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Vertical Ridge Augmentation of the Atrophic Posterior Mandible With Custom-Made, Computer-Aided Design/Computer-Aided Manufacturing Porous Hydroxyapatite Scaffolds

Figliuzzi, Michele DDS*; Mangano, Francesco Guido DDS; Fortunato, Leonzio MD, DDS*; De Fazio, Rossella DDS*; Macchi, Aldo MD, DDS; Iezzi, Giovanna DDS, PhD; Piattelli, Adriano MD, DDS; Mangano, Carlo MD, DDS

Journal of Craniofacial Surgery: May 2013 - Volume 24 - Issue 3 - p 856–859
doi: 10.1097/SCS.0b013e31827ca3a7
Original Articles

The present study describes a new protocol for the manufacturing of custom-made hydroxyapatite scaffolds using computer-aided design/computer-aided manufacturing (CAD/CAM), to augment posterior mandibular bone and minimize surgery when severe atrophy is present. Computed tomographic images of an atrophic posterior mandible were acquired and modified into a 3-dimensional (3D) reconstruction model. This model was transferred as a stereolithographic file to a CAD program, where virtual 3D reconstructions of the alveolar ridge were performed, drawing 2 anatomically shaped, custom-made scaffolds. Computer-aided-manufacturing software generated a set of tool-paths for manufacture on a computer-numerical-control milling machine into the exact shape of the 3D projects. Clinically sized, anatomically shaped scaffolds were generated from commercially available porous hydroxyapatite blocks. The custom-made scaffolds well matched the shape of the bone defects and could be easily implanted during surgery. This matching of the shape helped to reduce the time for the operation and contributed to the good healing of the defects. At the 6-month recall, a newly formed and well-integrated bone was observed, completely filling the mandibular posterior defects, and implants were placed, with good primary stability. At the 1-year follow-up examination, the implant-supported restorations showed a good functional and esthetic integration. Although this is an interim report, this study demonstrates that anatomically shaped custom-made scaffolds can be fabricated by combining computed tomographic scans and CAD/CAM techniques. Further studies are needed to confirm these results.

From the *Dental School, University of Catanzaro, Catanzaro; †Dental School, University of Varese, Varese; and ‡Dental School, University of Chieti-Pescara, Chieti-Pescara, Italy.

Received October 29, 2012.

Accepted for publication November 4, 2012.

Address correspondence and reprint requests to Francesco Guido Mangano, DDS, Piazza Trento 4, 22015, Gravedona (Como), Italy; E-mail: francescomangano1@mclink.net

The authors report no conflicts of interest.

© 2013Wolters Kluwer Health | Lippincott Williams & Wilkins