Draenert Florian G, Gebhart Florian, Mitov Gergo, Neff Andreas
D Implant Institute, Munich, Germany; Extraordinary Professor for Oral & Maxillofacial Surgery, University of Marburg, Germany.
Private practice for orthodontics, Munich, Germany.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Jun;123(6):651-660. doi: 10.1016/j.oooo.2016.12.011. Epub 2017 Jan 4.
Alveolar ridge and vertical augmentations are challenging procedures in dental implantology. Even material blocks with an interconnecting porous system are never completely resorbed. Shell techniques combined with autologous bone chips are therefore the gold standard. Using biopolymers for these techniques is well documented. We applied three-dimensional (3-D) techniques to create an individualized bending model for the adjustment of a plane biopolymer membrane made of polylactide.
Two cases with a vertical alveolar ridge defect in the maxilla were chosen. The cone beam computed tomography data were processed with a 3-D slicer and the Autodesk Meshmixer to generate data about the desired augmentation result. STL data were used to print a bending model. A 0.2-mm poly-D, L-lactic acid membrane (KLS Matin Inc., Tuttlingen, Germany) was bended accordingly and placed into the defect via a tunnel approach in both cases. A mesh graft of autologous bone chips and hydroxylapatite material was augmented beneath the shell, which was fixed with osteosynthesis screws.
The operative procedure was fast and without peri- or postoperative complications or complaints. The panoramic x-ray showed correct fitting of the material in the location. Bone quality at the time of implant placement was type II, resulting in good primary stability.
A custom-made 3-D model for bending confectioned biomaterial pieces is an appropriate method for individualized adjustment in shell techniques. The advantages over direct printing of the biomaterial shell and products on the market, such as the Xyoss shell (Reoss Inc., Germany), include cost-efficiency and avoidance of regulatory issues.
牙槽嵴增高术和垂直骨增量术在牙种植学中是具有挑战性的手术。即使是具有相互连通的多孔系统的材料块也不会完全被吸收。因此，结合自体骨屑的覆盖技术是金标准。使用生物聚合物进行这些技术已有充分记录。我们应用三维（3-D）技术创建个性化弯曲模型，以调整由聚丙交酯制成的平面生物聚合物膜。
选择两例上颌垂直牙槽嵴缺损的病例。使用3-D切片软件和Autodesk Meshmixer处理锥形束计算机断层扫描数据，以生成有关预期骨增量结果的数据。使用STL数据打印弯曲模型。在两例病例中，均相应地弯曲一片0.2毫米厚的聚-D，L-乳酸膜（德国图特林根的KLS Matin公司），并通过隧道法将其放入缺损处。在覆盖物下方植入自体骨屑和羟基磷灰石材料的网状移植物，并用接骨螺钉固定。
手术过程迅速，无术中或术后并发症或不适。全景X线片显示材料在植入部位贴合良好。种植体植入时的骨质为II型，具有良好的初期稳定性。
为定制生物材料片弯曲制作的定制3-D模型是覆盖技术中进行个性化调整的合适方法。与直接打印生物材料覆盖物以及市场上的产品（如德国Reoss公司的Xyoss覆盖物）相比，其优势包括成本效益和避免监管问题。
