Custom-Made Titanium Mesh for Maxillary Bone Augmentation With Immediate Implants and Delayed Loading

Cucchi, Alessandro; Giavatto, M. A.; Giannatiempo, J.; Lizio, Giuseppe; Corinaldesi, Giuseppe

doi:10.1563/aaid-joi-d-18-00141

Cited by 18 publications

(22 citation statements)

References 5 publications

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“…In total, 10 consecutive patients, five women and five men, mean age 52 years, showing a localized bone defect in maxilla ( n = 5) or mandible (n = 5) and in need of bone augmentation were consecutively treated according to the study protocol, from January 2017 to December 2018. The whole digital workflow and the mesh production phases had already been described in a previous study [ 16 ]. Five patients had a history of periodontitis or peri-implantitis, two patients had smoking habits (less than 10 cigarettes/die), and no patients had severe systemic or metabolic disease.…”

Section: Resultsmentioning

confidence: 99%

“…The use of customized CAD/CAM titanium mesh, designed in 3D and fabricated via DMLS can guarantee a practical advantage since the surgeon receives the mesh already in the desired shape, there is no waste of time in adapting it on the site and therefore the intervention is potentially faster, with a reduced risk of infection [ 16 ]. In addition, the edges of the mesh are designed so as not to traumatize the soft tissues and avoid exposures [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…During the development phase of customized devices, the use of dedicated software resulted very effective (i) in performing the virtual augmentation, (ii) in designing a 3D virtual mesh that fits precisely to the residual bone, and (iii) to evaluate the effects of planned surgery superimposing the virtual augmented bone to the native bone profile [ 16 ]. The external shape of the mesh should be constructed as round as possible to avoid flap damage; similarly, the surface should be as smooth as possible to avoid bacterial colonization or infection.…”

Section: Discussionmentioning

confidence: 99%

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Clinical and volumetric outcomes after vertical ridge augmentation using computer-aided-design/computer-aided manufacturing (CAD/CAM) customized titanium meshes: a pilot study

Cucchi

Bianchi

Calamai³

et al. 2020

BMC Oral Health

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Background One of the most recent innovations in bone augmentation surgery is represented by computer-aided-design/computer-aided-manufacturing (CAD/CAM) customized titanium meshes, which can be used to restore vertical bone defects before implant-prosthetic rehabilitations. The aim of this study was to evaluate the effectiveness/reliability of this technique in a consecutive series of cases. Methods Ten patients in need of bone augmentation before implant therapy were treated using CAD/CAM customized titanium meshes. A digital workflow was adopted to design virtual meshes on 3D bone models. Then, Direct Metal Laser Sintering (DMLS) technology was used to produce the titanium meshes, and vertical ridge augmentation was performed according to an established surgical protocol. Surgical complications, healing complications, vertical bone gain (VBG), planned bone volume (PBV), lacking bone volume (LBV), regenerated bone volume (RBV), average regeneration rate (RR) and implant success rate were evaluated. Results All augmented sites were successfully restored with definitive implant-supported fixed partial dentures. Measurements showed an average VBG of 4.5 ± 1.8 mm at surgical re-entry. Surgical and healing complications occurred in 30% and 10% of cases, respectively. Mean values of PBV, LBV, and RBV were 984, 92, and 892 mm 3 , respectively. The average RR achieved was 89%. All 26 implants were successfully in function after 1 year of follow-up. Conclusions The results of this study suggest that the bone augmentation by means of DMLS custom-made titanium meshes can be considered a reliable and effective technique in restoring vertical bone defects.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical and volumetric outcomes after vertical ridge augmentation using computer-aided-design/computer-aided manufacturing (CAD/CAM) customized titanium meshes: a pilot study

Cucchi

Bianchi

Calamai³

et al. 2020

BMC Oral Health

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“…The ideal application area for these technologies seems to be implantology. In fact, thanks to CBCT and intraoral scanners, it is now possible to acquire accurate information on bone, dental, and soft tissue anatomy; combining this information in a virtual environment, within dedicated surgical CAD, it is possible to construct a virtual patient model [ 27 ] on which to plan the intervention (for example, the placement of implants [ 14 , 15 , 28 ], but also a bone regeneration with custom-made grafts [ 29 , 30 ], blades [ 31 ], meshes [ 32 ], as well as root analogue [ 33 ] or subperiosteal [ 34 ] implants).…”

Section: Discussionmentioning

confidence: 99%

Full in-Office Guided Surgery with Open Selective Tooth-Supported Templates: A Prospective Clinical Study on 20 Patients

Mangano

Hauschild²,

Admakin

2018

IJERPH

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Background: Guided implant surgery appears to have several benefits, such as the possibility of inserting flapless implants in a prosthetically driven manner, avoiding dangerous anatomical structures. However, to date, only a few surgeons routinely use guided surgery in partially edentulous patients. Aim: To present the results obtained with tooth-supported surgical templates characterized by an innovative open design with selective support, and manufactured via a full in-office procedure with a low-cost desktop 3D printer. Methods: Over a two-year period (2016–2018), all partially edentulous patients with one to three missing teeth (in maxilla and/or mandible), referred to a private dental practice for restoration with dental implants, were considered for inclusion in this prospective clinical study. An intraoral scanner (CS 3600®, Carestream Dental) and cone beam computed tomography (CS 9300®, Carestream Dental) were used to acquire the 3D information on the patients. Guided surgery software (SMOP®, Swissmeda) was used to plan the surgeries and to design open, selective, tooth-supported templates that were fabricated with a stereolithographic (SLA) desktop 3D printer (XFAB2000®, DWS). Guided implant surgeries were performed and patients were followed for a period of one year. The study outcomes were fit and stability of surgical templates, duration (time) of surgery, intra and post-operative complications, and implant stability and survival. Results: Twenty (20) partially edentulous patients (9 males, 11 females; mean age 54.4 ± 9.4 years) were included in the study; 28 open, selective, tooth-supported templates were designed with the aim of inserting 38 implants. Among the surgical templates, 24 had optimal fit and stability, three had optimal fit and sufficient stability, and only one had inadequate fit and unsatisfactory stability and was therefore not suitable for clinical use. The average time of the intervention was 15.7 ± 5.2 min per template. No intra-operative complications were reported, but one implant was not stable at placement and had to be removed. In total, 36 implants were restored with 10 two-unit fixed partial prostheses and 16 single crowns. All implants were successfully functioning at one year, even if, in two single crowns, minor prosthetic complications (abutment screw loosening) occurred. Conclusions: Full in-office guided surgery with open, selective, tooth-supported templates seem to represent a clinically predictable surgical procedure to restore partially edentulous patients. Further studies are needed to confirm these positive outcomes.

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“…This digital revolution opens up new horizons, such as 3D printing and in particular direct metal laser sintering (DMLS) [29], which allows fabrication of custom-made meshes [30,31] and even implants [32,33] perfectly adapted to the patient's specific anatomy.…”

Section: Introductionmentioning

confidence: 99%

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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Custom-Made Titanium Mesh for Maxillary Bone Augmentation With Immediate Implants and Delayed Loading

Abstract: No abstract is required for clinical case letters.

Cited by 18 publications

References 5 publications

Clinical and volumetric outcomes after vertical ridge augmentation using computer-aided-design/computer-aided manufacturing (CAD/CAM) customized titanium meshes: a pilot study

Clinical and volumetric outcomes after vertical ridge augmentation using computer-aided-design/computer-aided manufacturing (CAD/CAM) customized titanium meshes: a pilot study

Full in-Office Guided Surgery with Open Selective Tooth-Supported Templates: A Prospective Clinical Study on 20 Patients

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

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