Hartmann Amely, Seiler Marcus
Private Practitioner, Affiliate to the Department of Oral and Maxillofacial Surgery, University Medical Centre of the Johannes Gutenberg University of Mainz, Augustusplatz 2, 55131, Mainz, Germany.
Department Head, Private Dental Practice, Echterdinger Str. 7, 70794, Filderstadt, Germany.
BMC Oral Health. 2020 Feb 3;20(1):36. doi: 10.1186/s12903-020-1023-y.
Recommendations for soft tissue management associated with customized bone regeneration should be developed. The aim of this study was to evaluate a new protocol for customized bone augmentation in a digital workflow.
The investigators implemented a treatment of three-dimensional bone defects based on a customized titanium mesh (Yxoss CBR®, ReOSS, Filderstadt, Germany). Patients and augmentation sites were retrospectively analysed focussing on defect regions, demographic factors, healing difficulties and potential risk factors. An exposure rate was investigated concerning surgical splint application, A®- PRF and flap design.
In total, 98 implants could be placed. Yxoss CBR® was removed after mean time of 6.53 ± 2.7 months. Flap design was performed as full flap preparation (27.9%), full flap and periosteal incision (39.7%), periosteal incision (1.5%), poncho/split flap (27.9%) and rotation flap (2.9%). In 25% of the cases, exposures of the meshes were documented. Within this exposure rate, most of them were slight and only punctual (A = 16.2%), like one tooth width (B = 1.5%) and complete (C = 7.4%). A®- PRF provided significantly less exposures of the titanium meshes (76.5% no exposure vs. 23.5% yes, p = 0.029). Other parameters like tobacco abuse (p = 0.669), diabetes (p = 0.568) or surgical parameters (mesh size, defect region, flap design) did not influence the exposure rate. Surgical splints were not evaluated to reduce the exposure rate (p = 0.239). Gender (female) was significantly associated with less exposure rate (78,4% female vs. 21.6% male, p = 0.043).
The results of this study suggest that the new digital protocol including patient-specific titanium meshes, resorbable membranes and bone grafting materials was proven to be a promising technique. To improve soft tissue healing, especially A®-PRF should be recommended.
应制定与定制骨再生相关的软组织管理建议。本研究的目的是评估一种数字工作流程中定制骨增量的新方案。
研究人员采用定制钛网（Yxoss CBR®，ReOSS，德国菲尔德施塔特）对三维骨缺损进行治疗。对患者和骨增量部位进行回顾性分析，重点关注缺损区域、人口统计学因素、愈合困难和潜在风险因素。研究了手术夹板应用、A®-PRF和皮瓣设计的暴露率。
总共植入了98颗种植体。Yxoss CBR®在平均6.53±2.7个月后取出。皮瓣设计包括全厚皮瓣制备（27.9%）、全厚皮瓣和骨膜切口（39.7%）、骨膜切口（1.5%）、雨披/劈开皮瓣（27.9%）和旋转皮瓣（2.9%）。在25%的病例中记录到钛网暴露。在这个暴露率范围内，大多数暴露轻微且仅为点状（A=16.2%），如一个牙宽度（B=1.5%）和完全暴露（C=7.4%）。A®-PRF使钛网暴露明显减少（76.5%未暴露 vs. 23.5%暴露，p=0.029）。其他参数如吸烟（p=0.669）、糖尿病（p=0.568）或手术参数（网片尺寸、缺损区域、皮瓣设计）不影响暴露率。未评估手术夹板对降低暴露率的作用（p=0.239）。性别（女性）与较低的暴露率显著相关（女性78.4% vs.男性21.6%，p=0.043）。
本研究结果表明，包括患者特异性钛网、可吸收膜和骨移植材料的新数字方案被证明是一种有前景的技术。为改善软组织愈合，尤其应推荐A®-PRF。
