A novel digital and visualized guided bone regeneration procedure and digital precise bone augmentation: A case series

Abstract

Background Although the traditional bone augmentation technology can basically meet the clinical needs at present, the effect of bone augmentation in most cases is related to the experience of the operator. Propose This study commits to providing a digital solution for precise bone augmentation in the field of oral implantology. Materials and methods After collecting the data of patients' intraoral scanning and DICOM (digital imaging and communications in medicine), the implant position is digitally designed, and the alveolar bone is digitally augmented around the ideal implant position. On the premise of ensuring that the thickness of labial bone is 2 mm, and there is sufficient alveolar bone 3 to 4 mm apically from the ideal gingival margin for implant placing, we carry out excessive augmentation of 0.5 and 1 mm on the labial bone and alveolar crest, respectively, to compensate for possible bone resorption after 6 months. After 3D printing the reconstructed alveolar bone model, the titanium mesh is trimmed and preformed on the alveolar bone model. Outcomes are reported in terms of mean values (5%‐95% percentile values). Results Thirty implant sites have accepted this novel virtually designed alveolar bone augmentation. Before the second‐stage surgery, the average vertical bone gain was 2.48 mm (0.29‐6.32), the average horizontal bone gain was 4.11 mm (1.19‐8.74), the average height of the residual alveolar bone above the implant platform was 1.44 mm (0.59‐2.92), the average thickness of the labial bone width at the implant platform was 2.00 mm (0.93‐3.64), the average thickness of the labial bone width at 2 mm apically from the implant platform was 2.74 mm (1.40‐5.46). The virtual augmentation of each tooth position was 349.41 mm3 (165.70‐482.70), while the actual augmentation of each tooth position was 352.94 mm3 (159.24‐501.78), the accuracy of the final actual augmentation reached 95.82% (range from 88.53% to 99.15%). Conclusion This case series suggests that a virtually digital guided bone regeneration (GBR) workflow is precise and controllable. The practicality, safety and effectiveness of this procedure needs to be compared to other bone augmentation procedures in randomized controlled trials.

Titanium mesh for bone augmentation in oral implantology: current application and progress

“…According to the theory of Li et al, types 2/4 and 3/4 can be subclassified into mild and severe based on the degree of vertical absorption on the buccal or palatal bone wall. 46 Utilizing the excellent bone augmentation and maintenance ability, for alveolar ridges with light buccal or palatal plate absorption in vertical direction (mild type 2/4 or 3/4), GBR with titanium mesh can be applied in simultaneous implantation, as the implant can obtain sufficient initial stability. For alveolar ridges with severe vertical resorption on the buccal or palatal plate (severe type 2/4 or 3/4), excessive threads would be exposed with simultaneous implantation procedure, which may lead to failure of implantation owing to subsequent micromotion of the implant.…”

“…Hence, it is more recommended to conduct titanium mesh bone augmentation with delayed implantation. 46 Figure 1 shows the suitable bone augmentation methods for different types and subtypes of alveolar ridge defects. However, the selection of these procedures still needs to be analyzed according to the clinical situation.…”

“…And due to the relatively broad area of the bone defects that may cause movement on titanium mesh, titanium screws are usually used to fix the mesh firmly to facilitate blood clot stability and wound healing. 46 Besides, for the titanium mesh preformed in the digital process, with the appropriate implant system, the corresponding accessories (height, cover cap, or healing abutment) can be directly connected to the implant to immobilize the titanium mesh. The cover cap or healing abutment can be respectively used for submerged and non-submerged implantation as appropriate.…”

Hard tissue stability after guided bone regeneration: a comparison between digital titanium mesh and resorbable membrane

“… 21 The titanium mesh was preformed on the printed bone model, autoclaved, and then prepared for intraoperative use. 22 Preoperative preparation of the mesh greatly reduced the operative time, patient’s pain, and the possibility of infection in the operative area. In addition, we reduced the mechanical stimulation by the titanium mesh to the soft tissues by covering it with a collagen membrane and by the purposeful design of the bone augmentation area.…”

“… 23 Moreover, in our previous study, a lower exposure rate was observed for digital titanium meshes compared with other studies. 17 , 22 Therefore, the aforementioned methods could be utilized to overcome the disadvantages of the titanium mesh to obtain optimal osteogenic results, minimal complication rates, and good spatial maintenance. 24 …”