Custom-Made Computer-Aided-Design/Computer-Aided-Manufacturing Biphasic Calcium-Phosphate Scaffold for Augmentation of an Atrophic Mandibular Anterior Ridge
Identifieur interne : 000F04 ( Pmc/Checkpoint ); précédent : 000F03; suivant : 000F05Custom-Made Computer-Aided-Design/Computer-Aided-Manufacturing Biphasic Calcium-Phosphate Scaffold for Augmentation of an Atrophic Mandibular Anterior Ridge
Auteurs : Francesco Guido Mangano [Italie] ; Piero Antonio Zecca [Italie] ; Ric Van Noort [Royaume-Uni] ; Samvel Apresyan [Russie] ; Giovanna Iezzi [Italie] ; Adriano Piattelli [Italie] ; Aldo Macchi [Italie] ; Carlo Mangano [Italie]Source :
- Case Reports in Dentistry [ 2090-6447 ] ; 2015.
Abstract
This report documents the clinical, radiographic, and histologic outcome of a custom-made computer-aided-design/computer-aided-manufactured (CAD/CAM) scaffold used for the alveolar ridge augmentation of a severely atrophic anterior mandible. Computed tomographic (CT) images of an atrophic anterior mandible were acquired and modified into a 3-dimensional (3D) reconstruction model; this was transferred to a CAD program, where a custom-made scaffold was designed. CAM software generated a set of tool-paths for the manufacture of the scaffold on a computer-numerical-control milling machine into the exact shape of the 3D design. A custom-made scaffold was milled from a synthetic micromacroporous biphasic calcium phosphate (BCP) block. The scaffold closely matched the shape of the defect: this helped to reduce the time for the surgery and contributed to good healing. One year later, newly formed and well-integrated bone was clinically available, and two implants (AnyRidge, MegaGen, Gyeongbuk, South Korea) were placed. The histologic samples retrieved from the implant sites revealed compact mature bone undergoing remodelling, marrow spaces, and newly formed trabecular bone surrounded by residual BCP particles. This study demonstrates that custom-made scaffolds can be fabricated by combining CT scans and CAD/CAM techniques. Further studies on a larger sample of patients are needed to confirm these results.
Url:
DOI: 10.1155/2015/941265
PubMed: 26064701
PubMed Central: 4442008
Affiliations:
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uniqKey="Iezzi G" first="Giovanna" last="Iezzi">Giovanna Iezzi</name><affiliation wicri:level="1"><nlm:aff id="I5">Department of Medical, Oral and Biotechnological Sciences, Dental School, G. d'Annunzio University, Via dei Vestini 31, 66100 Chieti, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Medical, Oral and Biotechnological Sciences, Dental School, G. d'Annunzio University, Via dei Vestini 31, 66100 Chieti</wicri:regionArea><wicri:noRegion>66100 Chieti</wicri:noRegion></affiliation></author><author><name sortKey="Piattelli, Adriano" sort="Piattelli, Adriano" uniqKey="Piattelli A" first="Adriano" last="Piattelli">Adriano Piattelli</name><affiliation wicri:level="1"><nlm:aff id="I5">Department of Medical, Oral and Biotechnological Sciences, Dental School, G. d'Annunzio University, Via dei Vestini 31, 66100 Chieti, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Medical, Oral and Biotechnological Sciences, 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21100 Varese</wicri:regionArea><wicri:noRegion>21100 Varese</wicri:noRegion></affiliation></author><author><name sortKey="Mangano, Carlo" sort="Mangano, Carlo" uniqKey="Mangano C" first="Carlo" last="Mangano">Carlo Mangano</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Surgical and Morphological Science, Dental School, University of Insubria, Via Giuseppe Piatti 10, 21100 Varese, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Surgical and Morphological Science, Dental School, University of Insubria, Via Giuseppe Piatti 10, 21100 Varese</wicri:regionArea><wicri:noRegion>21100 Varese</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I2">ITEB Research Centre, University of Insubria, Via Giuseppe Piatti 10, 21100 Varese, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>ITEB Research Centre, University of Insubria, Via Giuseppe Piatti 10, 21100 Varese</wicri:regionArea><wicri:noRegion>21100 Varese</wicri:noRegion></affiliation></author></analytic><series><title level="j">Case Reports in Dentistry</title><idno type="ISSN">2090-6447</idno><idno type="eISSN">2090-6455</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>This report documents the clinical, radiographic, and histologic outcome of a custom-made computer-aided-design/computer-aided-manufactured (CAD/CAM) scaffold used for the alveolar ridge augmentation of a severely atrophic anterior mandible. Computed tomographic (CT) images of an atrophic anterior mandible were acquired and modified into a 3-dimensional (3D) reconstruction model; this was transferred to a CAD program, where a custom-made scaffold was designed. CAM software generated a set of tool-paths for the manufacture of the scaffold on a computer-numerical-control milling machine into the exact shape of the 3D design. A custom-made scaffold was milled from a synthetic micromacroporous biphasic calcium phosphate (BCP) block. The scaffold closely matched the shape of the defect: this helped to reduce the time for the surgery and contributed to good healing. One year later, newly formed and well-integrated bone was clinically available, and two implants (AnyRidge, MegaGen, Gyeongbuk, South Korea) were placed. The histologic samples retrieved from the implant sites revealed compact mature bone undergoing remodelling, marrow spaces, and newly formed trabecular bone surrounded by residual BCP particles. This study demonstrates that custom-made scaffolds can be fabricated by combining CT scans and CAD/CAM techniques. Further studies on a larger sample of patients are needed to confirm these results.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Mangano, F" uniqKey="Mangano F">F. Mangano</name></author><author><name sortKey="Macchi, A" uniqKey="Macchi A">A. Macchi</name></author><author><name sortKey="Caprioglio, A" uniqKey="Caprioglio A">A. Caprioglio</name></author><author><name sortKey="Sammons, R L" uniqKey="Sammons R">R. L. Sammons</name></author><author><name sortKey="Piattelli, A" uniqKey="Piattelli A">A. Piattelli</name></author><author><name sortKey="Mangano, C" uniqKey="Mangano C">C. Mangano</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mangano, F" uniqKey="Mangano F">F. Mangano</name></author><author><name sortKey="Shibli, J A" uniqKey="Shibli J">J. A. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Case Rep Dent</journal-id><journal-id journal-id-type="iso-abbrev">Case Rep Dent</journal-id><journal-id journal-id-type="publisher-id">CRID</journal-id><journal-title-group><journal-title>Case Reports in Dentistry</journal-title></journal-title-group><issn pub-type="ppub">2090-6447</issn><issn pub-type="epub">2090-6455</issn><publisher><publisher-name>Hindawi Publishing Corporation</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26064701</article-id><article-id pub-id-type="pmc">4442008</article-id><article-id pub-id-type="doi">10.1155/2015/941265</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Custom-Made Computer-Aided-Design/Computer-Aided-Manufacturing Biphasic Calcium-Phosphate Scaffold for Augmentation of an Atrophic Mandibular Anterior Ridge</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Mangano</surname><given-names>Francesco Guido</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref><xref ref-type="aff" rid="I2"><sup>2</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0001-9646-4958</contrib-id><name><surname>Zecca</surname><given-names>Piero Antonio</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref><xref ref-type="aff" rid="I2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>van Noort</surname><given-names>Ric</given-names></name><xref ref-type="aff" rid="I3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Apresyan</surname><given-names>Samvel</given-names></name><xref ref-type="aff" rid="I4"><sup>4</sup></xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0002-2391-6594</contrib-id><name><surname>Iezzi</surname><given-names>Giovanna</given-names></name><xref ref-type="aff" rid="I5"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>Piattelli</surname><given-names>Adriano</given-names></name><xref ref-type="aff" rid="I5"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>Macchi</surname><given-names>Aldo</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref><xref ref-type="aff" rid="I2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0002-4419-4674</contrib-id><name><surname>Mangano</surname><given-names>Carlo</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref><xref ref-type="aff" rid="I2"><sup>2</sup></xref></contrib></contrib-group><aff id="I1"><sup>1</sup>Department of Surgical and Morphological Science, Dental School, University of Insubria, Via Giuseppe Piatti 10, 21100 Varese, Italy</aff><aff id="I2"><sup>2</sup>ITEB Research Centre, University of Insubria, Via Giuseppe Piatti 10, 21100 Varese, Italy</aff><aff id="I3"><sup>3</sup>Academic Unit of Restorative Dentistry, School of Clinical Dentistry, University of Sheffield, 19 Claremont Crescent, Sheffield S10 2TA, UK</aff><aff id="I4"><sup>4</sup>Academic Unit of Prosthodontics, Moscow State University of Medicine and Dentistry, 20 Delegatskaya Street, Moscow 127473, Russia</aff><aff id="I5"><sup>5</sup>Department of Medical, Oral and Biotechnological Sciences, Dental School, G. d'Annunzio University, Via dei Vestini 31, 66100 Chieti, Italy</aff><author-notes><corresp id="cor1">*Francesco Guido Mangano: <email>francescomangano1@mclink.net</email></corresp><fn fn-type="other"><p>Academic Editor: Miguel Peñarrocha</p></fn></author-notes><pub-date pub-type="ppub"><year>2015</year></pub-date><pub-date pub-type="epub"><day>10</day><month>5</month><year>2015</year></pub-date><volume>2015</volume><elocation-id>941265</elocation-id><history><date date-type="received"><day>6</day><month>2</month><year>2015</year></date><date date-type="accepted"><day>21</day><month>4</month><year>2015</year></date></history><permissions><copyright-statement>Copyright © 2015 Francesco Guido Mangano et al.</copyright-statement><copyright-year>2015</copyright-year><license xlink:href="https://creativecommons.org/licenses/by/3.0/"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>This report documents the clinical, radiographic, and histologic outcome of a custom-made computer-aided-design/computer-aided-manufactured (CAD/CAM) scaffold used for the alveolar ridge augmentation of a severely atrophic anterior mandible. Computed tomographic (CT) images of an atrophic anterior mandible were acquired and modified into a 3-dimensional (3D) reconstruction model; this was transferred to a CAD program, where a custom-made scaffold was designed. CAM software generated a set of tool-paths for the manufacture of the scaffold on a computer-numerical-control milling machine into the exact shape of the 3D design. A custom-made scaffold was milled from a synthetic micromacroporous biphasic calcium phosphate (BCP) block. The scaffold closely matched the shape of the defect: this helped to reduce the time for the surgery and contributed to good healing. One year later, newly formed and well-integrated bone was clinically available, and two implants (AnyRidge, MegaGen, Gyeongbuk, South Korea) were placed. The histologic samples retrieved from the implant sites revealed compact mature bone undergoing remodelling, marrow spaces, and newly formed trabecular bone surrounded by residual BCP particles. This study demonstrates that custom-made scaffolds can be fabricated by combining CT scans and CAD/CAM techniques. Further studies on a larger sample of patients are needed to confirm these results.</p></abstract></article-meta></front><floats-group><fig id="fig1" orientation="portrait" position="float"><label>Figure 1</label><caption><p>Preoperative situation. (a) 3D reconstruction of the atrophic anterior mandible by means of specific software: a huge vertical bone defect is present in the symphyseal area, combined with a marked reduction in the horizontal alveolar ridge width. (b) Photorealistic rendering of the mandible. The severe posttraumatic atrophy of the mandibular anterior ridge is evidenced.</p></caption><graphic xlink:href="CRID2015-941265.001"></graphic></fig><fig id="fig2" orientation="portrait" position="float"><label>Figure 2</label><caption><p>The anatomically shaped, custom-made scaffold is designed. The scaffold includes a hole in its centre to allow the placement of a fixation screw.</p></caption><graphic xlink:href="CRID2015-941265.002"></graphic></fig><fig id="fig3" orientation="portrait" position="float"><label>Figure 3</label><caption><p>Surgery on patient. (a) Preoperative situation; (b) a PTFE replica is placed in position; (c) the PTFE replica is used for precise positioning of the hole for the fixation screw of the scaffold; (d) multiple small holes are drilled through the remaining alveolar bone into the marrow cavity, with a 1 mm round bur, under copious saline irrigation, to enhance bleeding of the mandibular cortex; (e) a preparation rich in growth factor (PRGF) is prepared and applied to the surgical site; (f) the custom-made BCP scaffold is removed from its sterile packaging; (g) the scaffold is placed in position strictly overlapping the underlying alveolar crest; (h) fixation of the scaffold is obtained by means of a small titanium screw; (i) the BCP scaffold rapidly acts as a sponge, absorbing a large amount of blood from the surgical site; (j) the surgical site is protected with a fibrin membrane; (k) care is taken to obtain a tension-free suture above the scaffold, so as to avoid ischemic damage to the mucosa and suture dehiscence; (l) 2 weeks after surgery sutures are removed.</p></caption><graphic xlink:href="CRID2015-941265.003"></graphic></fig><fig id="fig4" orientation="portrait" position="float"><label>Figure 4</label><caption><p>One year after surgery. (a) 3D reconstruction of the mandible by means of specific software: the vertical and horizontal bone gains are clearly evidenced. (b) Photorealistic rendering of the mandible.</p></caption><graphic xlink:href="CRID2015-941265.004"></graphic></fig><fig id="fig5" orientation="portrait" position="float"><label>Figure 5</label><caption><p>Overlapping of digital images. The DICOM (Digital Imaging and Communication in Medicine) files of the obtained CT datasets, before and 1 year after grafting, are converted into a surface mesh model with digital imaging software (Mimics, Materialise, Leuven, Belgium). The two surface mesh models are then superimposed and rigidly aligned with anatomical landmarks, with the aid of software for the overlapping of digital images (Geomagic Studio, Morrisville, NC, USA). The distance between the 2 surface meshes is presented as color-coded graded figures (blue: tissue loss; yellow/orange/red: tissue apposition; green: little or no modifications) to identify zones of apposition/resorption.</p></caption><graphic xlink:href="CRID2015-941265.005"></graphic></fig><fig id="fig6" orientation="portrait" position="float"><label>Figure 6</label><caption><p>Placement of dental implants in the regenerated area. (a) The placement of two implants is planned with the aim of implant navigation software (Invivo Dental 5, Anatomage, San Jose, CA, USA). (b, c, and d) Two AnyRidge dental implants (AnyRidge, MegaGen Implants Co., Ltd., Gyeongbuk, South Korea), 3.75 mm diameter × 11.5 mm length, are placed in locations numbers 32 and 42.</p></caption><graphic xlink:href="CRID2015-941265.006"></graphic></fig><fig id="fig7" orientation="portrait" position="float"><label>Figure 7</label><caption><p>Histological evaluation. (a, b) The left specimen is made of compact mature bone undergoing remodelling, with a few marrow spaces; no residual biomaterial particles are found, as only traces of BCP mixed with mineralized bone matrix are present. (c, d) The right specimen is made of residual particles of BCP surrounded by compact bone. In some areas, traces of residual particles surrounded by mineralized bone matrix are evidenced; multinucleated cells are in close contact with the BCP particles. In the marrow spaces, new blood vessels are evident.</p></caption><graphic xlink:href="CRID2015-941265.007"></graphic></fig><fig id="fig8" orientation="portrait" position="float"><label>Figure 8</label><caption><p>Prosthetic restoration. (a) The implants are left submerged for a period of 3 months, after which they are uncovered and healing abutments are placed. (b) A provisional acrylic resin fixed partial denture is provided. (c, d) Three months later, the definitive ceramometallic restoration is delivered.</p></caption><graphic xlink:href="CRID2015-941265.008"></graphic></fig></floats-group></pmc><affiliations><list><country><li>Italie</li><li>Royaume-Uni</li><li>Russie</li></country><region><li>District fédéral central</li></region><settlement><li>Moscou</li></settlement></list><tree><country name="Italie"><noRegion><name sortKey="Mangano, Francesco Guido" sort="Mangano, Francesco Guido" uniqKey="Mangano F" first="Francesco Guido" last="Mangano">Francesco Guido Mangano</name></noRegion><name sortKey="Iezzi, Giovanna" sort="Iezzi, Giovanna" uniqKey="Iezzi G" first="Giovanna" last="Iezzi">Giovanna Iezzi</name><name sortKey="Macchi, Aldo" sort="Macchi, Aldo" uniqKey="Macchi A" first="Aldo" last="Macchi">Aldo Macchi</name><name sortKey="Macchi, Aldo" sort="Macchi, Aldo" uniqKey="Macchi A" first="Aldo" last="Macchi">Aldo Macchi</name><name sortKey="Mangano, Carlo" sort="Mangano, Carlo" uniqKey="Mangano C" first="Carlo" last="Mangano">Carlo Mangano</name><name sortKey="Mangano, Carlo" sort="Mangano, Carlo" uniqKey="Mangano C" first="Carlo" last="Mangano">Carlo Mangano</name><name sortKey="Mangano, Francesco Guido" sort="Mangano, Francesco Guido" uniqKey="Mangano F" first="Francesco Guido" last="Mangano">Francesco Guido Mangano</name><name sortKey="Piattelli, Adriano" sort="Piattelli, Adriano" uniqKey="Piattelli A" first="Adriano" last="Piattelli">Adriano Piattelli</name><name sortKey="Zecca, Piero Antonio" sort="Zecca, Piero Antonio" uniqKey="Zecca P" first="Piero Antonio" last="Zecca">Piero Antonio Zecca</name><name sortKey="Zecca, Piero Antonio" sort="Zecca, Piero Antonio" uniqKey="Zecca P" first="Piero Antonio" last="Zecca">Piero Antonio Zecca</name></country><country name="Royaume-Uni"><noRegion><name sortKey="Van Noort, Ric" sort="Van Noort, Ric" uniqKey="Van Noort R" first="Ric" last="Van Noort">Ric Van Noort</name></noRegion></country><country name="Russie"><region name="District fédéral central"><name sortKey="Apresyan, Samvel" sort="Apresyan, Samvel" uniqKey="Apresyan S" first="Samvel" last="Apresyan">Samvel Apresyan</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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