Computer‐Guided Surgery Using Human Allogenic Bone Ring With Simultaneous Implant Placement: A Case Report

Abstract

Introduction The allogenic bone ring technique allows for horizontal and vertical bone augmentation with simultaneous implant placement in severely compromised sites. The aim of this report is to present a modified protocol for simultaneous placement of implant and allogenic bone ring graft using a computer‐guided surgery technique. Case Presentation Patient's chief complaint was to replace a missing lateral incisor. The implant site presented both vertical and horizontal tissue deficiencies. Study models and wax‐ups were digitally scanned to stl files and merged with the existing CBCT data in the implant planning software. A 3D representation of an allogenic bone ring was developed, and two digitally designed guides were created: a 5 mm sleeve guide for the implant site and a 7 mm sleeve guide for the allogenic bone ring trephine. Both the implant site and the allogenic bone ring recipient site were prepared using the computer‐generated guides. Once the ring was adapted into the recipient site, the implant was inserted through the allogenic bone ring. The healing was monitored and the implant was restored at 12 months. The accuracy of implant placement was measured and the difference in the final positioning was as follows: 0.6 mm at entry point, 0.55 mm vertical displacement, 1.94 mm at the apex, and angle discrepancy 6.1°. Conclusion The use of computer‐guided technology for planning and placement of an allograft bone block with simultaneous implant insertion allows for a prosthetically driven team approach to compromised site grafting in addition to improving precision and accuracy when compared with non‐guided techniques.

Horizontal Bone Augmentation and Simultaneous Implant Placement using Xenogeneic Bone Rings Technique: A Retrospective Clinical Study

“…Based on previous reports, the allogeneic bone ring grafts had been used in a few clinical trials 12,13,15,33 and got sufficient bone augmentation. Still, the application of allogeneic grafts is restricted by factors such as high cost, limited sources, the risk of disease transmission, and immunologic tissue reactions.…”

“…9,10,11 In this context, increasing studies have explored simultaneous bone augmentation technique and implant placement (Bone Ring Technique) in recent years . 6,12,13 Numerous studies have demonstrated that the bone ring technique integrated with an autogenous bone block can offer excellent outcome for dimensional bone augmentation. 6,10,12,13,14,15,16 With this technique, the implant is simultaneously placed with the bone augmentation procedure which both reduces the treatment time and maintains a sufficiently stable spatial structure.…”

“…6,12,13 Numerous studies have demonstrated that the bone ring technique integrated with an autogenous bone block can offer excellent outcome for dimensional bone augmentation. 6,10,12,13,14,15,16 With this technique, the implant is simultaneously placed with the bone augmentation procedure which both reduces the treatment time and maintains a sufficiently stable spatial structure. 17 Besides, due to the osteoinductive, osteoconductive, and osteogenic properties of autogenous grafts, clinicians in most cases graft the autogenous bone block to reconstruct the alveolar defects in this approach.…”

“…Presently, a few clinical trials have started to explore the application of bone substitute materials in the bone ring technique to achieve sufficient bone augmentation and circumvent the deficiency of autogenous grafts. 12,13,15 A wealth of clinical trials demonstrated that the allogeneic grafts, xenografts, and synthetic materials are efficient just like the autogenous bone to increase bone volume thereby avoiding extra surgical site. 3,8,20 However, allogeneic grafts can easily fracture due to their poor biomechanical properties, also, they may induce immunologic tissue reactions and risk of disease transmission.…”

The Digital Abutment Check: An Improvement of the Fully Digital Workflow

“…The template used in the present report provided a precise implementation of the digitally determined implant position [ 5 , 9 – 11 , 15 , 16 ]. The navigated procedure offered further advantages by eliminating the need for intraoperative flap formation, thus reducing surgical trauma and reducing the postoperative need for analgesics [ 8 , 17 ].…”