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Schematic diagram of 3D-printed patient-specific titanium mesh and guide plate in bone defect (A) Oblique view; B Top view; C Example image of 3D-printed patient-specific titanium mesh; D Schematic diagram of the guide plate
Source publication
Objective
Additively manufactured (3D-printed) titanium meshes have been adopted in the dental field as non-resorbable membranes for guided bone regeneration (GBR) surgery. However, according to previous studies, inaccuracies between planned and created bone volume and contour are common, and many reasons have been speculated to affect its accuracy...
Similar publications
Meshes, especially titanium ones, are being widely applied in oral surgery. In guided bone regeneration (GBR) procedures, their use is often paired with membranes, being resorbable or non-resorbable. However, they present some limitations, such as difficulty in the treatment of severe bone defects, alongside frequent mesh exposure. Customized meshe...
Citations
... Titanium mesh and autogenous bone block are the two main techniques to reconstruct severe bone defects. Titanium mesh provides excellent adaptability and can be shaped to fit various defect sizes and shapes, allowing for customized reconstructions [32][33][34]. Moreover, titanium mesh offers good stability and rigidity, maintaining the shape and contour of the reconstructed area. ...
Background
Onlay bone grafting is considered highly reliable for reconstructing severe horizontal bone defects. A critical problem is how to achieve precise position of the bone block to control alveolar ridge dimensions. This research aims to establish a digital workflow for prosthetically oriented onlay bone grafting and evaluate its accuracy and efficiency.
Methods
This prospective pilot study investigated eight patients who required implant restoration in the esthetic area with horizontal alveolar bone defects. The workflow includes preoperative virtual planning, design and manufacture of patient-specific templates, bone grafting surgery, and implant insertion. Primary outcomes were graft accuracy, defined by root mean square estimate (RMSE) values between preoperatively designed and actual implanted outer contours of bone blocks. Secondary outcomes were bone graft and implant success rates. Besides, the surgeons used the visual analog scale (VAS) to rate the intuitiveness, ease of understanding, and helpfulness of the workflow.
Results
No bone grafts or implants failed in any of the eight patients, resulting in a 100% success rate. The RMSE values between the preoperative design and the implanted outer contour of bone blocks were 0.41 ± 0.15 mm. The digital approach showed advantages in intuitiveness (9.3 ± 0.5), understanding (9.0 ± 0.5), and helpfulness (8.4 ± 1.1) according to surgeons' VAS scores.
Conclusions
A digital workflow provided encouraging results, in terms of accuracy and efficacy, for horizontal bone augmentation.
Trial registration
This study was registered in the National Clinical Trials Registry in 16/02/2023 under the identification number ChiCTR2300068361.
... 126 For (customized) titanium meshes, most reports analyzed horizontal augmentation of a maximum of 5-7 mm vertically and 4-5 mm in horizontal height, or did not give exact data on the augmented volume. 121,124,[127][128][129][130][131] In one case series, a vertical and horizontal gain of up to 9 mm with an exposure rate of 1/10 cases was reported. 132 ...
Reconstruction of significant maxillomandibular defects is a challenge that has been much discussed over the last few decades. Fundamental principles were developed decades ago (bone bed viability, graft immobilization). Clinical decision‐making criteria are highly relevant, including local/systemic factors and incision designs, the choice of material, grafting technique, and donor site morbidity. Stabilizing particulated grafts for defined defects—that is, via meshes or shells—might allow significant horizontal and vertical augmentation; the alternatives are onlay and inlay techniques. More significant defects might require extra orally harvested autologous bone blocks. The anterior iliac crest is often used for nonvascularized augmentation, whereas more extensive defects often require microvascular reconstruction. In those cases, the free fibula flap has become the standard of care. The development of alternatives is still ongoing (i.e., alloplastic reconstruction, zygomatic implants, obturators, distraction osteogenesis). Especially for these complex procedures, three‐dimensional planning tools enable facilitated planning and a surgical workflow.
... The studies were from four categories: controlled intervention studies [43,44], beforeafter (Pre-Post) studies with no control group [45], observational cohort studies [46][47][48][49][50][51], and case series/case report studies [52][53][54][55][56][57]. ...
... Cucchi et al., 2021 [43] Mounir et al., 2019 [44] Cucchi et al., 2022 [45] Lizio et al., 2022 [46] Dellavia et al., 2021 [47] Ciocca et al., 2018 [48] Chiapasco 2021 [49] avarro Cuellar 2021 [50] Yang et al., 2022 [51] Ghanaati et al., 2019 [52] Boogaard et al., 2019 [53] Nickenig et al., 2022 [54] De Santis et al., 2022 [55] Geletu et al., 2022 [56] Prosthesis 2023, 5, FOR PEER REVIEW [32][33][34][35][36][37][38][39][40][41][42]. ...
... The studies were from four categories: controlled interven before-after (Pre-Post) studies with no control group [45], observat [46][47][48][49][50][51], and case series/case report studies [52][53][54][55][56][57]. ...
Meshes, especially titanium ones, are being widely applied in oral surgery. In guided bone regeneration (GBR) procedures, their use is often paired with membranes, being resorbable or non-resorbable. However, they present some limitations, such as difficulty in the treatment of severe bone defects, alongside frequent mesh exposure. Customized meshes, produced by a full-digital process, have been recently introduced in GBR procedures. Therefore, the focus of the present review is to describe the main findings in recent years of clinical trials regarding patient-specific mesh produced by CAD/CAM and 3D printing workflow, made in titanium or even PEEK, applied to GBR surgeries. The purpose is to analyze their clinical management, advantages, and complications. This scoping review considered randomized clinical trials, observational studies, cohort studies, and case series/case reports studies. Studies that did not meet inclusion criteria were excluded. The preferred reporting items for scoping reviews (PRISMA-ScR) consensus was followed. A total of 15 studies were selected for this review. Based on the studies included, the literature suggests that meshes produced by a digital process are used to restore complex and severe bone defects. Moreover, they give satisfactory aesthetic results and fit the defects, counteracting grid exposure. However, more clinical trials should be conducted to evaluate long-term results, the rate of complications, and new materials for mesh manufacturing.
Objectives
The aim of this narrative review was to explore the application of digital technologies (DT) for the simplification and improvement of bone augmentation procedures in advanced implant dentistry.
Material and methods
A search on electronic databases was performed to identify systematic reviews, meta‐analyses, randomized and non‐randomized controlled trials, prospective/retrospective case series, and case reports related to the application of DT in advanced implant dentistry.
Results
Seventy‐nine articles were included. Potential fields of application of DT are the following: 1) the use of intra‐oral scanners for the definition of soft tissue profile and the residual dentition; 2) the use of dental lab CAD (computer‐aided design) software to create a digital wax‐up replicating the ideal ridge and tooth morphology; 3) the matching of STL (Standard Triangulation Language) files with DICOM (DIgital COmmunication in Medicine) files from CBCTs with a dedicated software; 4) the production of stereolithographic 3D models reproducing the jaws and the bone defects; 5) the creation of surgical templates to guide implant placement and augmentation procedures; 6) the production of customized meshes for bone regeneration; and 7) the use of static or dynamic computer‐aided implant placement.
Conclusions
Results from this narrative review seem to demonstrate that the use of a partially or fully digital workflow can be successfully used also in advanced implant dentistry. However, the number of studies (in particular RCTs) focused on the use of a fully digital workflow in advanced implant dentistry is still limited and more studies are needed to properly evaluate the potentials of DT.
The rehabilitation of alveolar bone defects of moderate to severe size is often challenging. Currently, the therapeutic approaches used include, among others, the guided bone regeneration technique combined with various bone grafts. Although these techniques are widely applied, several limitations and complications have been reported such as morbidity, suboptimal graft/membrane resorption rate, low structural integrity, and dimensional stability. Thus, the development of biomimetic scaffolds with tailor-made characteristics that can modulate cell and tissue interaction may be a promising tool. This article presents a critical consideration in scaffold’s design and development while also providing information on various fabrication methods of these nanosystems. Their utilization as delivery systems will also be mentioned.
Background:
Customized computer-aided-design/computer-aided-manufacturing (CAD/CAM) titanium meshes have been adopted for alveolar bone augmentation. But the inaccuracies between planned and created bone volume/contour are quite common, and the surgical placement of the customized mesh was considered as the first critical factor. However, the evaluation of surgical placement accuracy of customized mesh is currently lacking.
Purpose:
The aim of this study was to evaluate the accuracy of the surgical placement of customized meshes.
Methods:
A total of 30 cases, 20 without the screws-position-guided template and 10 with the screws-position-guided template, were included in this study. The cone beam CT (CBCT) data sets of pre- and postoperative were converted into 3D models and digitally aligned. Then the actual placement of customized mesh and retainer titanium screws was compared to the virtual one to assess the surgical placement accuracy of customized mesh. At least 6 months after surgery, a new CBCT was taken and converted into 3D models. Planned bone volume, created bone volume, vertical bone augmentation, healing complications rate, pseudo-periosteum rate, exposure rate, and infection rate were all evaluated.
Results:
The 3D digital reconstruction/registration analysis showed that the average difference between actual placement and planned one of customized mesh in positive and negative directions was 2.69 ± 0.70 mm and -1.41 ± 0.90 mm, respectively, without the screws-position-guided template. And the mean difference values between the actual and planned placement of the screws on the X and Y axes were 0.74 ± 0.85 mm and 0.89 ± 0.84 mm. In contrast, with the screws-position-guided template, the results were 2.38 ± 0.69 mm and -1.30 ± 1.13 mm. Accordingly, the mean difference values of screws were 0.76 ± 0.84 mm and 0.94 ± 0.72 mm. There was no statistical difference between the two groups, and the noninferiority of the control group compared to the test group was also confirmed by the comparative analysis.
Conclusion:
It can be concluded that there is a certain deviation between the planned surgical placement and actual one of customized mesh, and using screws-position-guided template is of limited help for its accurate placement. Further research is needed to achieve precise surgical placement of the customized mesh to achieve precise alveolar bone augmentation.
