Vertical Bone Augmentation With Customized CAD/CAM Titanium Mesh for Severe Alveolar Ridge Defect in the Posterior Mandible: A Case Letter
Implant rehabilitation after implant removal is a major challenge, especially in mandibular posterior arches. This case report describes the reconstruction of a severe vertical bone defect using customized titanium mesh covered by collagen membrane and solid advanced platelet-rich fibrin, combined with autogenous bone, deproteinized bovine bone mineral, and injectable platelet-rich fibrin after implant removal caused by advanced peri-implantitis. This individualized titanium mesh may be a reliable technique for severe alveolar ridge reconstruction, with the additional benefits of reduced surgery time and a simplified operation.
(a) Preoperative X-ray image before implant removal. (b) FGG sutured over periosteum and stabilized with PTFE sutures. (c) Rapid prototyping of the mesh with slight concave profile.
(a) Evidence of severe vertical bone defect: decortication of the alveolar cortical bone and adequate flap release of the buccal and lingual flaps to achieve passive primary closure. (b) Surgical stabilization of CTM with 3 screws. (c) Filling the prefixed CTM with autogenous bone and DBBM, applied with i-PRF. (d) CTM covering by CM. (e) CM covering by A-PRF. (f) Postoperative X-ray image after CTM application.
(a) Clinical situation at 9 months. (b) After CTM removal and placement of 4 implants. (c) Healing after FGG. (d) Final prosthetic rehabilitation. (e) Final postoperative X-ray image.
Newly formed bone trabeculae (nb) and graft material (*). A few osteoclasts (arrows) were seen around the graft material (hematoxylin-eosin a: ×40, b: ×100, c: ×200). Newly formed bone trabeculae (nb) and graft material (*) in the core biopsy material (light green-Periodic Acid-Schiff (PAS) d: ×40, e: ×100, f: ×200).
Contributor Notes