No abstract

Fixed restorations on locking-taper implants seem to be a successful procedure for the rehabilitation of partially and completely edentulous arches.

Several procedures have been proposed to achieve maxillary ridge augmentation. These require bone replacement materials to be manually cut, shaped, and formed at the time of implantation, resulting in an expensive and time-consuming process. In the present study, we describe a technique for the design and fabrication of custom-made scaffolds for maxillary ridge augmentation, using three-dimensional computerized tomography (3D CT) and computer-aided design/computer-aided manufacturing (CAD/CAM). CT images of the atrophic maxillary ridge of 10 patients were acquired and modified into 3D reconstruction models. These models were transferred as stereolithographic files to a CAD program, where a virtual 3D reconstruction of the alveolar ridge was generated, producing anatomically shaped, custom-made scaffolds. CAM software generated a set of tool-paths for manufacture by a computer-numerical-control milling machine into the exact shape of the reconstruction, starting from porous hydroxyapatite blocks. The custom-made scaffolds were of satisfactory size, shape, and appearance; they matched the defect area, suited the surgeon's requirements, and were easily implanted during surgery. This helped reduce the time for surgery and contributed to the good healing of the defects.

This study evaluated the 1-year survival and success rate of root-analogue direct laser metal sintering (DLMS) implants, placed into the extraction sockets of 15 patients. DLMS is a technology which allows solids with complex geometry to be fabricated by annealing metal powder microparticles in a focused laser beam, according to a computer-generated three-dimensional (3D) model; the fabrication process involves the laser-induced fusion of titanium microparticles, in order to build, layer-by-layer, the desired object. Cone-beam computed tomography (CBCT) acquisition and 3D image conversion, combined with the DLMS process, allow the fabrication of custom-made, root-analogue implants (RAIs). CBCT images of 15 non-restorable premolars (eight maxilla; seven mandible) were acquired and transformed into 3D models: from these, custom-made, root-analogue DLMS implants with integral abutment were fabricated. Immediately after tooth extraction, the RAIs were placed in the sockets and restored with a single crown. One year after implant placement, clinical and radiographic parameters were assessed: success criteria included absence of pain, suppuration, and exudation; absence of implant mobility and absence of continuous peri-implant radiolucency; distance between the implant shoulder and the first visible bone-to-implant contact <1.5 mm from initial surgery; and absence of prosthetic complications. At the 1-year follow-up, no implants were lost, for a survival rate of 100 %. All implants were stable, with no signs of infection. The good conditions of the peri-implant tissues were confirmed by the radiographic examination, with a mean DIB of 0.7 mm (±0.2). The possibility of fabricating custom-made, RAI DLMS implants opens new interesting horizons for immediate placement of dental implants.

The present study describes a new protocol for the manufacturing of custom-made hydroxyapatite scaffolds using computer-aided design/computer-aided manufacturing (CAD/CAM), to augment posterior mandibular bone and minimize surgery when severe atrophy is present. Computed tomographic images of an atrophic posterior mandible were acquired and modified into a 3-dimensional (3D) reconstruction model. This model was transferred as a stereolithographic file to a CAD program, where virtual 3D reconstructions of the alveolar ridge were performed, drawing 2 anatomically shaped, custom-made scaffolds. Computer-aided-manufacturing software generated a set of tool-paths for manufacture on a computer-numerical-control milling machine into the exact shape of the 3D projects. Clinically sized, anatomically shaped scaffolds were generated from commercially available porous hydroxyapatite blocks. The custom-made scaffolds well matched the shape of the bone defects and could be easily implanted during surgery. This matching of the shape helped to reduce the time for the operation and contributed to the good healing of the defects. At the 6-month recall, a newly formed and well-integrated bone was observed, completely filling the mandibular posterior defects, and implants were placed, with good primary stability. At the 1-year follow-up examination, the implant-supported restorations showed a good functional and esthetic integration. Although this is an interim report, this study demonstrates that anatomically shaped custom-made scaffolds can be fabricated by combining computed tomographic scans and CAD/CAM techniques. Further studies are needed to confirm these results.