CATEGORY 64 AUSTRALASIAN DENTIST LINICAL Re-establishing Bone Volume using Customised Bone Regeneration (Yxoss CBR®) Dr Jamil Alayan Treatment by: Dr Jamil Alayan Aim: Treatment planning relied on an initial digital restorative plan. Based on this diagnostic information, an advanced horizontal ridge defect on both buccal and palatal aspects was obvious. A 3D-printed custom titanium scaffold was utilised to regerate the ridge Conclusion: The challenging defect parameters in this situation required the use of a patient specific 3D printed titanium scaffold. The defect was successfully regenerated, allowing for implant placement in restorative driven positions and delivery of fixed screw retained Fig 1 Frontal view demonstrating the preoperative situation of long-term partial edentulism. Fig 4 Periosteal release and coronal flap advancement was performed to ensure tension free primary wound closure. Excessive thinning of the buccal flap was avoided, especially in the areas overlying the customised titanium frame. Fig 7 Gingival augmentation was performed at 2nd stage surgery 12 weeks later. After a further 4 weeks of healing, the patient was referred for the restorative phase of treatment. Fig 2 Ridge perforations performed after full mucoperiosteal flap elevation. Note the significantly reduced horizontal ridge width. Fig 5 Full mucoperiosteal flap elevation and titanium scaffold removal was carried out 8 months later. Fig 8 Baseline assessment was performed 1 month post-delivery of the screw retained fixed implant restorations. Fig 3 3D printed custom titanium scaffold loaded with Geistlich Bio-Oss® and autogenous bone (1:1 ratio). The loaded scaffold was secured using two fixation screws. Geistlich Bio-Gide® was used to cover the titanium scaffold. Fig 6 Successful regeneration of the defect was achieved allowing for implant placement in restorative driven positions. Fig 9 The radiographic appearance after 12 months of function. Note the stable mesial and distal crestal bone levels around both implants. implant restorations. The patient‘s quality of life was thereby improved by no longer wearing a removable partial denture and without the biological cost associated with abutment teeth preparation. u sufficicently to allow for dental implant placement 9 months later. A submerged healing modality was utilised followed by gingival augmentation at 2nd stage surgery. A conventional loading protocol was employed with cantilevered, screw retained, and implant supported fixed partial dentures.
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