严重萎缩骨和癌症切除术后的三维增强是具有挑战性的临床指征,主要使用自体骨移植解决。数字技术的发展以及增材制造和三维(3D)打印为重建口腔和颌面外科开辟了新途径。因此,患者特异性钛网是一种新的方法,可以使用颗粒骨替代材料(BSM)与自体骨结合作为微创概念来稳定增强区域。然而,裂开是该领域经常报道的并发症。因此,本病例系列的目的是在暴露开放愈合方面引入基于生物材料的再生概念,以克服与3D钛网相关的开裂。此外,本病例系列提出了一种新的方案,该方案使用异种BSM与自体血液浓缩系统(富血小板纤维蛋白[PRF])和胶原基质的组合,无需任何自体移植。7例不同病因的牙槽嵴萎缩患者(癌症切除术,牙齿脱落后严重萎缩,发育不全,创伤,植入物感染)使用开放愈合概念进行治疗。因此,在使用描述的生物材料进行3D增强后,皮瓣边缘近似,使用载有液体PRF的胶原基质桥接皮瓣边缘之间的间隙,然后用PTFE基膜或无菌乳胶覆盖。在任何时间点不进行骨膜分裂。经过4-8个月的愈合期,所有患者都按照实际计划接受了种植牙.在插入牙齿期间进行骨活检以进行组织学评估。增强区域显示出重要的且血管化良好的新形成的骨骼,该骨骼掺入了BSM颗粒以构建混合骨骼。此外,开放愈合导致新形成的软组织,没有任何瘢痕形成或纤维化的迹象。再生的软组织在植入物插入过程中用于构建新的皮瓣,并在植入物插入后显示出良好的功能和美学效果。软组织与骨组织一起再生以再生谐波植入床的开放愈合概念是一种微创干预措施,无需骨膜分裂或大皮瓣动员。然而,需要进一步的临床对照研究在更大的患者队列中评估这一概念,以概述潜在的临床获益.
Three-dimensional augmentation in severely atrophic bone and after cancer resection is a challenging clinical indication that is mostly solved using autologous bone transplantation. The development of the digital technique along with the additive manufacturing and three-dimensional (3D) printing opened new avenues for reconstructive oral and maxillofacial surgery. Therefore, patient-specific titanium mesh is a novel means of stabilizing the augmentation region using particulate bone substitute materials (BSMs) combined with autologous bone as a minimally invasive concept. However, dehiscence is a frequently reported complication in this field. Therefore, the aim of the present case series was to introduce a biomaterial-based regenerative concept in terms of exposed open healing to overcome the dehiscence related to 3D-titanium meshes. Additionally, this case series presents a novel protocol using a combination of xenogeneic BSMs with an autologous blood concentrate system (platelet-rich fibrin [PRF]) and collagen matrices without any autologous transplantation. Seven patients with alveolar ridge atrophy with different etiologies (cancer resection, severe atrophy after tooth loss, aplasia, trauma, implant infections) were treated using the open-healing concept. Therefore, after 3D augmentation using the described biomaterials, the flap margins were approximated, and the gap between the flap margins was bridged using a collagen matrix loaded with liquid PRF that was then covered by either a PTFE-based membrane or sterile latex. No periosteum splitting was performed at any time point. After a healing period of 4-8 months, all patients received dental implants as virtually planned. Bone biopsies were performed during dental insertion for histological evaluation. The augmentation area displayed a vital and well-vascularized newly formed bone that incorporated the BSM granules to build a hybrid bone. Additionally, open healing resulted in newly formed soft tissue without any signs of scar formation or fibrosis. The regenerated soft tissue was used to build a new flap during implant insertion and showed good functional and aesthetic results after implant insertion. The open-healing concept of the regeneration of the soft tissue along with bone tissue to regenerate a harmonic implantation bed is a minimally invasive intervention without periosteum splitting or large flap mobilization. However, further controlled clinical studies are needed to evaluate this concept in a larger patient cohort to outline the potential clinical benefit.