Introduction: Complex, three-dimensional bony defects still represent challenging situations in routine implant dentistry. The aim of this study was to evaluate implant survival in customized bone regeneration using a patient-specific titanium mesh (Yxoss CBR®) after >five years. Furthermore, bone loss and potential symptoms of periimplantitis were be evaluated.
Keywords: Customized titanium mesh, long-term evaluation, patient-specific grafting, bone augmentation, implant survival
Methods: Patients (n=21, implants 36) who had obtained an augmentation procedure with Yxoss CBR® as described elsewhere1 were examined after 5.7 ± 0.38 years. Survival rate, clinical parameters for periimplantitis (bleeding on probing (BOP), percussion, suppuration) and radiographic examination were evaluated. Bone loss was calculated using Image J®1.53k. Additionally, the influence of various factors on treatment outcome like periodontitis, smoking, professional maintenance, or diabetes was assessed as well as the impact on quality of life applying the Oral Health Impact Profile (OHIP).
Results: The implant survival rate was 97%, with one implant loss in the lower jaw. The lower jaw showed statistically significantly more bone loss mesial compared to the upper jaw (p=0.01). Periodontitis was significantly associated with bone loss mesial and distal (p<0.05). Smoking and gender were not significantly associated with bone loss. Pain was not associated with bone loss distally and mesially. Positive BOP (four implants) was significantly associated with bone loss mesially (p=0.0031) and distally (p=0.0018). Bone loss was significantly associated with suppuration (three implants) mesially (p<0.0001) and distally (p<0.0001). Suppuration was not related to smoking and diabetes. Evaluating bone loss and positive percussion, results were significant (mesial: p<0.0001, distal p<0.0001). Percussion was also significantly associated with positive BOP (p=0.0053) and suppuration (p=0.0014). Evaluation of quality of life showed an OHIP score of 2.97 ± 4.19.
Discussion & Conclusion: CBR® results in high implant survival rate and stabilized augmented marginal bone after follow-up of minimum 5 years. Quality of life was unaffected by the surgical procedure and remained stable after 5 years. Periodontitis seems to play the major role for long-term stability indicated by BOP, suppuration, and percussion sound. The importance of professional maintenance must be emphasized.
References: 1 Chiapasco, M., et al. (2021). Customized CAD/CAM titanium meshes for the guided bone regeneration of severe alveolar ridge defects: Preliminary results of a retrospective clinical study in humans. Clin Oral Implants Res, 32(4), 498-510.