Combined horizontal and vertical regeneration using CAD-CAM titanium scaffold

The Situation

A 54-year old and systematically healthy male patient (ASA I) came to our attention presenting partial edentulism in the lower jaw and requiring a fixed and aesthetic rehabilitation, refusing any removable solution. The clinical and radiographic evaluation results in a significant bone atrophy both in vertical and horizontal component; which makes it impossible to place both conventional implants and short or narrow implants.

The Approach

The approach to solving the case was developed in two steps: first the bone reconstruction to restore the ideal anatomy, second the positioning of the prosthetically guided implants. For all this, we have chosen an individualized and customized regeneration technique using a CAD-CAM titanium scaffold (Yxoss CBR®) in conjunction with a mix of 60% autologous bone and 40% Geistlich Bio-Oss®, covered by a resorbable collagen membrane Geistlich Bio-Gide®. At 9 months, the titanium scaffold was easily removed and 3 prosthetically guided implants were placed, completely surrounded by bone. At 12 months, a free gingival graft was performed to re-establish the missing amount of keratinized mucosa. Finally, at 16 months, the final rehabilitation was carried out with a fixed prosthesis on implants.

The Outcome

The final resolution of the case was very satisfactory. There were no complications during all the procedures performed. The Yxoss CBR® allowed for easier reconstructive surgery and a significant reduction in surgical times, thanks to the precise dimensions of the scaffold. This resulted in a favourable postoperative situation for the patient and complications were prevented.
 

Keys to Success

• The scaffold was fixed with 2 titanium micro screws
• Substantially reduced surgery time vs. conventional, non-indivualized titanium meshes
• Augmentation performed with a mix of 60 % autologous bone particles and 40 % Geistlich Bio-Oss®
• Resorbable collagen membrane (Geistlich Bio-Gide®) in order to optimize the barrier effect