Horizontal ridge reconstruction of the anterior maxilla using customized allogeneic bone blocks with a minimally invasive technique - a case series

Abstract

BackgroundDifferent surgical procedures have been proposed to achieve horizontal ridge reconstruction of the anterior maxilla; all these procedures, however, require bone replacement materials to be adapted to the bone defect at the time of implantation, resulting in complex and time-consuming procedures. The purpose of this study was to describe how to use a 3D printed hardcopy model of the maxilla to prepare customized milled bone blocks, to be adapted on the bone defect areas using a minimally invasive subperiosteal tunneling technique.MethodsCone beam computed tomography (CBCT) images of the atrophic maxilla of six patients were acquired and modified into 3D reconstruction models. Data were transferred to a 3D printer and solid models were fabricated using autoclavable nylon polyamide. Before the surgery, freeze-dried cortico-cancellous blocks were manually milled and adapted on the 3D printed hardcopy models of the maxillary bone, in order to obtain customized allogeneic bone blocks.ResultsIn total, eleven onlay customized allogeneic bone grafts were prepared and implanted in 6 patients, using a minimally invasive subperiosteal tunneling technique. The scaffolds closely matched the shape of the defects: this reduced the operation time and contributed to good healing. The patients did not demonstrate adverse events such as inflammation, dehiscence or flap re-opening during the recovery period; however, one patient experienced scaffold resorption, which was likely caused by uncontrolled motion of the removable provisional prosthesis. Following a 6 month healing period, CBCT was used to assess graft integration, which was followed by insertion of implants into the augmented areas. Prosthetic restorations were placed 4 months later.ConclusionsThese observations suggest that customized bone allografts can be successfully used for horizontal ridge reconstruction of the anterior maxilla: patients demonstrated reduced morbidity and decreased total surgery time. Further studies on a larger sample of patients, with histologic evaluation and longer follow-up are needed to confirm the present observations.

Design Techniques to Optimize the Scaffold Performance: Freeze-dried Bone Custom-made Allografts for Maxillary Alveolar Horizontal Ridge Augmentation

“…Inclusion criteria was a horizontal severely atrophic maxilla (Cawood and Howell class IV), needing a bone grafting procedure prior to implant placement. Exclusion criteria were established according to Venet et al (2017) [12]. Plaque index score was maintained ≤25% throughout the study [14].…”

“…The clinically sized, anatomically shaped, custom-made bone block was placed in position strictly overlapping the underlying alveolar crest and fitted securely to the residual bone ( Figure 4b1). The recipient site was weakened with multiple micro-holes to enhance bleeding from the trabecular bone [12,21,22]. Rigid fixation of the scaffold to the residual crest was obtained by means of a titanium mini-screw (1.5 mm width, 8 mm length) (Tekka by Global-D, Lyon, France) ( Figure 4b2) [12].…”

Design Techniques to Optimize the Scaffold Performance: Freeze-dried Bone Custom-made Allografts for Maxillary Alveolar Horizontal Ridge Augmentation

“…The clinically sized, anatomically shaped custom-made bone block was placed in position strictly overlapping the underlying alveolar crest and fitted securely to the residual bone [ Figure 4-b1]. The recipient site was weakened with multiple micro-holes to enhance bleeding from the trabecular bone [19][20][21]. Rigid fixation of the scaffold to the residual crest was obtained by means of a 1,5Wx8L titanium mini-screw (Tekka by Global-D Lyon, Fr) [ Figure 4-b2] [20].…”

“…The recipient site was weakened with multiple micro-holes to enhance bleeding from the trabecular bone [19][20][21]. Rigid fixation of the scaffold to the residual crest was obtained by means of a 1,5Wx8L titanium mini-screw (Tekka by Global-D Lyon, Fr) [ Figure 4-b2] [20]. Preceding to the second phase, supplementary CBCT scans were taken in in order to evaluate grafts gain [ Figure 5].…”

Custom-made 3D printed subperiosteal titanium implants for the prosthetic restoration of the atrophic posterior mandible of elderly patients: a case series

“…In the absence of adequate bone, three possible solutions presently exist. The first is to use reconstructive materials with techniques identified as onlay/inlay bone grafting [13], guided bone regeneration with non-resorbable [14] or resorbable membranes [15], alveolar ridge split [16], distraction osteogenesis [17] or sinus augmentation [18]. The issue with these techniques is the length of treatment, with the possibility of intra-and postoperative complications, due to the complexity of the procedures.…”