Clinical and volumetric outcomes after vertical ridge augmentation using computer-aided-design/computer-aided manufacturing (CAD/CAM) customized titanium meshes: a pilot study

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 mm 3 , 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.

Guided bone regeneration using titanium mesh to augment 3‐dimensional alveolar defects prior to implant placement. A pilot study

“…With traditional manually created titanium meshes, the exposure range is extensive (0–68.9%) (Lizio et al, 2014; Pieri et al, 2008; Poomprakobsri et al, 2021). Ciocca et al, using digitally customized meshes, reported 66% of postoperative exposure morbidity in nine cases (Ciocca et al, 2018), and Li et al reported 25% morbidity in 16 patients (Li et al, 2021); Chiapasco et al reported 11 exposure cases in 53 dehiscence cases (Chiapasco et al, 2021), and Cucchi et al recorded one in 10 cases (Cucchi et al, 2020). Sumida et al, comparing two groups of 13 patients, found one and three exposures for CAD/CAM and traditional devices, respectively (Sumida et al, 2015).…”

“…A recent meta‐analysis stated exposure rates of 31% with custom‐made meshes and 51% with conventional meshes (Zhou et al, 2021). Comparing the actual bone volumes with digitally planned bone volumes from CAD/CAM procedures, Cucchi et al and Chiapasco et al reported technique reliability rates of 89% and 91.9%, respectively (Chiapasco et al, 2021; Cucchi et al, 2020). These results are consistent with Li et al, recording 95.82% reliability (range: 88.53%–99.15%) (Pellegrino et al, 2021), but higher than Lizio et al, with a 69.8% of obtained bone, both using meshes preformed on stereo‐lithographic models (Lizio et al, 2014).…”

Monitoring Alveolar Ridge Remodelling Post-Extraction Using Sequential Intraoral Scanning over a Period of Four Months

“…Intraoral scanning offers reduced chairside time and improved patient comfort, compared to conventional impression making [7]. Moreover, intraoral scanning in conjunction with cone-beam computed tomography (CBCT), 3D printing, and extraoral face scans can assist in creating a virtual dental patient image and possibly offer a more streamlined and accurate digital workflow for dental care delivery [4,16]. On the other hand, a possible limitation of the technique is the need to ensure that a strict and standardised protocol is followed in acquiring the scans.…”

“…Studies have previously used in-vivo cone beam computed tomographic (CBCT) scanning or extraoral surface scanning of patient casts to monitor and quantify bone remodelling up to four months post-extraction [2,3]. Indeed, a recent study involving ten patients demonstrated the use of CBCT to measure volumetric changes post vertical ridge augmentation in the form of vertical bone gain, planned bone volume, lacking bone volume, and regenerated bone volume, using computer-aided design/computer-aided manufacturing customised titanium meshes [4]. However, CBCT scans carry the disadvantage of radiation exposure, whereas dental stone casts undergo linear expansion over time that can significantly affect their accuracy [5].…”

Volumetric changes in edentulous alveolar ridge sites utilizing guided bone regeneration and a custom titanium ridge augmentation matrix (CTRAM): a case series study

“…Multiple recent studies have reported favorable vertical and horizontal linear bone gain at sites augmented with customized titanium mesh [ 9 , 15 ]. A recent study by Cucchi et al also evaluated augmentation with customized titanium mesh volumetrically in 10 patients, reporting an average of 89% regeneration of defect area [ 16 ]. The aims of this prospective pilot study were threefold: (1) to compare pre- and post-treatment CBCT scans to determine the volume of radiographic bone fill attained, (2) to assess surgical accuracy of the placement of the CTRAM compared to the digitally planned location, and (3) to record bone fill clinically by comparing pre- and post-surgical probing measurements at designated points from the surface of the CTRAM to the underlying bone.…”