Patient-specific beta-tricalcium phosphate scaffold for customized alveolar ridge augmentation: a case report : Case Report: patient-specific β-TCP scaffold for alveolar ridge CBR

Abstract

Background: Beta-tricalcium phosphate (β-TCP) is a biocompatible ceramic material widely used in the field of oral regeneration. Due to its excellent biological and mechanical properties, it is increasingly utilized for alveolar ridge augmentation or guided bone regeneration (GBR). With recent advances in computer-aided design and manufacturing (CAD/CAM), β-TCP can now be used in the form of digitally designed patient-specific scaffolds for customized bone regeneration (CBR) of advanced defects in a two-stage implant therapy concept. In this case report following the CARE case report guidelines, we present a novel application of a patient-specific β-TCP scaffold in pre-implant mandibular alveolar ridge augmentation.

Case presentation: A 63-year-old female patient with significant horizontal bone loss in the posterior mandible was treated with a custom β-TCP scaffold in the context of a two-stage backward-planned implant therapy. Cone-beam computed tomography nine months after augmentation showed successful integration of the scaffold into the surrounding bone, allowing implant placement. Follow-up until two years after initial surgery showed excellent oral and peri-implant health.

Conclusions: This case highlights the potential of patient-specific β-TCP scaffolds for alveolar ridge augmentation and their advantage over traditional techniques, including avoidance of xeno-, allo-, and autografts. The results provide encouraging evidence for their use in clinical practice. Patient-specific β-TCP scaffolds may be a promising alternative for clinicians seeking to provide their patients with safe, predictable, and effective alveolar ridge augmentation results in customized bone regeneration procedures.

Keywords: CBR; Case report; Customized bone regeneration; Guided bone regeneration; Two-stage implant therapy; beta-tricalcium phosphate; β-TCP.

Fig. 1

Pre-operative clinical (left) and radiologic (middle) situation demonstrating extensive horizontal and vertical bone defect after extraction of the right mandibular first molar. Right: digitally planned beta-tricalcium phosphate (β-TCP) scaffold with the matching drilling guide

Fig. 2

Intraoperative photographs demonstrating the bony defect (a), placement of the drilling guide (b), positioning of the custom beta-tricalcium phosphate (β-TCP) scaffold (c) and its fixation with resorbable poly-lactide pins (d)

Fig. 3

Post-operative axial (a) and coronal (b) reconstruction of the patient’s cone-beam computed tomography (CBCT) scan showing successful customized bone regeneration (CBR). Note that the structure of the beta-tricalcium phosphate (β-TCP) scaffold is still visible

Fig. 4

Intraoperative photograph showing the 3D-printed implant guide (a). Re-entry proved sufficient bone regeneration (b). After pre-drilling (c), the implant was placed with good primary stability and left for transmucosal healing (d)

Fig. 5

Histological examination of the drilled-out bone cylinder. Newly formed trabecular bone is stained blue, newly formed osteoid appears light gray, while preexisting bone prior to augmentation is dark gray

Fig. 6

Post-operative clinical (a, b) and radiologic (c) situation