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. 2025 Jun;36(6):759-770.
doi: 10.1111/clr.14425. Epub 2025 Mar 7.

Customized Bone Regeneration-A Retrospective Clinical Follow-Up Study of the Aesthetic Outcome

Marcus Seiler  1 , Peer W Kämmerer  2 , Amely Hartmann  1   2
Affiliations

Customized Bone Regeneration-A Retrospective Clinical Follow-Up Study of the Aesthetic Outcome

Marcus Seiler et al. Clin Oral Implants Res. 2025 Jun.

Abstract

Objectives: This study aimed to evaluate the long-term stability of soft tissue aesthetics as the primary outcome concerning bone levels (secondary outcome) following customized bone regeneration. Additionally, the influence of flap management techniques on aesthetic outcomes in customized bone augmentation was assessed.

Material and methods: 21 patients (45 implants) who underwent reconstruction of three-dimensional bone defects using patient-specific titanium meshes at least 5 years prior were evaluated. The Pink Esthetic Score (PES) was used to assess aesthetic outcomes. Incision lines and flap designs were correlated with aesthetic parameters (primary outcome) and bone levels (secondary outcome). Radiographic measurements of bone levels were taken at implant placement and after more than 5 years. Changes over time in aesthetic outcomes were analyzed using Fisher's Exact Test, Mann-Whitney U-test, and Kruskal-Wallis Test.

Results: Crestal incisions without vertical releasing incisions showed significantly superior outcomes in aesthetics (primary outcome) and bone level mesially (p < 0.001) and distally (p = 0.001) compared to Poncho flaps or crestal incisions with vertical releasing incisions after > 5 years (secondary outcome). Across parameters, 52.6% to 69.2% of cases achieved a maximum aesthetic rating ("2"). The mean PES score was 11.09 (±3.70) across all implants. The implant survival rate was 100%.

Conclusions: A crestal incision line without releasing incisions was superior in preserving bone levels and achieving favorable aesthetic outcomes. The findings highlight the importance of incision and flap design in the long-term outcomes of customized bone regeneration. The 100% implant survival rate and lack of side effects further underscore the reliability of this approach.

Keywords: aesthetics; bone augmentation procedures; guided bone regeneration; pink aesthetic score; soft tissue.

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Conflict of interest statement

M. Seiler is the inventor of the customized bone regeneration technique.

Figures

FIGURE 1
FIGURE 1
Complex defect situation.
FIGURE 2
FIGURE 2
Digitally added grafting volume (orange) and titanium mesh on the bony defect.
FIGURE 3
FIGURE 3
Uncovering the implant in 2016.
FIGURE 4
FIGURE 4
Soft tissue situation at the time of uncovering.
FIGURE 5
FIGURE 5
X‐Ray taken at the follow‐up appointment in 2022.
FIGURE 6
FIGURE 6
Schematic scenario of a flap management without releasing incision (part 1).
FIGURE 7
FIGURE 7
Schematic scenario of a flap management without releasing incision (part 2).
FIGURE 8
FIGURE 8
Schematic scenario of a flap management with releasing incision (part 1).
FIGURE 9
FIGURE 9
Schematic scenario of a flap management with releasing incision (part 2).
FIGURE 10
FIGURE 10
Schematic scenario of a flap management with poncho flap (part 1).
FIGURE 11
FIGURE 11
Schematic scenario of a flap management with poncho flap (part 2).
FIGURE 12
FIGURE 12
Pink Esthetic Score with the seven parameters (adopted from Furhauser et al. (2005)). Clinical picture of a situation 5 years after complex bone augmentation procedure. (1) Mesial papilla. (2) Distal papilla. (3) Level of soft tissue margin. (4) Soft tissue contour. (5) Soft tissue colour. (6) Alveolar process. (7) Soft tissue texture.
FIGURE 13
FIGURE 13
Influence of incision technique and flap design on aesthetic/PES‐parameter color.
FIGURE 14
FIGURE 14
MBL (Marginal bone loss) mesial: upper versus lower jaw.
FIGURE 15
FIGURE 15
Bone level relation (mesial and distal after 5 years, spearman correlation 0.560).
See this image and copyright information in PMC

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