3D printing has an expanding role in implantology

GBR is crucial in ensuring the success of dental implants, particularly in patients who have lost significant amounts of bone owing to trauma, disease or atrophy after tooth extraction. 3D-printed technologies work well towards achieving the goal of GBR. These technologies allow for the creation of highly customised solutions, such as titanium meshes, resorbable and non-resorbable membranes, synthetic bone grafts and implants. Customised 3D-printed products can be tailored to the patient’s specific anatomical needs, enhancing the precision of location and improving clinical outcomes.

In the review, the authors discuss how 3D printing has transformed the approach to GBR. The 3D-printing process typically involves three steps: image acquisition, data post-processing and the actual 3D printing. During image acquisition, patient-specific data is collected through methods such as intra-oral scans and CBCT or CT scans. These digital images are then processed using CAD/CAM software, allowing for the creation of customised meshes, membranes, bone grafts and implants, unique to the patient’s bone defect.

The 3D-printing technology used for these products employs various methods, including stereolithography and selective laser sintering, methods that also ensure dramatic waste reduction during appliance development. In terms of material, titanium is widely used in GBR owing to its biocompatibility, mechanical strength and resistance to corrosion.

Though clinicians conventionally make use of either resorbable collagen or non-resorbable membranes in surgery, customised 3D-printed membranes are proving an equal or an even better solution due to the science of mixing polymers to achieve desired mechanical properties and enabling clinicians to even control biodegradation. The ratio of the polymers used allows clinicians to meld the benefits of resorbable and non-resorbable membranes into one surgical material that holds the properties of collagen such as biocompatibility, biodegradation and tissue integration with the capacity to maintain space, provide mechanical stability and longevity of non-resorbable membranes. These membranes can be designed with varying pore sizes, and with the inclusion of growth factors and other necessary drugs within the material itself.

It is also possible to produce 3D-printed synthetic bone grafts, often made from materials such as hydroxyapatite or beta-tricalcium phosphate, which serve as scaffolds for osteogenesis. These materials are designed to promote bone regeneration and can be combined with natural bone grafts to optimise outcomes.

Clinical studies reviewed in the paper show promising results for 3D-printed GBR materials, particularly in terms of bone regeneration and implant success. 3D-printed titanium meshes have demonstrated effectiveness in vertical and horizontal bone regeneration, and 3D-printed polymeric membranes show potential in combining the advantages of conventional resorbable and non-resorbable membranes.

However, while early results are encouraging, the authors recommended more clinical trials involving human participants. Most available data comes from animal studies and in vitro research, and more human studies are required to assess the long-term success of these technologies, particularly regarding peri-implant bone volume after implant loading. Furthermore, at the present time, the use of 3D printing in GBR presents a significant cost factor, both financially and regarding the amount of time required for training, reducing access to these novel treatments.

The study, titled “Customized 3D-printed mesh, membrane, bone substitute, and dental implant applied to guided bone regeneration in oral implantology: A narrative review”, was published online on 25 September 2024 in Dentistry Journal.

 

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