CBCT-Based Design of Patient-Specific 3D Bone Grafts for Periodontal Regeneration

Abstract

The purpose of this article is to define and implement a methodology for the 3D design of customized patient-specific scaffolds (bone grafts) for the regeneration of periodontal tissues. The prerequisite of the proposed workflow is the three-dimensional (3D) structure of the periodontal defect, i.e., the 3D model of the hard tissues (alveolar bone and teeth) around the periodontal damage, which is proposed to be generated via a segmentation and 3D editing methodology using cone beam computed tomography (CBCT) data. Two types of methodologies for 3D periodontal scaffold (graft) design are described: (i) The methodology of designing periodontal defect customized block grafts and (ii) the methodology of designing extraction socket preservation customized grafts. The application of the proposed methodology for the generation of a 3D model of the hard tissues around periodontal defects of a patient using a CBCT scan and the 3D design of the two aforementioned types of scaffolds for personalized periodontal regenerative treatment shows promising results. The outputs of this work will be used as the basis for the 3D printing of bioabsorbable scaffolds of personalized treatment against periodontitis, which will simultaneously be used as sustained-release drug carriers.

Recent Advances in Scaffolds for Guided Bone Regeneration

“…Additive manufacturing (AM), also known as 3D printing, incorporates a group of novel techniques used to fabricate three-dimensional (3D) tissue-engineering constructs that have been designed through computer-aided technologies in a layer-by-layer approach [ 132 , 133 ]. The bone defect is scanned with magnetic resonance imaging (MRI), or cone beam computed tomography (CBCT) and a scaffold model with volumetric shape that would fit into the defect is then designed [ 132 , 133 , 134 , 135 ]. The most abundantly used AM techniques in dentoalveolar settings are SLA, SLS, and FDM [ 46 ].…”

The Role of Cone Beam Computed Tomography in Periodontology: From 3D Models of Periodontal Defects to 3D-Printed Scaffolds

“…In our latest study [13], we presented two types of methodology for designing 3D periodontal scaffolds. The initial method pertains to designing periodontal defect customized block grafts; the second one involves creating extraction socket preservation customized grafts.…”

“…Nevertheless, despite CBCT providing cross-sectional views in various orientations (sagittal, coronal, axial planes), it does not directly reveal the true morphology of the periodontal defect, unless a 3D model of the oral cavity is created using these data. Most studies primarily employ a simplistic thresholding segmentation method, leading to the creation of 3D models with high levels of noise and reduced accuracy [8][9][10], while other studies explore more complex partially automated segmentation techniques in dental CBCT scans using existing segmentation solutions [11][12][13][14]. Apart from the utilization of the available segmentation software, various automated methods have been employed for segmenting CBCT data in dental applications.…”

“…In our prior studies, we introduced an approach for creating 3D models of hard tissues surrounding periodontal defects by using CBCT data [12] and designing 3D scaffolds (bone grafts) [13] that can be 3D-printed and placed for patient-specific periodontal defects for regeneration. The primary objective of this study is to refine and finalize our CBCT-based 3D-modeling pipeline presented in [12,13] and verify the accuracy of 3D-printed scaffolds for periodontal regeneration. Specifically, herein, we improve our methodology for CBCTbased generation of 3D models of alveolar bone and teeth surrounding periodontal defects and test our proposed approach for three new cases of patients.…”

Evolving Strategies and Materials for Scaffold Development in Regenerative Dentistry

“…For now, there have not been detailed instructions formulated that would vouch for successful living tissue replacement with no adverse effects. This narrative review provides the reader with up-to-date information and novel trends in the field of regenerative dentistry and tissue replacement therapy [9][10][11][12], including the most current utilization, applications, improvements, and methods over the last five years (2019-August 2023). To replace living tissue in the human body using biocompatible 3D-printed grafts (usually in the form of scaffolds), we need to understand numerous biological processes and interactions between native tissues, cells, and scaffolds, promote their migration towards the injured area, ensure adequate vascularization and biodegradation, etc.…”