Histological assessment of mandibular bone tissue after guided bone regeneration with customized computer‐aided design/computer‐assisted manufacture titanium mesh in humans: A cohort study

Abstract

Background Innovative customized computer‐aided design/computer‐assisted manufacture (CAD‐CAM) titanium meshes have been proposed for guided alveolar bone regeneration. Histological confirmation on the quality of the regenerated bone is needed. Purpose of the study is to assess the integration capabilities of these innovative meshes and to evaluate the histological features of the regenerated alveolar bone. Materials and methods Twenty partially edentulous patients, with severe posterior mandibular atrophy, underwent a guided bone regeneration technique by means of customized CAD‐CAM titanium mesh in association with a mixture of autologous bone in chips and deproteinized bovine bone (1:1). At 9 months of healing, titanium meshes and bone samples were collected and histomorphometrically analyzed. Results In all patients, implants were placed according to the original plan. At histologic analysis, mesh appeared well osseointegrated, except that in sites where membrane exposure occurred. In all sites, newly formed tissue resulted highly mineralized, well‐organized, and formed by 35.88% of new lamellar bone, 16.42% of woven bone, 10.88% of osteoid matrix, 14.10% of grafted remnants, and 22.72% of medullary spaces. Blood vessels were the 4% of the tissue. Conclusions Data from this study support the use of customized CAD/CAM titanium mesh for regeneration of vital, well‐structured, and vascularized alveolar bone.

Understanding the Role of Surface Modification of Randomized Trabecular Titanium Structures in Bone Tissue Regeneration: An Experimental Study

“…Both the shape and the surface of the titanium implants are considered decisive factors for achieving primary and secondary stability as they speed up osseointegration. [20][21][22][23][24]. AM technologies allow the realization of complex 3D structures with…”

“…The bone-to-implant contact (BIC) as a percentage of the surface of the implant in direct contact with the regenerated bone matrix and the bone in-growth (BIn) as the percentage of new bone matrix regenerated within the randomized trabecular titanium structure implant were calculated [20] to characterize the interface between the implants and the newly formed bone. The BIC is considered an essential marker for assessing osseointegration [23]. The BIC and the BIn were computed for each section on the whole scanned area using dedicated navigation software (NDP.view2 software, Hamamatsu, Japan) [20,23,24].…”

“…The BIC is considered an essential marker for assessing osseointegration [23]. The BIC and the BIn were computed for each section on the whole scanned area using dedicated navigation software (NDP.view2 software, Hamamatsu, Japan) [20,23,24].…”

Recent Advances in Vertical Alveolar Bone Augmentation Using Additive Manufacturing Technologies

“…This technology is already in clinical use, and while it represents a breakthrough for vertical bone regeneration, it is relatively recent and ongoing clinical studies to verify and quantify the efficacy of this approach for vertical bone augmentation are required. Indeed, recent case reports have shown that this approach can yield favourable clinical outcomes (Dellavia et al, 2021), although complications such as transmucosal exposure of the device (Chiapasco et al, 2021) and inaccuracies between planned and created volume and bone height (Li et al, 2021) are common. The exposure of the device is strongly related to the management of the soft tissue healing component of the vertical bone augmentation procedure.…”

Customized Barrier Membrane (Titanium Alloy, Poly Ether-Ether Ketone and Unsintered Hydroxyapatite/Poly-l-Lactide) for Guided Bone Regeneration

“…Warnke et al demonstrated the biocompatibility of patient-specific SLM Ti mesh at the cellular level through scanning electron microscopy, cell vitality staining, and biocompatibility testing ( Warnke et al, 2009 ). Gyu-Un Jung et al obtained fairly good bone regeneration results under a preformed Ti barrier membrane ( Jung et al, 2014 ), and their histological results showed that newly regenerated bone was perfectly incorporated into the remaining allograft ( Dellavia et al, 2021 ). These results indicate that a customized Ti mesh engineered with digital modeling technology and 3D printing technology is highly biocompatible, has the characteristics of high strength, good shape, high precision, simplicity, and convenience, can fit closely to the alveolar bone anatomy, and reconstruct the jaw precisely in terms of 3D volume and position.…”