Alveolar bone augmentation using the SmartBuilder with new “Anchor”; Case Reports
By: Kyung-Tae Park, So-Mi Jeong, Yong-Jin Kim
Titanium mesh can give a favorable result to the severe bone defects or vertical bone augmentation case due to its rigidity. Also, it works as a frame to keep the space and stabilize inside bone graft materials.
Recently, Osstem implant company has produced the SmartBuilder. The SmartBuilder is customized titanium mesh pre-formed in 3 dimension. Since SmartBuilder is ready-made according to the general types of alveolar bone loss, there is no need to spend time for trimming and bending to form the overall shape of titanium mesh.
Besides, it can be removed easily by replacing the screws used in fixing traditional titanium mesh with healing abutment or cover cap. So, I would like to present clinical cases of alveolar bone augmentation using the SmartBuilder with new “Anchor”.
Case Report 1:
Age / Sex: 72Y / M
Chief complain: Partial Edentulism
Past medical history: HTN & Controlled DM
Treatment plan: 17, 18 Extraction & Implant placement with GBR
Fig. 1~3. Pre-operative radiograph & Intra-oral view
Fig. 4-12. Intra-operative view Full thickness mucoperiosteal flap was elevated. Horizontal bone resorption of #14 area was observed. TSIII SA implant 4.0x11.5mm was installed at #14. Insertion torque was 30NCm. Autogenous bone was harvested from the maxillary tuberosity and particulated using the Bone crusher. The new “Anchor” for the SmartBuilder was connected and particulated autogenous bone was grafted. Two wall augmentation type SmartBuilder was used. The SmartBuilder was fixed with cover cap.
Fig. 13-15. Post-operative radiograph. On the post-operative CT scan, it is observed that the SmartBuilder contours an ideal shape of buccal alveolar bone and the bone graft material is well maintained under the SmartBuilder
Fig. 16-19. 2nd stage surgery was done after 16 weeks. During the healing period, the SmartBuilder was not exposed. Mucoperiosteal flap was elevated with crestal incision and the SmartBuilder was removed. Successful bone regeneration around #14 implant and horizontally increased alveolar bone volume was observed.
Case Report 2:
Age / Sex: 46Y / F
Chief complain: Missing of #16
Past medical history: N/S
Past dental history: Extraction of #16 3 months ago Treatment plan: Implant placement with GBR
Fig. 1-3. Pre-operative radiograph & Intra-oral view Pre-op CT scan shows severe palatal bone defect at right 1st molar area.
Fig. 4-10. Intra-operative view. Full thickness mucoperiosteal flap was elevated. Palatal bone resorption of #16 area was observed. TSIII SA implant 5.0x11.5mm was installed at #16. An implant was placed 1 mm below buccal crest bone level and insertion torque was about 20NCm. The new “Anchor” for the SmartBuilder was connected and bone graft was done.
Fig. 11-13. Post-operative radiograph. In the post-op CT scan, the SmartBuilder is contouring an ideal shape of palatal alveolar bone and bone graft materials are placed stably under the SmartBuilder.
Fig. 14. Post-operative 2 weeks. Stitch out was done after 2 weeks. Soft tissue healed very well without any SmartBuilder exposure.
The new internal connection type “Anchor” of the SmartBuilder might decrease the possibility of the wound dehiscence and SmartBuilder exposure. For that reason, the new internal connection type “Anchor” could enhance the predictability of alveolar bone augmentation procedure using the SmartBuilder.