Custom-Made Synthetic Scaffolds for Bone Reconstruction: A Retrospective, Multicenter Clinical Study on 15 Patients
Identifieur interne : 002929 ( Pmc/Curation ); précédent : 002928; suivant : 002930Custom-Made Synthetic Scaffolds for Bone Reconstruction: A Retrospective, Multicenter Clinical Study on 15 Patients
Auteurs : Fabrizia Luongo [Italie] ; Francesco Guido Mangano [Italie] ; Aldo Macchi [Italie] ; Giuseppe Luongo [Italie] ; Carlo Mangano [Italie]Source :
- BioMed Research International [ 2314-6133 ] ; 2016.
Abstract
Url:
DOI: 10.1155/2016/5862586
PubMed: 28070512
PubMed Central: 5192311
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Custom-Made Synthetic Scaffolds for Bone Reconstruction: A Retrospective, Multicenter Clinical Study on 15 Patients</title><author><name sortKey="Luongo, Fabrizia" sort="Luongo, Fabrizia" uniqKey="Luongo F" first="Fabrizia" last="Luongo">Fabrizia Luongo</name><affiliation wicri:level="1"><nlm:aff id="I1">Private Practice, 00193 Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Private Practice, 00193 Rome</wicri:regionArea></affiliation></author><author><name sortKey="Mangano, Francesco Guido" sort="Mangano, Francesco Guido" uniqKey="Mangano F" first="Francesco Guido" last="Mangano">Francesco Guido Mangano</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Surgical and Morphological Science, Dental School, Insubria University, 21100 Varese, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Surgical and Morphological Science, Dental School, Insubria University, 21100 Varese</wicri:regionArea></affiliation></author><author><name sortKey="Macchi, Aldo" sort="Macchi, Aldo" uniqKey="Macchi A" first="Aldo" last="Macchi">Aldo Macchi</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Surgical and Morphological Science, Dental School, Insubria University, 21100 Varese, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Surgical and Morphological Science, Dental School, Insubria University, 21100 Varese</wicri:regionArea></affiliation></author><author><name sortKey="Luongo, Giuseppe" sort="Luongo, Giuseppe" uniqKey="Luongo G" first="Giuseppe" last="Luongo">Giuseppe Luongo</name><affiliation wicri:level="1"><nlm:aff id="I3">Department of Oral and Maxillofacial Surgery, Federico II University, 80131 Naples, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Oral and Maxillofacial Surgery, Federico II University, 80131 Naples</wicri:regionArea></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="I4">Department of Dental Sciences, Vita Salute San Raffaele University, 20132 Milan, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Dental Sciences, Vita Salute San Raffaele University, 20132 Milan</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">28070512</idno><idno type="pmc">5192311</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5192311</idno><idno type="RBID">PMC:5192311</idno><idno type="doi">10.1155/2016/5862586</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">002929</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002929</idno><idno type="wicri:Area/Pmc/Curation">002929</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">002929</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Custom-Made Synthetic Scaffolds for Bone Reconstruction: A Retrospective, Multicenter Clinical Study on 15 Patients</title><author><name sortKey="Luongo, Fabrizia" sort="Luongo, Fabrizia" uniqKey="Luongo F" first="Fabrizia" last="Luongo">Fabrizia Luongo</name><affiliation wicri:level="1"><nlm:aff id="I1">Private Practice, 00193 Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Private Practice, 00193 Rome</wicri:regionArea></affiliation></author><author><name sortKey="Mangano, Francesco Guido" sort="Mangano, Francesco Guido" uniqKey="Mangano F" first="Francesco Guido" last="Mangano">Francesco Guido Mangano</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Surgical and Morphological Science, Dental School, Insubria University, 21100 Varese, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Surgical and Morphological Science, Dental School, Insubria University, 21100 Varese</wicri:regionArea></affiliation></author><author><name sortKey="Macchi, Aldo" sort="Macchi, Aldo" uniqKey="Macchi A" first="Aldo" last="Macchi">Aldo Macchi</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Surgical and Morphological Science, Dental School, Insubria University, 21100 Varese, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Surgical and Morphological Science, Dental School, Insubria University, 21100 Varese</wicri:regionArea></affiliation></author><author><name sortKey="Luongo, Giuseppe" sort="Luongo, Giuseppe" uniqKey="Luongo G" first="Giuseppe" last="Luongo">Giuseppe Luongo</name><affiliation wicri:level="1"><nlm:aff id="I3">Department of Oral and Maxillofacial Surgery, Federico II University, 80131 Naples, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Oral and Maxillofacial Surgery, Federico II University, 80131 Naples</wicri:regionArea></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="I4">Department of Dental Sciences, Vita Salute San Raffaele University, 20132 Milan, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Dental Sciences, Vita Salute San Raffaele University, 20132 Milan</wicri:regionArea></affiliation></author></analytic><series><title level="j">BioMed Research International</title><idno type="ISSN">2314-6133</idno><idno type="eISSN">2314-6141</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><italic>Purpose</italic>. To present a computer-assisted-design/computer-assisted-manufacturing (CAD/CAM) technique for the design, fabrication, and clinical application of custom-made synthetic scaffolds, for alveolar ridge augmentation.<italic> Methods</italic>. The CAD/CAM procedure consisted of (1) virtual planning/design of the custom-made scaffold; (2) milling of the scaffold into the exact size/shape from a preformed synthetic bone block; (3) reconstructive surgery. The main clinical/radiographic outcomes were vertical/horizontal bone gain, any biological complication, and implant survival.<italic> Results</italic>. Fifteen patients were selected who had been treated with a custom-made synthetic scaffold for ridge augmentation. The scaffolds closely matched the shape of the defects: this reduced the operation time and contributed to good healing. A few patients experienced biological complications, such as pain/swelling (2/15: 13.3%) and exposure of the scaffold (3/15: 20.0%); one of these had infection and complete graft loss. In all other patients, 8 months after reconstruction, a well-integrated newly formed bone was clinically available, and the radiographic evaluation revealed a mean vertical and horizontal bone gain of 2.1 ± 0.9 mm and 3.0 ± 1.0 mm, respectively. Fourteen implants were placed and restored with single crowns. The implant survival rate was 100%.<italic> Conclusions</italic>. Although positive outcomes have been found with custom-made synthetic scaffolds in alveolar ridge augmentation, further studies are needed to validate this technique. </p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Mangano, C" uniqKey="Mangano C">C. Mangano</name></author><author><name sortKey="Iaculli, F" uniqKey="Iaculli F">F. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Biomed Res Int</journal-id><journal-id journal-id-type="iso-abbrev">Biomed Res Int</journal-id><journal-id journal-id-type="publisher-id">BMRI</journal-id><journal-title-group><journal-title>BioMed Research International</journal-title></journal-title-group><issn pub-type="ppub">2314-6133</issn><issn pub-type="epub">2314-6141</issn><publisher><publisher-name>Hindawi Publishing Corporation</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28070512</article-id><article-id pub-id-type="pmc">5192311</article-id><article-id pub-id-type="doi">10.1155/2016/5862586</article-id><article-categories><subj-group subj-group-type="heading"><subject>Clinical Study</subject></subj-group></article-categories><title-group><article-title>Custom-Made Synthetic Scaffolds for Bone Reconstruction: A Retrospective, Multicenter Clinical Study on 15 Patients</article-title></title-group><contrib-group><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0001-7998-613X</contrib-id><name><surname>Luongo</surname><given-names>Fabrizia</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0001-5488-4268</contrib-id><name><surname>Mangano</surname><given-names>Francesco Guido</given-names></name><xref ref-type="aff" rid="I2"><sup>2</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Macchi</surname><given-names>Aldo</given-names></name><xref ref-type="aff" rid="I2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Luongo</surname><given-names>Giuseppe</given-names></name><xref ref-type="aff" rid="I3"><sup>3</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="I4"><sup>4</sup></xref></contrib></contrib-group><aff id="I1"><sup>1</sup>Private Practice, 00193 Rome, Italy</aff><aff id="I2"><sup>2</sup>Department of Surgical and Morphological Science, Dental School, Insubria University, 21100 Varese, Italy</aff><aff id="I3"><sup>3</sup>Department of Oral and Maxillofacial Surgery, Federico II University, 80131 Naples, Italy</aff><aff id="I4"><sup>4</sup>Department of Dental Sciences, Vita Salute San Raffaele University, 20132 Milan, Italy</aff><author-notes><corresp id="cor1">*Francesco Guido Mangano: <email>francescomangano1@mclink.net</email></corresp><fn fn-type="other"><p>Academic Editor: Sérgio Alexandre Gehrke</p></fn></author-notes><pub-date pub-type="ppub"><year>2016</year></pub-date><pub-date pub-type="epub"><day>14</day><month>12</month><year>2016</year></pub-date><volume>2016</volume><elocation-id>5862586</elocation-id><history><date date-type="received"><day>31</day><month>10</month><year>2016</year></date><date date-type="accepted"><day>23</day><month>11</month><year>2016</year></date></history><permissions><copyright-statement>Copyright © 2016 Fabrizia Luongo et al.</copyright-statement><copyright-year>2016</copyright-year><license xlink:href="https://creativecommons.org/licenses/by/4.0/"><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><italic>Purpose</italic>. To present a computer-assisted-design/computer-assisted-manufacturing (CAD/CAM) technique for the design, fabrication, and clinical application of custom-made synthetic scaffolds, for alveolar ridge augmentation.<italic> Methods</italic>. The CAD/CAM procedure consisted of (1) virtual planning/design of the custom-made scaffold; (2) milling of the scaffold into the exact size/shape from a preformed synthetic bone block; (3) reconstructive surgery. The main clinical/radiographic outcomes were vertical/horizontal bone gain, any biological complication, and implant survival.<italic> Results</italic>. Fifteen patients were selected who had been treated with a custom-made synthetic scaffold for ridge augmentation. The scaffolds closely matched the shape of the defects: this reduced the operation time and contributed to good healing. A few patients experienced biological complications, such as pain/swelling (2/15: 13.3%) and exposure of the scaffold (3/15: 20.0%); one of these had infection and complete graft loss. In all other patients, 8 months after reconstruction, a well-integrated newly formed bone was clinically available, and the radiographic evaluation revealed a mean vertical and horizontal bone gain of 2.1 ± 0.9 mm and 3.0 ± 1.0 mm, respectively. Fourteen implants were placed and restored with single crowns. The implant survival rate was 100%.<italic> Conclusions</italic>. Although positive outcomes have been found with custom-made synthetic scaffolds in alveolar ridge augmentation, further studies are needed to validate this technique. </p></abstract></article-meta></front><floats-group><fig id="fig1" orientation="portrait" position="float"><label>Figure 1</label><caption><p>Virtual 3D model of the deficient ridge and first drawing of the customized scaffold (Mimics®, Materialise. Leuven, Belgium): (a) frontal view of the ridge without the customized scaffold; (b) frontal view of the ridge with the customized scaffold; (c) occlusal view of the ridge without the customized scaffold; (d) occlusal view of the ridge with the customized scaffold.</p></caption><graphic xlink:href="BMRI2016-5862586.001"></graphic></fig><fig id="fig2" orientation="portrait" position="float"><label>Figure 2</label><caption><p>The customized synthetic scaffold was designed with a hole in its centre to allow the placement of a fixation screw (Rhino®, Robert McNeel & Associates, Seattle, WA, USA): (a-b-c-d) different views of the scaffold design.</p></caption><graphic xlink:href="BMRI2016-5862586.002"></graphic></fig><fig id="fig3" orientation="portrait" position="float"><label>Figure 3</label><caption><p>The proper size/shape of the customized scaffold was verified and the adaptation to the bone defect and the congruence with the bony walls was perfectioned (Mimics®, Materialise. Leuven, Belgium): (a) frontal view; (b) axial view; (c) lateral view; (d) 3D reconstruction.</p></caption><graphic xlink:href="BMRI2016-5862586.003"></graphic></fig><fig id="fig4" orientation="portrait" position="float"><label>Figure 4</label><caption><p>A block of synthetic micromacroporous biphasic calcium-phosphate (BCP), consisting of 70% beta-tricalcium-phosphate and 30% hydroxyapatite (BTK®, Dueville, Vicenza, Italy), was placed into the CNC milling machine (DWX-51®, Roland DG Mid Europe, Acquaviva Picena, AP, Italy) and milled into the size/shape of the 3D virtual model, so that a customised synthetic BCP scaffold was fabricated: (a) buccal aspect of the scaffold design; (b) lingual aspect of the scaffold design; (c) the milled customized scaffold ready for clinical use.</p></caption><graphic xlink:href="BMRI2016-5862586.004"></graphic></fig><fig id="fig5" orientation="portrait" position="float"><label>Figure 5</label><caption><p>Bone reconstruction: (a) a full-thickness flap was elevated in order to fully expose the bone defect, and a series of little perforations, 1-2 mm deep, were made on the defect walls, in order to increase the amount of bleeding at the surgical site; (b) the customized synthetic scaffold was placed in position; (c) the scaffold was fixed to the remaining wall by means of a titanium mini-screw, positioned through the predetermined hole; (d) an absorbable collagen membrane was placed, in order to protect the scaffold.</p></caption><graphic xlink:href="BMRI2016-5862586.005"></graphic></fig><fig id="fig6" orientation="portrait" position="float"><label>Figure 6</label><caption><p>After 8 months from the regenerative surgery, the implant was placed: (a) after the elevation of a full-thickness flap, the regenerated site showed an increased bone thickness with a considerable amount of new, clinically well-integrated bone; (b) the mini-screw used for fixation was removed; (c) the preparation of the surgical site was performed with drills of increasing diameter; (d) a 3.5 diameter × 13 mm length implant (NobelActive®, Nobel Biocare, Kloten, Switzerland) was placed in the regenerated site.</p></caption><graphic xlink:href="BMRI2016-5862586.006"></graphic></fig><fig id="fig7" orientation="portrait" position="float"><label>Figure 7</label><caption><p>The implant was located in the perfect 3D position: (a) it was placed in a clinically well-integrated, regenerated bone; (b) as confirmed by the CBCT control examination.</p></caption><graphic xlink:href="BMRI2016-5862586.007"></graphic></fig><fig id="fig8" orientation="portrait" position="float"><label>Figure 8</label><caption><p>After being submerged for a period of 2-3 months, the implant was uncovered and a prosthetic restoration was placed: (a) a full-thickness surgical flap was raised; (b) the implant was uncovered; (c) the cover cap was replaced by a transmucosal healing abutment and interrupted sutures were performed; (d) two weeks later, the provisional crown was placed.</p></caption><graphic xlink:href="BMRI2016-5862586.008"></graphic></fig><fig id="fig9" orientation="portrait" position="float"><label>Figure 9</label><caption><p>Radiographic history of the case: (a) periapical rx taken immediately after the reconstructive procedure; (b) periapical rx taken immediately after implant placement; (c) the implant during the provisional phase, 4 months after placement of the fixture; (d) final rx control of the definitive crown, 3 years after implant placement.</p></caption><graphic xlink:href="BMRI2016-5862586.009"></graphic></fig></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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