logo 19 • CAMLOG Partner Magazine • December 2018 18 Dr. Amely Hartmann, Dr. Marcus Seiler MSc. MSc., both Filderstadt, Dr. Silke Stuff , Pforzheim RECONSTRUCTION OF A THREE-DIMENSIONAL BONE DEFECT WITH PATIENT-SPECIFIC CAD/CAM TITANIUM MESH Fig. 1: The initial situation on the OPG. Tooth 26 is not worth preserving due to a perio-endo lesion. Digital workflows in implant dentistry, surgery and prosthetics have found their way into many dental practices today. The scientific topicality and relevance of this field of research also becomes clear when one considers the number of recently published publications on the subject [1-4]. This case report describes a surgical digital workflow in which a single-tooth implant-prosthetic prosthesis is performed with an individual bone reconstruction. Clinical and radiological results after 2 years are presented. The trend towards individualized (dental) medicine enables patient-specific therapy concepts far detached from ready-made molded parts and procedures. Therapeutic measures are offered on the basis of Computer Aided Design/Computer Aided Manufacturing (CAD/CAM) technologies and 3-dimensional (3D) printing. This also includes patient-specific titanium meshes [5-7], which are used in the course of surgical bone augmentation. Generally speaking, this should shorten the intervention time through the associated digital workflows. This is possible as the intervention is simulated virtually on the computer beforehand. The three-dimensional implant position and prosthetic restoration are part of the initial planning here. The contour of the mesh is also designed digitally such that the bone is later rebuilt at the prosthetically ideal position calculated through backward-planning. Studies indicate that intraoperative pre-bending, as is the case with ready-made meshes, is eliminated, reducing patient co-morbidity through faster intervention [5, 8]. The active principle is that the lumen to be augmented is supported, thus avoiding soft tissue collapse. Bone grafts protected by titanium meshes exhibit significantly lower bone resorption [9]. Individual titanium meshes can be used for all types of jaw defects, especially the pronounced vertical and threedimensional reconstructions [10]. Classical alternatives for vertical reconstruction would include segment osteotomy, the onlay technique, distraction osteogenesis or block augmentation. [11, 12]. Purely transversal deficits can be compensated by the ridge-splitting technique, classically by the membrane technique of Guided Bone Regeneration (GBR), or the use of block augmentations [13]. Three-dimensional defects can also be treated using block augmentations or interposition plasty. Here, the autologous blocks are harvested from intraoral and extraoral donor sites. Transplant resorption is to be expected via remodeling of the bone. This knowledge requires distinct overcontouring in planning, as melting of a part of the transplant is to be expected. Increased morbidity of the patient due to a larger harvesting site can result as a consequence as can more difficult soft tissue management at the recipient site. Patient case The 44-year-old patient presented for the first time on 03.02.2015 with complaints in region 26. The patient did not report any abnormalities in her general medical history. She is a non-smoker. When the dental anamnesis was taken, tooth 26 was not worth preserving (Fig. 1) due Fig. 3: Clinical, healed situation three months after extraction. There is only a slight transversal deficit from occlusal. CASE STUDY Fig. 2: Radiologically, there is a pronounced vertical defect in region 26.
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