Reverse Guided Bone Regeneration (R-GBR) Digital Workflow for Atrophic Jaws Rehabilitation

Abstract

Background: Treating extended alveolar defects is challenging for their irregular shape and lack of hard and soft tissues. Virtual planned guided bone regeneration (GBR) with customized meshes aims to optimize the treatment by reducing the risk of dehiscence. The mucosa characteristics are crucial in preserving the bone graft covering and vitality. Methods: Two three-dimensional and extended defects, a mandibular posterior and anterior maxillary atrophy were reconstructed with a particulate graft and a digitally customized scaffold. The workflow entailed merging the pre-operatory clinical related data from intra-oral scanning with the radiologic ones from cone beam-CT. A final ideal prediction of the soft tissue relationship with the implant-borne prosthesis was virtually elaborated, conditioning the design of the titanium membrane fitting the bone defects. Results: A good matching between the scaffold and the bone surface was intra-operatory noted; no complications were registered in the first months of healing with complete integrity of the soft tissues above the graft. Conclusions: A careful evaluation of the soft tissues and a forecast of their final relationship with the implant and prosthesis can improve digital mesh/membrane manufacturing with a suitable healing process up to implant placement and loading, favoring peri-implant tissue stability over time.

Digital planning and bone regenerative technologies: A narrative review

“…Fifty-six articles are focused on a digital workflow applied to advanced implant dentistry (relevant alveolar ridge defects and sinus expansion), including digitally guided implant placement in the regenerated areas (Atef et al, 2020;Bahaa et al, 2023;Cecchetti et al, 2021;Chiapasco et al, 2021;Ciocca et al, 2011Ciocca et al, , 2015Cucchi et al, 2017Cucchi et al, , 2020Cucchi et al, , 2022Cucchi et al, , 2023Cucchi, Vignudelli, Franceschi, et al, 2021;Cucchi, Vignudelli, Sartori, et al, 2021;de Almeida Malzoni et al, 2022;De Angelis et al, 2023;De Santis et al, 2022;De Stavola et al, 2015Felice et al, 2022;Figliuzzi et al, 2013;Garagiola et al, 2016;Goodacre et al, 2018;Lee et al, 2021;Liu et al, 2023;Li, Wang, et al, 2021;Li, Zhao, et al, 2021;Lizio et al, 2022;Mandelaris & Rosenfeld, 2008;Mangano et al, 2013;Mounir et al, 2017Mounir et al, , 2019Osman et al, Scribante al., 2023;Seiler et al, 2018;Seoung-Won et al, 2020;Shi et al, 2022;Stanley & Kurtzman, 2017;Strbac et al, 2020;Sumida et al, 2015;Tallarico et al, 2020;Tarce ...…”

“…As regards digitally guided augmentation with CAD-CAM customized titanium meshes (Atef et al, 2020;Bahaa et al, 2023;Chiapasco et al, 2021;Ciocca et al, 2011Ciocca et al, , 2015Cucchi et al, 2017Cucchi et al, , 2020Cucchi et al, , 2023Cucchi, Vignudelli, Franceschi, et al, 2021;Cucchi, Vignudelli, Sartori, et al, 2021;De Angelis et al, 2023;De Santis et al, 2022;Felice et al, 2022;Lee et al, 2021;Li, Wang, et al, 2021;Li, Zhao, et al, 2021;Lizio et al, 2022;Mounir et al, 2017Mounir et al, , 2019Sagheb et al, 2017;Scribante et al, 2023;Seiler et al, 2018;Shi et al, 2022;Sumida et al, 2015;Tallarico et al, 2020;Xie et al, 2020;Yang et al, 2022), the digital workflow makes it possible to obtain an extremely precise titanium scaffold which does not need any adaptation to recipient site: this will simplify the procedure and shorten operating times. Moreover, it will be possible to pre-operatively calculate the quantity of grafting materials needed.…”

“…This can be followed by infection and partial or total loss of the initial bone gain (Briguglio et al, 2019;Carini et al, 2014;Her et al, 2012;Miyamoto et al, 2012;Rasia-dal Polo et al, 2014;Roccuzzo et al, 2007). On the contrary, a digital workflow makes it possible not only to precisely plan all the pre-operative phases (as described above-see Figure 2), but also to produce customized titanium meshes with a CAD-CAM technology (Atef et al, 2020;Bahaa et al, 2023;Chiapasco et al, 2021;Ciocca et al, 2011Ciocca et al, , 2015Cucchi et al, 2017Cucchi et al, , 2020Cucchi et al, , 2023Cucchi, Vignudelli, Franceschi, et al, 2021;Cucchi, Vignudelli, Sartori, et al, 2021;De Angelis et al, 2023;De Santis et al, 2022;Felice et al, 2022;Lee et al, 2021;Li, Wang, et al, 2021;Li, Zhao, et al, 2021;Lizio et al, 2022;Mounir et al, 2017Mounir et al, , 2019Sagheb et al, 2017;Scribante et al, 2023;Seiler et al, 2018;Shi et al, 2022;Sumida et al, 2015;Tallarico et al, 2020;Xie et al, 2020;Yang et al, 2022), mainly by means of laser sintering. Most of them are designed as "open structures" to favor the re-vascularization of the underlying grafting material.…”

“…The majority of these articles are focused on CAD-CAM technologies (Montero et al, 2021) applied to design and production of titanium meshes (Atef et al, 2020;Bahaa et al, 2023;Chiapasco et al, 2021;Ciocca et al, 2011Ciocca et al, , 2015Cucchi et al, 2017Cucchi et al, , 2020Cucchi et al, , 2023Cucchi, Vignudelli, Franceschi, et al, 2021;Cucchi, Vignudelli, Sartori, et al, 2021;De Angelis et al, 2023;De Santis et al, 2022;Felice et al, 2022;Lee et al, 2021;Li, Wang, et al, 2021;Li, Zhao, et al, 2021;Lizio et al, 2022;Mounir et al, 2017Mounir et al, , 2019Sagheb et al, 2017;Scribante et al, 2023;Seiler et al, 2018;Shi et al, 2022;Sumida et al, 2015;Tallarico et al, 2020;Xie et al, 2020;Yang et al, 2022) or blocks (allograft or xenograft) created with a CAD-CAM procedure (Jacotti, 2006;Garagiola et al, 2016;Mangano et al, 2015;Venet et al, 2017).…”

Special Issue on Dental Materials: Latest Advances and Prospects—Volume II

“…Felice et al hypothesized that virtual planned guided bone regeneration (GBR), with the aid of customized meshes, could optimize the treatment of extended alveolar defects by reducing the risk of dehiscence. The authors concluded that a careful evaluation of the soft tissues and knowledge of their final relationship with the implant and prosthesis can improve digital mesh/membrane manufacturing, with a suitable healing process occurring up to implant placement and loading, as well as favoring peri-implant tissue stability over time [4].…”