Clinical outcome of alveolar ridge augmentation with individualized CAD-CAM-produced titanium mesh

Abstract

Background: The augmentation of the jaw has been and continues to be a sophisticated therapy in implantology. Modern CAD-CAM technologies lead to revival of old and established augmentation techniques such as the use of titanium mesh (TM) for bone augmentation. The aim of this retrospective study was to evaluate the clinical outcome of an individualized CAD-CAM-produced TM based on the CT/DVT-DICOM data of the patients for the first time.

Methods: In 17 patients, 21 different regions were augmented with an individualized CAD-CAM-produced TM (Yxoss CBR®, Filderstadt, Germany). For the augmentation, a mixture of autologous bone and deproteinized bovine bone mineral (DBBM) or autologous bone alone was used. Reentry with explantation of the TM and simultaneous implantation of 44 implants were performed after 6 months. Preoperative and 6-month postoperative cone beam computed tomographies (CBCT) were performed to measure the gained bone height.

Results: The success rate for the bone grafting procedure was 100%. Thirty-three percent of cases presented an exposure of the TM during the healing period. However, premature removal of these exposed meshes was not necessary. Exposure rate in augmentations performed with mid-crestal incisions was higher than in augmentations performed with a modified poncho incision (45.5 vs. 20%, p = 0.221). In addition, exposure rates in the maxilla were significantly higher than in the mandible (66.7 vs. 8.3%, p = 0.009). Gender, smoking, periodontal disease, gingiva type, used augmentation material, and used membrane had no significant influence on the exposure rate (p > 0.05). The mean vertical augmentation was 6.5 ± 1.7 mm, and the mean horizontal augmentation was 5.5 ± 1.9 mm. Implant survival rate after a mean follow-up of 12 ± 6 months after reentry was 100%.

Conclusion: Within the limits of the retrospective character of this study, this study shows for the first time that individualized CAD-CAM TM provide a sufficient and safe augmentation technique, especially for vertical and combined defects. However, the soft tissue handling for sufficient mesh covering remains one of the most critical steps using this technique.

Keywords: Augmentation; Bone atrophy; Bone regeneration; CAD-CAM; PRF; Titanium mesh.

Conflict of interest statement

Competing interests

Keyvan Sagheb reports personal fees and grants from Dentsply, Geistlich, and Nobel Biocare outside the submitted work. Eik Schiegnitz reports personal fees and grants from Septodont, Dentsply, Geistlich, and Straumann outside the submitted work. Maximilian Moergel reports grants from Camlog outside the submitted work. Christian Walter reports grants and personal fees from Straumann outside the submitted work. Bilal Al-Nawas reports grants and personal fees from Camlog, Dentsply, Geistlich, Nobel Biocare, and Straumann outside the submitted work. Wilfried Wagner reports grants and personal fees from Camlog, Dentsply, Geistlich, Nobel Biocare, Straumann, and Zimmer outside the submitted work.

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Figures

Fig. 1

Schematic drawing of the poncho flap approach

Fig. 2

Preoperative CBCT scan showing the vertical and horizontal deficit

Fig. 3

3D design of the CAD-CAM-based individualized TM by ReOss®

Fig. 4

Intraoperative clinical picture after insertion of CAD-CAM mesh

Fig. 5

Orthopantomogram after augmentation

Fig. 6

Clinical picture after 6 months showing an exposure of the mesh

Fig. 7

Orthopantomogram after implant insertion

Fig. 8

Clinical picture after implant insertion

Fig. 9

Representative picture of analysis of vertical and horizontal bone augmentation on CBCT scan

Fig. 10

Mean vertical and horizontal augmentation height (mm)