Custom-Made Computer-Aided-Design/Computer-Aided-Manufacturing Biphasic Calcium-Phosphate Scaffold for Augmentation of an Atrophic Mandibular Anterior Ridge

Abstract

This report documents the clinical, radiographic, and histologic outcome of a custom-made computer-aided-design/computer-aided-manufactured (CAD/CAM) scaffold used for the alveolar ridge augmentation of a severely atrophic anterior mandible. Computed tomographic (CT) images of an atrophic anterior mandible were acquired and modified into a 3-dimensional (3D) reconstruction model; this was transferred to a CAD program, where a custom-made scaffold was designed. CAM software generated a set of tool-paths for the manufacture of the scaffold on a computer-numerical-control milling machine into the exact shape of the 3D design. A custom-made scaffold was milled from a synthetic micromacroporous biphasic calcium phosphate (BCP) block. The scaffold closely matched the shape of the defect: this helped to reduce the time for the surgery and contributed to good healing. One year later, newly formed and well-integrated bone was clinically available, and two implants (AnyRidge, MegaGen, Gyeongbuk, South Korea) were placed. The histologic samples retrieved from the implant sites revealed compact mature bone undergoing remodelling, marrow spaces, and newly formed trabecular bone surrounded by residual BCP particles. This study demonstrates that custom-made scaffolds can be fabricated by combining CT scans and CAD/CAM techniques. Further studies on a larger sample of patients are needed to confirm these results.

Custom-Made Synthetic Scaffolds for Bone Reconstruction: A Retrospective, Multicenter Clinical Study on 15 Patients

“…Nowadays, modern digital technologies allow the surgeon to virtually design and then fabricate custom-made synthetic porous scaffolds, for use in bone reconstructive procedures [20, 23–26, 36]. In different medical fields, several studies have demonstrated that the combination of modern image acquisition techniques with 3D reconstruction software allows the clinician to obtain custom-made scaffolds for the regeneration of bone structures [20, 23–26, 36–40].…”

“…In different medical fields, several studies have demonstrated that the combination of modern image acquisition techniques with 3D reconstruction software allows the clinician to obtain custom-made scaffolds for the regeneration of bone structures [20, 23–26, 36–40]. This powerful combination allows the surgeon to virtually plan the reconstruction of an atrophic bone area on his/her computer and to fabricate a custom-made biocompatible scaffold designing its size, thickness, and shape [20, 23–26, 36–40]. The fabrication of the scaffold can be obtained by milling blocks of synthetic bone substitutes that mimic the structure of natural bone and therefore promote the formation of new bone when implanted in the area of defect [36–40].…”

“…In fact, the recent improvements in computer-guided technologies provide clinicians with the possibility of evaluating the size and shape of the bone defect in 3D, before the surgery, with the aid of a cone beam computed tomography (CBCT) examination [20–25]. CBCT files can be transferred to specific reconstruction software, where a 3D model of the maxilla/mandible of the patient can be easily obtained [25, 26]. Finally, a custom-made bone graft can be designed directly on this 3D model, using powerful computer-assisted-design (CAD) software [20, 21, 25, 26].…”

“…CBCT files can be transferred to specific reconstruction software, where a 3D model of the maxilla/mandible of the patient can be easily obtained [25, 26]. Finally, a custom-made bone graft can be designed directly on this 3D model, using powerful computer-assisted-design (CAD) software [20, 21, 25, 26]. The custom-made bone graft is then milled with a computer-numeric-control (CNC) machine, in the selected material (allograft, xenograft, or alloplast), according to the file received from the 3D planning made by the surgeon [20, 21, 25, 26].…”

“…Finally, a custom-made bone graft can be designed directly on this 3D model, using powerful computer-assisted-design (CAD) software [20, 21, 25, 26]. The custom-made bone graft is then milled with a computer-numeric-control (CNC) machine, in the selected material (allograft, xenograft, or alloplast), according to the file received from the 3D planning made by the surgeon [20, 21, 25, 26]. This custom-made bone graft will be easily adapted in the surgical site, with high accuracy: this approach can facilitate surgery, reducing the operative time and discomfort of the patient [20, 21, 25, 26].…”