Ciocca Leonardo, Lizio Giuseppe, Baldissara Paolo, Sambuco Alessandro, Scotti Roberto, Corinaldesi Giuseppe
1 Section of Prosthodontics, Department of Biomedical and Neuromotor Science, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
2 Section of Oral Surgery, Department of Biomedical and Neuromotor Science, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
J Oral Implantol. 2018 Apr;44(2):131-137. doi: 10.1563/aaid-joi-D-17-00125. Epub 2018 Jan 5.
This study evaluated the outcomes of computer-aided design-computer-aided machining (CAD-CAM)-customized titanium mesh used for prosthetically guided bone augmentation related to the occlusion-driven implant position, to the vertical bone volume gain of the mandible and maxilla, and to complications, such as mesh exposure. Nine patients scheduled for bone augmentation of atrophic sites were treated with custom titanium mesh and particulate bone grafts with autologous bone and anorganic bovine bone in a 1:1 ratio prior to implant surgery. The bone volume needed to augment was virtually projected based on implant position, width, and length, and the mesh design was programmed for the necessary retaining screws. After 6 to 8 months, bone augmentations of 1.72 to 4.1 mm (mean: 3.83 mm) for the mandibular arch and 2.14 to 6.88 mm (mean: 3.95 mm) for the maxilla were registered on cone-beam computerized tomography. Mesh premature (within 4 to 6 weeks) exposure was observed in 3 cases and delayed (after 4 to 6 weeks) in 3 other cases. One titanium mesh was removed before the programmed time but in all augmented sites was possible implant insertion. No complication occurred during prosthetic follow-up. Using CAD-CAM technology for prosthetically guided bone augmentation showed important postoperative morbidity of mesh exposure (66%). Because of this high prevalence of mesh exposure and the potential infection that could affect the expected bone augmentation, this study suggests a cautious approach to this procedure when designing the titanium mesh, to avoid flap tension that may cause mucosal rupture.
本研究评估了计算机辅助设计-计算机辅助加工（CAD-CAM）定制钛网用于修复引导性骨增量的效果，该效果与咬合驱动的种植体位置、下颌骨和上颌骨的垂直骨量增加以及并发症（如钛网暴露）相关。9例计划进行萎缩部位骨增量的患者在种植手术前接受了定制钛网和颗粒骨移植治疗，颗粒骨移植材料为自体骨和无机牛骨，比例为1:1。根据种植体的位置、宽度和长度虚拟预测所需的骨增量，并为必要的固定螺钉对钛网设计进行编程。6至8个月后，锥形束计算机断层扫描显示下颌弓的骨增量为1.72至4.1毫米（平均：3.83毫米），上颌骨的骨增量为2.14至6.88毫米（平均：3.95毫米）。观察到3例钛网过早（4至6周内）暴露，另外3例延迟（4至6周后）暴露。1个钛网在预定时间前被取出，但在所有骨增量部位均成功植入了种植体。修复随访期间未发生并发症。使用CAD-CAM技术进行修复引导性骨增量显示钛网暴露的术后发病率较高（66%）。鉴于钛网暴露的高发生率以及可能影响预期骨增量的潜在感染，本研究建议在设计钛网时对该手术采取谨慎方法，以避免可能导致黏膜破裂的皮瓣张力。
