Research on the dimensional accuracy of customized bone augmentation combined with 3D‐printing individualized titanium mesh: A retrospective case series study

Abstract

Background Few studies have focused on the dimensional accuracy of customized bone grafting by means of guided bone regeneration (GBR) with 3D‐Printed Individual Titanium Mesh (3D‐PITM). Purpose Digital technologies were applied to evaluate the dimensional accuracy of customized bone augmentation with 3D‐PITM with a two‐stage technique. Materials and methods Sixteen patients were included in this study. The CBCT data of post‐GBR (immediate post‐GBR) and post‐implantation (immediate post‐implant placement) were 3D reconstructed and compared with the pre‐surgical planned bone augmentation. The dimensional differences were evaluated by superimposition using the Materialize 3‐matic software. Results The superimposition analysis showed that the maximum deviations of contour between were 3.4 mm, and the average differences of the augmentation contour were 0.5 ± 0.4 and 0.6 ± 0.5 mm respectively. The planned volume of bone regeneration was approximately equal to the amount of regenerated bone present 6 to 9 months after the surgical procedure. On average, the vertical gain in bone height was about 0.5 mm less than planned. And, the horizontal bone gain on the straight buccal of the dental implants and 2 to 4 mm apical of the platform fell also about a 0.5 mm short on average. Statistically significant differences were observed between the augmented volume of virtual and post‐GBR, and the horizontal bone gain of post‐implantation on the level of 4 mm apical to the implant platform (P < .05). Conclusions The dimensional accuracy of customized bone augmentation with the 3D‐PITM approach needs further improvement and compared to other surgical approaches of bone augmentation.

Guided bone regeneration using titanium mesh to augment 3‐dimensional alveolar defects prior to implant placement. A pilot study

“…Only one study in the literature focused on this issue (Li et al, 2021), adopting two evaluation methods after the superimposition of the preoperatory model with virtually augmented the preimplant and postimplant models. Regarding the volumetric evaluation, these authors recorded an average volume value under the mesh in the post‐GBR model of +19.3% than what was virtually planned preoperatively, perhaps due to an upward shifting of the device, resulting in a statistically significant difference on a sample of 16 sites (Li et al, 2021). Our trial detected a mean correspondence of 82% among the virtual volumes and those under the mesh in the postoperative CBCT, with lower average volumes of 18%.…”

“…Even if not statistically significant, these data, with a range of values from 53.3% to 100%, should be an incentive better to address the problem of mesh fitting in future studies. As a second evaluation, Li et al reported a mean value of 0.59 ± 0.47 mm of mesh contour deviation among the virtual preoperatory and the post‐GBR, with a maximum deviation discrepancy of 3.4 mm (Li et al, 2021). Another study recorded an accuracy rate of 95.82% (88.53%–99.15%) with meshes bent on stereolithographic models (Pellegrino et al, 2021).…”

“…Realistically, apart from the expertise of the operators, the quality of the fitting could depend significantly on the defect's characteristics. Since the postoperative data were obtained by a CBCT taken just before the implant placement, our study, as in Li et al (Li et al, 2021), cannot be excluded the possibility of the mesh shifting during the healing period due to muscular activity, any complications that occurred, the wearing of a complete denture in case of total edentulism, or the loss of stabilization power of the fixation screws. Conversely, taking a CT scan just after the surgical intervention appears to be an ethical and scientifically valid evaluation method.…”

“…With traditional manually created titanium meshes, the exposure range is extensive (0–68.9%) (Lizio et al, 2014; Pieri et al, 2008; Poomprakobsri et al, 2021). Ciocca et al, using digitally customized meshes, reported 66% of postoperative exposure morbidity in nine cases (Ciocca et al, 2018), and Li et al reported 25% morbidity in 16 patients (Li et al, 2021); Chiapasco et al reported 11 exposure cases in 53 dehiscence cases (Chiapasco et al, 2021), and Cucchi et al recorded one in 10 cases (Cucchi et al, 2020). Sumida et al, comparing two groups of 13 patients, found one and three exposures for CAD/CAM and traditional devices, respectively (Sumida et al, 2015).…”

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.…”