Customized 3D printed nanohydroxyapatite bone block grafts for implant sites: A case series.

PATIENTS: A case series of 12 patients (mean age, 53.5 years) with horizontal ridge deficiencies had augmentations with customized 3D printed nanohydroxyapatite (3DHA) block grafts prior to implant placement. 3DHA graft materials were fabricated to fit the individual patient defects using DICOMs from CBCT images obtained from each patient. The CBCT images were then converted into the STL file format and 3DHA was reconstructed by 3D printing. Surgical bone augmentation consisted of 3DHA incorporating concentrated growth factors (CGFs) and platelet-rich fibrin (PRF) membrane. At 6 months, a bone biopsy and implantation were performed. The primary outcome was horizontal bone gain after 6 months. The secondary outcomes included information on the clinical outcomes, dimensions, and histomorphometric results. DISCUSSION: The 3DHA block graft was successful in 10 of 12 patients. Graft adjustment was not required. All 3DHA adapted and fit well at all defect sites. Maximum mean horizontal bone gains were 3.06 ± 1.02 and 3.56 ± 0.23 mm from the DICOMs and STL data sets, respectively. The volume gain was 229.8 ± 82.96 mm3. A low pain score after surgery was reported of 1.41 ± 0.51, while the healing index score increased with a maximum mean of 4.7 ± 0.67. Thirteen implants were placed with good primary stability (ISQ = 65 ± 4.08), without additional guided bone regeneration. Histomorphometric analysis revealed that new bone formation, bone tissue, residual grafts, and connective tissue were 28.6 ± 1.88, 30.48 ± 4.81, 19.82 ± 4.07, and 20.81 ± 4.41%, respectively. CONCLUSIONS: A customized 3DHA block graft is a viable treatment option for primary implant-site augmentation.

Clinical evaluation of 3D printed nano-porous hydroxyapatite bone graft for alveolar ridge preservation: A randomized controlled trial.

BACKGROUND/PURPOSE: Ridge resorption after tooth extraction may result in inadequate bone volume and unfavorable ridge architecture for ideal implant placement. The use of bone substitutes has been advocated to fill extraction sites and to enhance primary implant stability. This study was made to evaluate the clinical efficacy of novel 3D printed nano-porous hydroxyapatite (3DP HA, test group) in comparison to nano-crystalline bone graft (NanoBone®, control group) in alveolar ridge preservation prior to implant placement. MATERIALS AND METHODS: Thirty patients were randomized into two groups following tooth extraction. All extracted sockets were filled with 3DP HA or NanoBone® and covered with a non-resorbable membrane. After four months, cone-beam computed tomography (CBCT) and intraoral scanner were used to measure dimensional changes of bone and soft tissue surface. Bone core specimens were harvested for histological analysis during implant osteotomy. Implant stability was assessed using a modified damping capacity analysis. RESULTS: At four months postoperatively, dimensional changes in soft tissue surface resorption were less in the test group than in the control group; however, alveolar bone resorption was the same in both groups. Histological analysis revealed new bone formation, residual graft and fibrous connective tissue in both groups. The average primary implant stability (IST) value for both groups was approximately 70. There was no statistically significant difference in all parameters between two groups (p > 0.05). CONCLUSION: 3DP HA could potentially be used as an alternative bone graft material for alveolar ridge preservation.

Digital occlusal analysis of pre and post single posterior implant restoration delivery: A pilot study.

OBJECTIVES: The purposes of this study were to analyze the effects of single posterior implant restorations delivery on the redistribution of bite force and to evaluate the changes in occlusal force distribution of prostheses and potential influencing factors on occlusion variation at different stages. MATERIALS AND METHODS: Thirty-two single posterior restorations in 30 participants (18 women and 12 men aged 27 to 75 years) were placed into either a unilateral single-tooth defect (n = 17) or on either side of a bilateral teeth defects (n = 15). The bite force (%) of the prostheses, teeth and segments at the maximum intercuspation position (MIP) was evaluated using a T-scan at 5 stages (pre-placement, immediately following placement, and 2 weeks, 3 months, and 6 months post-placement). RESULTS: The occlusal force of implant-supported prostheses was significantly (P = .000) lower than those of the control natural teeth at the baseline, then no significant difference was found with that of the mesial teeth at 3 months, and finally it was significantly (P = .000) lower than that of the distal teeth at 6 months; meanwhile, it significantly (P = .008) increased by a mean of 2.04 times from 2 weeks (3.39 ± 2.61%) to 3 months (6.90 ± 4.77%), whereas no significant difference (P = .900) was found from 3 months (6.90 ± 4.77%) to 6 months (7.31 ± 4.60%). In addition, the bite force of the posterior segment on the restored side of both unilateral and bilateral gaps was significantly (P = .013,.001) improved by 3.31% and 6.83%, respectively, although the discrepancy in bite force significantly (P = .039) increased from an initial 3.52% to 5.02% for subjects with bilateral defects, accompanying increases in the proportion (15.38%) of the level III bilateral bite force deviation (P >.05). CONCLUSIONS: Bite force and masticatory ability can be improved with the immediate delivery of a single posterior implant restoration. The bite force distributed on the implant prosthesis inevitably increases after placement of implant prostheses, a routine follow-up and occlusal evaluation are strongly needed.

Effectiveness of bilayer porous polyethylene membrane for alveolar ridge preservation: A randomized controlled trial.

BACKGROUND: Porous polyethylene has been successfully used in several medical applications with good outcomes. Based on this, a new bilayer porous polyethylene membrane (B-PPM) was developed for possibly being used as a membrane in alveolar ridge preservation. PURPOSE: To evaluate the clinical efficacy of a new B-PPM in comparison to high-density polytetrafluoroethylene membrane (d-PTFE) in alveolar ridge preservation. MATERIALS AND METHODS: Thirty patients were randomized into two groups according to the membranes used to cover the socket (B-PPM or d-PTFE). Wound healing was monitored at day 1, 3, 7, 14, 28, and 4 months postoperatively. Dimensional changes of alveolar ridge were measured immediately after tooth extraction and at 4 months later using intraoral scanner and cone beam computed tomography. Bone cores were harvested before implant placement. Implant stability at insertion and prior to prosthesis delivery were also measured. RESULTS: No significant difference in socket wound closure between groups was observed excepting at day 14 that B-PPM showed a faster wound closure than d-PTFE (P = .03). Greater bone resorptions were seen on buccal than lingual side and on coronal than apical part of the alveolar ridge. No significant difference in dimensional changes of alveolar ridge, new bone formation, connective tissue content, residual bone grafts, and implant stability between two groups. CONCLUSION: B-PPPM was safe and effective for alveolar ridge preservation.