Über den Autor
Peetz M., Kaemmerer PW., Seiler M.
Reconstruction of three-dimensional alveolar defects by using a customized lattice structure (Yxoss CBR®) in 100 cases
Missing or reduced buccal bone plates as well as a reduced vertical dimension still represent challenges in bone augmentation and require a three-dimensional reconstruction.1,2 Modern individualized dentistry intends to provide new therapeutic concepts based on CAD/CAM technology and three-dimensional printing. The aim of this study was to establish a protocol for the clinical application of a patient-specific titanium lattice structure (Yxoss CBR®) for customized bone regeneration.
A three-dimensional projection of patients’ bony defect was generated and individualized titanium lattice structures were designed by using CAD/CAM procedures and rapid prototyping. The lattice structures were installed by using a mixture of autogenous bone graft harvested from various intraoral donor sites and Bio-Oss® particles in a 1:1 ratio. Implant placement was performed simultaneously with lattice structure insertion or after a healing period of 6 months combined with the removal of Yxoss CBR®. 100 lattice structures were installed with this technique during the last two years. Evaluation concerning sizes, different defect regions, augmentation site, healing difficulties and soft tissue management was performed, see also figure 1a-f.
This study evaluated 100 customized lattice structures in 89 patients with 174 inserted implants. Tobacco abuses was documented in 5.3% and periodontitis in 28.1%. No patient suffered from diabetes mellitus. Size of mesh was designed in order to replace 1-2 teeth (52%), 3-4 teeth (37%) and > 5 teeth (11%). Bone loss geometry was horizontal (5%), vertical (5%) and three-dimensional loss occurred in 90% of cases. Augmentation site was in the upper jaw (62%) and in the lower jaw (38%) (Figure 2).
Localization had no influence on dehiscence probability. Procedures in various sextants showed no differences compared to non-overlapping procedures (p=0.6). Size did not influence probability of dehiscence, see Figure 3. Dehiscence occurred in 20% of the cases (see Figure 4). This had no influence on implant placement procedures. Implant placement was not possible in only two cases (2%).
Risk factors didn’t influence dehiscence probability. Risk factors such as age and sex (p=0.08, p=0.02), tobacco abuses (p=0.2), periodontitis (p=0.2) and gingiva morphotypes were not relevant for the occurrence of dehiscence.
Defect geometry correlates with dehiscence probability. Cases with horizontal defects showed significantly lower dehiscence compared to vertical defects (17% vs. 83%, p=0.02). Comparisons between horizontal to combined and vertical to combined defects showed no significant differences.
- Merli, M. et al.: Fence technique for localized three-dimensional bone augmentation: a technical description and case reports. The International Journal of Periodontics & Restorative Dentistry 35, 57–64, doi:10.11607/prd.2029 (2015).
- Jung, G.U., Jeon, J.Y., Hwang, K.G. & Park, C.J.: Preliminary evaluation of a three-dimensional, customized, and preformed titanium mesh in peri-implant alveolar bone regeneration. Journal of the Korean Association of Oral and Maxillofacial Surgeons 40, 181–187, doi:10.5125/jkaoms.2014.40.4.181 (2014).
This study presents a novel patient-specific, customized lattice structure made of titanium (Yxoss CBR®), which is introduced for shaping and rebuilding a bone defect in complex cases. Results demonstrated this protocol as a successful and predictable procedure for rebuilding an atrophied bone defect. No serious complication was seen during the healing period and an exposure did not lead to augmentation loss. Implants could be placed in 98% as planned. This protocol facilitated and shortened surgery time.