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. 2020 Aug 5;20(1):219.
doi: 10.1186/s12903-020-01205-4.

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

Alessandro Cucchi  1 , Alessandro Bianchi  2 , Paolo Calamai  3 , Lisa Rinaldi  4 , Francesco Mangano  5 , Elisabetta Vignudelli  4 , Giuseppe Corinaldesi  4
Affiliations

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

Alessandro Cucchi et al. BMC Oral Health. .

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 mm3, 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.

Keywords: Alveolar ridge augmentation; Computer-aided-design/computer-aided-manufacturing; Custom-made; Dental implants; Titanium meshes.

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Conflict of interest statement

The authors declare that they have no competing interests in relation to the present study. Francesco Mangano is the editor of the Digital Dentistry section of BMC Oral Health.

Figures

Fig. 1
Fig. 1
Three-dimensional digital planning of customized mesh for alveolar deficiency in posterior mandible; definitive rendering of the customized mesh. a The mesh modelled over the mandible. b The mesh alone, buccal view. c The mesh alone, anterior (frontal) view. d The mesh alone: lingual view. e The mesh, posterior view
Fig. 2
Fig. 2
Digital planning of the implants (a) and the customized mesh (b) in the posterior mandible. c Alveolar ridge before augmentation. d CAD/CAM mesh. e Fixation of the mesh with three titanium screws. f Alveolar ridge 6 months after bone augmentation
Fig. 3
Fig. 3
Radiographic images of the customized mesh in position (a), of the implants placed in regenerated bone (b), the abutments (c), and the delivery of the final restoration (d). Radiographic controls 6 months (e) and 1 year (f) after the delivery of final restoration
Fig. 4
Fig. 4
Virtual rendering of customized mesh in anterior mandible (a). Soft tissues of the edentulous ridge before bone augmentation (b). Alveolar ridge with a severe defect (c). Fixation of the CAD/CAM mesh with two titanium screws (d). Soft tissues at 6 months, after uneventful healing (e). Alveolar ridge 8 months after bone augmentation (f)
Fig. 5
Fig. 5
Virtual rendering of customized mesh in posterior maxilla (a). Alveolar ridge before augmentation, showing a double bone window for maxillary sinus lift (b). CAD/CAM mesh filled with 50:50 of autogenous bone and xenograft material (c). Fixation of the mesh with three titanium screws (d). Soft tissues at 6 months, after uneventful healing (e). Alveolar ridge 9 months after bone augmentation (F)
Fig. 6
Fig. 6
Virtual rendering of customized mesh in the posterior mandible (a). Soft tissues of edentulous ridge before bone augmentation (b). CAD/CAM mesh (c). Fixation of the mesh with three titanium screws (d). Soft tissues at 6 months, after uneventful healing (e). Alveolar ridge 6 months after bone augmentation (f)
Fig. 7
Fig. 7
Measurements with dedicated software of bone volume pre- and post-operatively: .dicom files selection (a, b ,c), .stl files creation (d), interpolation (e), superimposition and volume calculation (f)
See this image and copyright information in PMC

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