3D Bone Augmentation Using Customized Titanium Mesh in Conjunction with Autogenous Bone and Bovine Bone Material Granules
A 75-year-old systemically healthy female came to our attention presenting with absent mandibular second bicuspids and molars and requiring a fixed rehabilitation supported by implants as she refused a removable solution. The clinical and radiographic evaluation showed a relevant vertical and horizontal bone atrophy of such an extent that short or narrow implants were not considered a reliable option. The patient smoked <10 cigarettes per day.
THE RISK PROFILE
|Low Risk||Medium Risk||High Risk|
|Patient’s health||Intact immune system||Light smoker||Impaired immune system|
|Patient’s esthetic requirements||Low||Medium||High|
|Height of smile line||Low||Medium||High|
|Gingival biotype||Thick – “low scalloped”||Medium – “medium scalloped”||Thin – “high scalloped”|
|Shape of dental crowns||Rectangular||Triangular|
|Infection at implant sight||None||Chronic||Acute|
|Bone height at adjacent tooth site||≤ 5 mm from contact point||5.5 – 6.5 mm from contact point||≥ 7 mm from contact point|
|Restorative status of adjacent tooth||Intact||Restored|
|Width of tooth gap||1 tooth (≥ 7 mm)||1 tooth (≤ 7 mm)||2 teeth or more|
|Bone anatomy of the alveolar ridge||No defect||Horizontal defect||Vertical defect|
Note: Yxoss CBR® by ReOss® Screws 5mm – MCbio (G-fix system)
The main goal was to obtain a horizontal and vertical reconstruction of the deficient alveolar bone in order to allow safe and prosthetically-guided implant placement. Reconstruction was obtained by means of a customized titanium mesh, Yxoss CBR®, in combination with a mixture of autologous bone chips harvested from the mandibular ramus and bovine bone mineral, Geistlich Bio-Oss®.
Post-operative recovery of this patient was uneventful, no complications such as dehiscence or late exposure of the customized mesh, with complete correction of the initial defect. The Yxoss CBR® allowed an easy and faster reconstruction thanks to the precision of the prefabricated mesh filled with autologous chips, Geistlich Bio-Oss® and Geistlich Bio-Gide®.
While it is important to be an expert in guided bone regeneration, this technique reduces the difficulties to less than one-half and is predictable, effective, and precise.Matteo Chiapasco, D.D.S., M.D.
GBR combining the use of Geistlich Bio-Oss®, autologous bone chips taken from the mandibular ramus associated with a customized Yxoss CBR®, covered with a Geistlich Bio-Gide®, is a predictable regenerative procedure allowing for the creation of an adequate volume suitable for a prosthetically-guided implant placement with optimization of the final restoration.Matteo Chiapasco, D.D.S., M.D.
Matteo Chiapasco, D.D.S., M.D.
Graduated in Medicine and specialized in Maxillofacial Surgery at the University of Milan, Italy. Professor, Unit of Oral Surgery, University of Milan; Associate Professor, Loma Linda University, Los Angeles, California, USA.
Grazia Tommasato, D.D.S., M.S.C.
Graduated in Dentistry in 2013, specialized in Oral Surgery at the University of Milan magna cum laude. PhD student and a medical consultant of the Clinical Unit of Oral Surgery (“G. Vogel” Clinic, Milan).