Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | | | - Lisa Rinaldi
- Unit of Oral and Maxillofacial Surgery, Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy
| | - Francesco Mangano
- Department of Prevention and Communal Dentistry, Sechenov First State Medical University, Moscow, Russia
| | - Elisabetta Vignudelli
- Unit of Oral and Maxillofacial Surgery, Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy
| | - Giuseppe Corinaldesi
- Unit of Oral and Maxillofacial Surgery, Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy
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Revilla‐León M, Sadeghpour M, Özcan M. A Review of the Applications of Additive Manufacturing Technologies Used to Fabricate Metals in Implant Dentistry. J Prosthodont 2020; 29:579-593. [DOI: 10.1111/jopr.13212] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Marta Revilla‐León
- Comprehensive Dentistry Department, College of DentistryTexas A&M University Dallas TX
- Gradute Prosthodontics, Department of Restorative Dentistry, School of DentistryUniversity of Washington Seattle WA
| | - Mehrad Sadeghpour
- Revilla Research Center Madrid Spain
- Private practice in Dallas Dallas TX
| | - Mutlu Özcan
- Division of Dental Biomaterials, Clinic for Reconstructive Dentistry, Center for Dental and Oral MedicineUniversity of Zurich Zürich Switzerland
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Clinical and Radiographic Evaluation of Simultaneous Alveolar Ridge Augmentation by Means of Preformed Titanium Meshes at Dehiscence-Type Peri-Implant Defects: A Prospective Pilot Study. MATERIALS 2020; 13:ma13102389. [PMID: 32455919 PMCID: PMC7287986 DOI: 10.3390/ma13102389] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/16/2020] [Accepted: 05/20/2020] [Indexed: 12/16/2022]
Abstract
Background: bone augmentation by means of manually shaped titanium mesh is an established procedure to regenerate atrophic alveolar ridges and recreate a proper contour of the peri-implant bone anatomy. Conversely, current literature on the use of preformed titanium meshes instead of traditional grids remains lacking. Therefore, the aim of the present prospective study was to evaluate the use of preformed titanium mesh to support bone regeneration simultaneously to implant placement at dehiscence-type defects from clinical, radiological, and patient-related outcomes. Methods: 8 implants showing buccal dehiscence defects were treated with preformed titanium mesh directly fixed to flat abutments screwed to the implant. Intrasurgical clinical measurements and radiographic evaluations by means of cone-beam computed tomography scans were performed to assess the horizontal bone gain after 8 months from the augmentation surgery. Biological and patient-centered outcomes were also evaluated.; Results: clinically, a mean horizontal bone gain of 4.95 ± 0.96 mm, and a mean horizontal thickness of the buccal plate of 3.25 ± 0.46 mm were found. A mean horizontal bone gain of 5.06 ± 0.88 mm associated with a mean horizontal thickness of the buccal plate of 3.45 ± 0.68 mm were observed radiographically. From a macroscopic aspect, the remodeled graft appeared well integrated with the host bone. Well vascularized newly formed bone-like tissue was observed in intimate contact with the implants. Conclusions: preformed titanium mesh may be effective in supporting simultaneous horizontal bone regeneration at dehiscence-type peri-implant defects. Titanium mesh exposure still remain an issue in this type of surgery.
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