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Journal of Oral Science & Rehabilitation No. 1, 2018

I n d i v i d u a l i z e d t i t a n i u m s c a f f o l d s Introduction Materials and methods Replacement of lost teeth with implants is a routine and effective treatment showing high survival rates after long-term monitoring.1, 2 In order to achieve adequate functional and esthetic outcomes, an optimal 3-D implant position has to be assured.3 In many cases, the residual bone width, height and ridge contour are not sufficient for optimal implant place- ment.4, 5 Therefore, ridge augmentation is rec- ommended in order to maintain the alveolar ridge and simplify subsequent treatment pro- cedures.6 Despite the availability of various augmentation procedures and materials, the restoration of an adequate amount of bone remains challenging. The use of titanium scaffolds in terms of guided bone regeneration is a widespread pro- cedure for horizontal and vertical ridge aug- mentation.4 Clinical and histological analysis has revealed increased morphological ridge repair and bone density after application of titanium scaffolds together with deproteinized bovine bone mineral (DBBM).7, 8 Larger vertical gain in ridge can be achieved using titanium scaffolds.5 The main disadvantage of prefab- ricated titanium scaffolds is the intraoperative and time-consuming manual 3-D trimming according to the individual defect size of the patient.9, 10 Computer-aided design/computer- aided manufacturing (CAD/CAM) technology can be used to overcome these disadvantages. Using individual patient computed tomography (CT) or cone beam computed tomography (CBCT), the necessary augmentation volume for the defects can be estimated preopera- tively. According to the calculated augmenta- tion volume, DICOM-based individualized CAD/CAM-produced titanium scaffolds (iCTSs) can be used to avoid intraoperative trimming of the prefabricated titanium scaffolds. Appli- cation of an iCTS shortens surgery time and may reduce the overall costs of the implanta- tion procedure.9, 10 The most common compli- cation of titanium scaffolds is flap dehis- cence.6, 7 Recently, Sagheb et al. reported on the use of the iCTS for alveolar ridge augmen- tation and found no negative impact of dehis- cence on the outcome.11 The objective of this study was to retrospectively analyze the dehis- cence rate after iCTS augmentation proce- dures regarding various demographic and surgery- related factors in 100 patients with 115 bony defects. S t u d y d e s i g n a n d p a t i e n t p o p u l a t i o n The retrospective analysis included patients who underwent implant therapy with additional augmentation procedures between 2014 and 2015 in a clinic for oral and maxillofacial surgery in Filderstadt, Germany. Screening of patients who needed bone augmentation before implan- tation was done during regular implant consul- tation. Cases with indication of onlay technique together with a titanium scaffold were evalu- ated. All of the patients were informed about the different augmentation possibilities. One hundred patients (56 male, 44 female) decided on the Yxoss CBR system (ReOss, Filderstadt, Germany), which provides an iCTS based on the CT/CBCT DICOM data of each patient. CT/CBCT was performed for all of the patients within 3 months before surgery. The production of an iCTS took 2–4 weeks. Each iCTS was controlled and finalized via an internet-based platform pro- vided by the supplier. Using CT/CBCT, the nec- essary augmentation volume for the defect was calculated and documented. In addition, demo- graphic (age, sex, smoking, periodontitis history) and surgical parameters (region, defect size, flap design, gingival morphotype, graft volume, use of membrane) were recorded. The gingival mor- photype was classified into thin gingival mor- photype A1 or A2 and into thick gingival mor- photype B as follows:12 – A1: high-scalloped, gingival thickness of < 1 mm, gingival width of < 3.5 mm, oval tooth form. – A2: high-scalloped, gingival thickness of < 1 mm, gingival width of < 4–5 mm, oval tooth form. – B: low-scalloped, gingival thickness of > 1 mm, gingival width of > 6 mm, square tooth form. S u r g i c a l p r o c e d u r e Surgery was performed under general anesthe- sia or under local anesthesia. Intraoperative defect assessment was performed using a poncho flap with a deep vestibular incision, a midcrestal ridge incision, a split-thickness flap or the tunnel technique.13 In some cases, an addi- tional palatal rotational flap was performed. For augmentation, a combination of a deproteinized bovine bone mineral (DBBM; Geistlich Bio-Oss granules, 1–2 mm; Geistlich Biomaterials, Journal of Oral Science & Rehabilitation Volume 4 | Issue 1/2018 39

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