Di Stefano Danilo Alessio, Greco Gian Battista, Cinci Lorenzo, Pieri Laura
Professor, Department of Dentistry, Vita e Salute San Raffaele University, Milan, Italy, Phone: 390248705703, e-mail:
Private Practice, Trezzano sul Naviglio, Milan, Italy.
J Contemp Dent Pract. 2015 Feb 1;16(2):154-62. doi: 10.5005/jp-journals-10024-1653.
The present work describes a horizontal ridge augmentation in which a titanium mesh was preshaped by adapting it to a stereolithographic model of the patient's jaw that was fabricated from CT scans.
Guided bone regeneration (GBR) involves covering the augmentation site with a long-lasting barrier to protect it from the invasion of surrounding soft tissues. Among barriers, titanium meshes may provide a successful outcome, but the intraoperatory time needed to shape them is a disadvantage.
The 54-year-old patient, missing the right mandibular second bicuspid, first molar, and second molar, had her atrophic ridge augmented with a 30:70 mixture of autogenous bone and equine, enzyme-deantigenic collagen-preserved bone substitute. Two conical implants were inserted concomitantly in the second bicuspid and first molar positions, and the site was protected with the preshaped mesh. Four months later, the titanium mesh was retrieved, a bone sample was collected, and histological and histomorphometric analyses were performed. Provisional and definitive prostheses were then delivered, and follow-up controls were performed for up to 24 months.
Preshaping the mesh on a model of the patient's mandible shortened the surgical time and enabled faster mesh placement. Two years after surgery, the implants were perfectly functional, and the bone width was stable over time as shown by radiographic controls. Histological analysis of the bone sample showed the heterologous biomaterial to be biocompatible and undergoing advanced remodeling and replacement with newly formed bone.
Preshaping a titanium mesh over a stereolithographic model of the patient's jaw allowed for a significant reduction of the intraoperative time and may be therefore, advisable in routine practice.
本研究描述了一种水平嵴增高术，其中通过将钛网适配于根据CT扫描制作的患者颌骨的立体光刻模型来进行预塑形。
引导骨再生（GBR）包括用持久的屏障覆盖增高部位，以保护其免受周围软组织的侵入。在屏障中，钛网可能会带来成功的结果，但塑形所需的手术时间是一个缺点。
该54岁患者缺失右下第二双尖牙、第一磨牙和第二磨牙，其萎缩嵴用自体骨与马源、酶解去抗原胶原蛋白保存骨替代物的30:70混合物进行增高。同时在第二双尖牙和第一磨牙位置植入两枚锥形种植体，并用预塑形的网片保护该部位。四个月后，取出钛网，采集骨样本，并进行组织学和组织形态计量学分析。然后戴入临时和最终修复体，并进行长达24个月的随访对照。
在患者下颌骨模型上对网片进行预塑形缩短了手术时间，并能更快地放置网片。术后两年，种植体功能良好，影像学对照显示骨宽度随时间稳定。骨样本的组织学分析表明，异种生物材料具有生物相容性，正在进行高级重塑并被新形成的骨替代。
在患者颌骨的立体光刻模型上对钛网进行预塑形可显著减少术中时间，因此在常规实践中可能是可取的。
