Cortical struts and computer aided bone augmentation

Jan Kielhorn

Osseointegration is the most important and challenging step in dental implantology. Acquiring the necessary skills for the demanding procedures is coupled with a high number of operations and is thus time consuming.

Despite this requirement, proper planning and diagnostics are often neglected prior to bone augmentation. The lack of standard procedures results in a range of different techniques, which are chosen by the surgeon based on subjective preferences. Surprisingly, implantology is performed with state-of-the-art devices and methodology (e.g. DVT, navigation), whereas augmentation is performed freehand with a significant amount of improvisation.

Three-dimensional planning of the operation based on DVT-scans is increasingly applied in hard-tissue regeneration, but methods to implement the precise diagnostics during the operation are often missing. Availability and quality of autologous bone and the sensitive harvesting techniques limit the possibilities for bone augmentation, but also cultural aspects may exclude the use of autologous bone in some patients.

The use of allogenic bone plates enables 3-dimensional bone augmentation by combining the widely applied Khoury technique with a bone regeneration material that is routinely used in orthopedic surgery. Availability of allogenic bone graft material is uncomplicated and it can be kept in stock at room temperature for up to 5 years. Due to the constant dimensions of the plates, the operation can be planned in advance and a special instrument can be applied for precise individual adjustment.

Thus, even unpredicted incidents can be treated using bone plates that are readily available. Additionally, drill templates can be used for proper fixation.

Computer aided bone augmentation (CAB) combined with the use of allogenic bone grafts enables standardized procedures and a reduced burden on the patient due to optimization, predictability and execution of former very demanding techniques. Consequently every surgeon is able to offer the respective procedures and to promote broad standardization for the wellbeing of the patients.

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