A customised digitally engineered solution for fixed dental rehabilitation in severe bone deficiency: A new innovative line extension in implant dentistry

Gellrich, Nils‐Claudius; Zimmerer, Rüdiger; Spalthoff, Simon; Jehn, Philipp; Pott, Philipp‐Cornelius; Rana, Majeed; Rahlf, Björn

doi:10.1016/j.jcms.2017.07.022

Cited by 39 publications

(33 citation statements)

References 13 publications

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“…For all these patients, and in all these situations, subperiosteal implants may be an alternative, due to the digital revolution and the advent of modern digital technologies in dentistry [34][35][36][37]46]. CBCT allows acquisition of 3D data of the patient's residual bone volume, with considerable accuracy, and a low dose of radiation directed exclusively at the area of interest [27,47].…”

Section: Discussionmentioning

confidence: 99%

“…CBCT allows acquisition of 3D data of the patient's residual bone volume, with considerable accuracy, and a low dose of radiation directed exclusively at the area of interest [27,47]. The data acquired with the CBCT is then re-elaborated with appropriate reconstruction software, which allows generation of a virtual bone model of the area of interest [34][35][36][37]. Capturing an optical impression of the dentate arches allows modelling of a virtual diagnostic wax-up.…”

Section: Discussionmentioning

confidence: 99%

“…Capturing an optical impression of the dentate arches allows modelling of a virtual diagnostic wax-up. Finally, the superimposition of bone and dental models, together with the virtual wax-up, makes it possible to design and model custom-made subperiosteal implants, designed and conceived specifically for the patient's needs, both as a bone-supported structure and as a prosthetic emergency [34][35][36][37]. These 3D-printed implants represent a possible alternative solution for the rehabilitation of the atrophic posterior mandible of elderly patients who do not want or cannot undergo traditional regenerative techniques, preparatory to insertion of classical endosseous implants [34][35][36][37].…”

Section: Discussionmentioning

confidence: 99%

“…This allows the opportunity to revisit some old concepts, such as the placement of subperiosteal implants, and reinterpret them in a new technological context based on consolidated anatomical and physiological principles [34][35][36]. The reduction of treatment to a single surgical session, lower costs for the patient and, above all, the precision that makes the method more predictable and safer in the short term have brought the attention of clinicians back to the use of subperiosteal implants, particularly for the management of complex atrophies such as in the posterior mandible of elderly patients [36,37].…”

Section: Introductionmentioning

confidence: 99%

“…In severe posterior mandible bone resorption, when the patient does not want to undergo bone regeneration, modern digital technologies may represent a viable solution, with the possibility to fabricate custom-made subperiosteal implants perfectly adapted to their local morphology and anatomy [36,37]. This is of particularly interest for elderly patients with special needs, who do not want or cannot undergo complex regenerative surgeries, but need a fixed prosthetic restoration [37].…”

Section: Introductionmentioning

confidence: 99%

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Custom-made 3D printed subperiosteal titanium implants for the prosthetic restoration of the atrophic posterior mandible of elderly patients: a case series

et al. 2020

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Purpose: To present the application of custom-made 3D-printed subperiosteal implants for fixed prosthetic restoration of the atrophic posterior mandible of elderly patients. Methods: Between January 2017 and June 2018, all partially edentulous patients aged over 65 years, with two or more missing teeth in the posterior atrophic mandible, and who did not want to undergo bone regenerative procedures, were included in this study. These patients were rehabilitated with custom-made subperiosteal implants, designed from cone beam computed tomography (CBCT) and fabricated in titanium by means of direct metal laser sintering (DMLS). The outcome measures were fit and stability of the implants at placement, duration of the intervention, implant survival, and early and late complications. All patients were followed for 1 year after surgery. Results: Ten patients (four males, six females; mean age 69.6, SD ± 2.8, median 69, 95% CI 67.9-71.6) were included in the study. The fit of the implants was satisfactory, with a mean rating of 7 out of 10 (SD ± 1.6, median 7, 95% CI 6-8). Only two implants had insufficient fit, because of the presence of scattering in the CBCT; however, they were adapted to the sites during the interventions. The mean duration of the intervention was 44.3 min (SD ± 19.4, median 37, 95% CI 32.3-56.3). At the one-year follow-up, no implants were lost (survival rate 100%). One implant presented immediate postoperative complications with pain, discomfort and swelling, and two patients experienced late complications, having their provisional restorations fractured during the temporisation phase. All these complications were minor in nature, but the final complication rate amounted to 30% (three of ten patients). Conclusions: Although this study has limits (small patient sample and short follow-up), DMLS has proven to be an effective method for fabricating accurate subperiosteal implants, with high survival rates. This may represent an alternative treatment procedure in elderly patients with a severely atrophic posterior mandible, since it allows avoidance of regenerative bone therapies. Further studies are needed to confirm these outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Custom-made 3D printed subperiosteal titanium implants for the prosthetic restoration of the atrophic posterior mandible of elderly patients: a case series

et al. 2020

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Submodelling approach to screw‐to‐bone interaction in additively manufactured subperiosteal implant structures

Castrillo

Carnicero

Perera

2023

Numer Methods Biomed Eng

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Thanks to new digital technologies, complex cases of severe maxillary atrophy may now be treated with additively manufactured subperiosteal implant structures (AMSISs). However, there are few studies addressing this topic and most of them focus on the mechanical behaviour of the AMSIS itself without considering its interaction with the maxilla bone. The aim of this study is to provide a methodology based on finite element analysis (FEA) to evaluate the effect of interaction between the maxilla bone and the screws fixing the AMSIS. The mechanical performance of an AMSIS was examined via a FEA based on submodelling. Significant differences were encountered in displacements and reaction forces when bone–screw interaction was considered. Stress in the cortical layer was found to be close to the maximum strength while the trabecular layer seems to have no effect on the results; stresses in the AMSIS are lower than the fatigue stress limit. Finally, the comparison of stresses between models with and without osseointegration shows how stresses drop once osseointegration is complete. The proposed submodelling approach considerably reduces the computational effort and enables both a detailed model of the interaction between the thread of the screws and the bone and an accurate evaluation of displacement and stress fields on the interface. The results have shown that stresses in the cortical bone are highly affected by the initial geometry of the thread inside the bone, which demonstrates the importance of modelling the effect of the thread.

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Use of Three-Dimensional Technology for Virtual Surgical Planning in Oral and Maxillofacial Surgery

Azri

Ghosh

Shum

2023

Advancements and Innovations in OMFS, ENT, and Facial Plastic Surgery

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A customised digitally engineered solution for fixed dental rehabilitation in severe bone deficiency: A new innovative line extension in implant dentistry

Cited by 39 publications

References 13 publications

Custom-made 3D printed subperiosteal titanium implants for the prosthetic restoration of the atrophic posterior mandible of elderly patients: a case series

Custom-made 3D printed subperiosteal titanium implants for the prosthetic restoration of the atrophic posterior mandible of elderly patients: a case series

Submodelling approach to screw‐to‐bone interaction in additively manufactured subperiosteal implant structures

Use of Three-Dimensional Technology for Virtual Surgical Planning in Oral and Maxillofacial Surgery

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