The integration of 3D printing in the diagnostic process preparatory to planning regenerative oral surgery (GBR) represents an undoubted advantage for the specialist.
Having 3D printed anatomical compartment in your hands favors:
- direct tests on the anatomical region of the implants to be placed and the possibility of modeling and cutting non-resorbable membranes or titanium meshes
- tactile memory of the steps to be taken during the intervention, identifying the anatomical findings
- evaluate the actual size of lesions or pathological conditions
An interesting example is the case of mandibular horizontal bone atrophy treated by Dr. Tommaso Costa of the CV Dental Clinic in Udine.
After performing a mandibular CBCT (MyRay Hyperion X9 Pro, Fig. 1) a model of the mandible was printed using the Shining3D AccuFab-D1s printer with DLP technology.
Fig. 1: Images CBCT MyRay Hyperion X9 Pro
Fig. 2: 3D reconstructed mandible model
During the planning it was decided to treat the patient by reconstructing the mandibular bone deficiency region with a titanium membrane (Regenplate) shaped directly on the printed part.
Once the segmentation of the Cone Beam images of the mandible was performed and the 3D model in STL format (Fig. 2) was obtained, we proceeded to prepare printing phase on the software Accuware integrated with the printer (Fig. 3).
Fig. 3: Preparation of slicing for 3D printing
After the printing phase and the final cleaning and curing procedures, a trial of preparation of the implant sites was carried out on the model with insertion of the implants, shaping of the titanium membrane and fixing with screws (see Fig. 4,5 and 6). The insertion of one jd evolution plus 3.2x10mm implant in position 45 and one jd evolution plus 3.7x10mm implant in position 46 has been programmed.
Fig. 4: 3D printed mandibular model
Fig. 5: Test for drilling and implant insertion
Fig. 6: Titanium membrane shaped on the model
During surgery, the mental foramen was isolated, and the planned implants were placed (Fig. 7). With the aid of a scraper, autologous bone was removed and mixed with OsteoBiol Gen-oss heterologous bone (Fig. 8).
Fig. 7: Implant insertion and bone grafting
Fig. 7: Implant insertion and bone grafting
The pre-modeled and sterilized titanium membrane was easily positioned on the mandibular bone and fixed with 2 vestibular screws and 1 lingual screw (Fig. 9). It was not necessary to change the membrane in the patient's mouth. The lingual and buccal flaps were passivated and a resorbable suture was performed (Fig. 10).
Fig. 9: Positioning and fixing of the titanium membrane
Fig. 10: Absorbable suture
The shaping of the membrane and the rounding of the margins are essential conditions for the success of the surgery and to prevent exposure of the membrane during the healing process.
According to Dr. Costa the practice of using the 3D printed mandibular region was essential, stating:
“It is often complicated to perform the shaping directly in the patient's mouth as access to the surgical site is limited, making the process uncomfortable for both the clinician and the patient
Being able to shape the membrane outside the oral cavity and before surgery is an undoubted advantage as it saves a considerable amount of time during the surgery by reducing the discomfort for the patient.”
The positive outcome of the operation was later confirmed with the recall of the patient 2 months after surgery without any exposure of the membrane (Fig. 11).
Fig. 11: Follow -up 2 months after surgery (L: Before; R: After)
