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ePaper created 2018-04-05, 09:17:31 | version 1.38.0
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 Fig. 1 Fig. 1 Intraoperative view of a DICOM-based individualized CAD/CAM-produced tita- nium scaffold after loading with grafting material and placement on the defect. The iCTS was fixated with a minimum of 1 bone screw. Wolhusen, Switzerland) and autogenous bone in a ratio of 1:1 (n = 104), autogenous bone alone (n = 2), bone substitute material (KNE) alone (n = 5), an allograft (n = 1) or no material (n = 1) was used. Autogenous bone was harvested from the retromolar region using a hollow trephine drill with an inner diameter of 6 mm, followed by grinding of the small bone cylinders in a bone mill (Bull Bone Mill, MONDEAL Medical Sys- tems, Mühlheim an der Donau, Germany). The iCTS was loaded with grafting material, placed on the defect and fixated with a minimum of 1 bone screw (Fig. 1). The iCTS was covered in situ with a porcine native bilayer collagen mem- brane (Geistlich Bio-Gide, Geistlich Biomaterials; n = 79) or left uncovered (n = 35). The surgical area was completely closed and the flap fixed with mattress, sling or single sutures. After sur- gery, antibiotics were prescribed orally for 5 days (amoxicillin, 1,000 mg, 1-0-1). Radiographic con- trol of the graft and the iCTS was performed using CBCT after healing. Postsurgery, patients were recalled for follow-ups to control the sur- gical area for wound dehiscence and inflamma- tion. Removal of the iCTS and simultaneous implantation were performed depending on the healing period (5–8 months) postsurgery. The same surgical approach was used for the base- line defect assessment. After loosening of the fixing screw, the iCTS was carefully removed by applying rotating forces to predetermined break- ing points of the summit of the iCTS at the top of the scaffold with a standard periosteal eleva- tor. The surgical area was closed without tension and the sutures removed 1 week after surgery. Implants were placed simultaneously (n = 63) with augmentation or after 5–8 months (n = 50). S t a t i s t i c a l d a t a a n a l y s i s Statistical analysis was performed using IBM SPSS Statistics for Windows (Version 21.0, IBM, Armonk, N.Y., U.S.). Quantitative data (augmen- tation volume) were descriptively analyzed for arithmetic mean and standard deviation. For comparison of augmented volumes in the defect sites with and without dehiscence, the Mann– Whitney U test was used because the data were not normally distributed (according to the Shapiro– Wilk test, P < 0.001). Association of dehiscence with demographic (age, sex, smoking, periodontitis history) and surgical parameters (gingival morphotype, surgical access, region, use of membrane) were analyzed using the chi- squared test or Fisher exact test (if cell occupancy numbers were < 5). Two-sample tests were per- formed. The impact of predictive factors on the risk of dehiscence was investigated using univar- iate and multivariate models for logistic regres- sion analysis. Results were considered to be statistically significant if the P value was ≤ 0.05. Adaptation for multiple testing was not per- formed, since the analysis was explorative and used to test the hypothesis. Nonconsideration of intrapatient correlations influencing P values might have influenced the statistical analysis. Results P a t i e n t p o p u l a t i o n a n d d e s c r i p t i o n o f d e f e c t s i t e s One hundred patients with 115 defect regions in total were retrospectively analyzed. Of these patients, 56 were male and 44 female, with an 40 Volume 4 | Issue 1/2018 Journal of Oral Science & Rehabilitation