The Application of Three-Dimensional Printing Model and Platelet-Rich Fibrin Technology in Guided Tissue Regeneration Surgery for Severe Bone Defects
A 36-year-old male patient diagnosed with severe chronic periodontitis was treated with novel surgery for his maxillary right lateral incisor. Preoperatively, a 3D printer was used, based on CBCT datasets, to produce a photosensitive resin bony anatomy replica. The patient's blood was centrifuged to obtain advanced platelet-rich fibrin (A-PRF) and injected platelet-rich fibrin (I-PRF), then mixed with Bio-Oss and packed onto the 3D replica to form the ideal shape. The replica was positioned at the planned sites without changes. The A-PRF membrane was applied over the replica as well as a Bio-Gide collagen membrane. Fifteen months after the surgery, clinical and radiographic followup revealed greatly reduced pocket depths and significant 3D alveolar bone fill at the treatment site. Based on these short-term results, the initial 3D printing surgical temple assisted guided tissue regeneration method resulted in significant clinical and radiographic improvements; A-PRF/I-PRF should be considered an ideal biomaterial for regenerative periodontal therapy.
Teeth No. 22–27 fixed dentures with gingiva swollen and pyorrhea; tooth No. 7 gingival recession and migration.
(a) Preoperative radiograph of tooth No. 7 showing extensive bone loss. (b) Postoperative radiograph at 6 months and (c) 12 months show significant bone filling with delayed Bio-Oss absorption, and (d) interval at 15 months showing bone regeneration at the treatment site.
Pre-operation (a) 3D printing replica of tooth No. 7 alveolar bone, cone-beam computerized tomography reconstruction of tooth No. 7 showing the (b) labial and (c) palatial bone loss, full thickness mucoperiosteal flap elevated, showing (d) the labial/mesial/distal bone loss of tooth No. 7, and (e) palatial bone loss of tooth No. 7, which is the same as 3D replica showed.
Surgery procedure: (a) 3D printing replica of the right anterior maxilla. (b) Advanced platelet-rich fibrin (A-PRF) structured fibrin clot in the middle of the tube between the red corpuscles at the bottom and cellular plasma at the top of the PRF. (c) Injectable platelet-rich fibrin (I-PRF). (d) Heart-shaped blend of A-PRF and (e) Bio-Oss in labial view and (f) fan-shaped in palatal view, and after moistened with (c) I-PRF, the mixture was soon molded and could be easily moved.
(g) Use 3D replica to cut (h) Bio-Guide membrane into a suitable shape (h,i). Placement of (j) A-PRF/I-PRF/Bio-Oss blend, (k) A-PRF and (l) Bio-Guide membrane.
(m) Flap was sutured in position. (n) After initial therapy and pre-operation. (o) 12-months after surgery; shows normal soft tissue contour.
Postoperative cone beam computerized tomography construction in (a) palatal and (b) labial view. (c) Bone regeneration (shown in gray). (d) Dramatically growing circular volume of 69.93 mm3 (measured using Mimics 10.1).
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