Maxillary Ridge Augmentation with Custom-Made CAD/CAM Scaffolds. A 1-Year Prospective Study on 10 Patients
Several procedures have been proposed to achieve maxillary ridge augmentation. These require bone replacement materials to be manually cut, shaped, and formed at the time of implantation, resulting in an expensive and time-consuming process. In the present study, we describe a technique for the design and fabrication of custom-made scaffolds for maxillary ridge augmentation, using three-dimensional computerized tomography (3D CT) and computer-aided design/computer-aided manufacturing (CAD/CAM). CT images of the atrophic maxillary ridge of 10 patients were acquired and modified into 3D reconstruction models. These models were transferred as stereolithographic files to a CAD program, where a virtual 3D reconstruction of the alveolar ridge was generated, producing anatomically shaped, custom-made scaffolds. CAM software generated a set of tool-paths for manufacture by a computer-numerical-control milling machine into the exact shape of the reconstruction, starting from porous hydroxyapatite blocks. The custom-made scaffolds were of satisfactory size, shape, and appearance; they matched the defect area, suited the surgeon's requirements, and were easily implanted during surgery. This helped reduce the time for surgery and contributed to the good healing of the defects.
Figure 1. 3D reconstruction of the maxilla. The alveolar ridge defect has been virtually reconstructed, drawing an anatomically shaped custom-made scaffold. Figure 2. Clinical view of the U-shaped defect. Figure 3. Clinical measurement of the U-shaped defect with a periodontal probe. Figure 4. Hydroxyapatite scaffold placed in position and fitted securely to the maxilla. Figure 5. Eight-month clinical control. Newly formed and well-integrated bone was observed filling the entire defect.
Figure 6. Representative examples of the histological sections: (a) Newly formed trabecular bone and biomaterial, in the central portion of the specimen (×12, acid fuchsin and toluidine blue). (b) The biomaterial is surrounded by newly formed bone, with wide osteocyte lacunae in the vicinity of and at close contact with the graft material, and osteoid matrix undergoing mineralization. New bone formation is observed inside the biomaterial too (×200, acid fuchsin and toluidine blue). (c) Osteoid matrix undergoing mineralization inside the biomaterial (×200, acid fuchsin and toluidine blue). Figure 7. Radiographic control. Figure 8. Clinical control.
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