Custom-Made Computer-Aided-Design/Computer-Aided-Manufacturing Biphasic Calcium-Phosphate Scaffold for Augmentation of an Atrophic Mandibular Anterior Ridge

Figure 3

Surgery on patient. (a) Preoperative situation; (b) a PTFE replica is placed in position; (c) the PTFE replica is used for precise positioning of the hole for the fixation screw of the scaffold; (d) multiple small holes are drilled through the remaining alveolar bone into the marrow cavity, with a 1 mm round bur, under copious saline irrigation, to enhance bleeding of the mandibular cortex; (e) a preparation rich in growth factor (PRGF) is prepared and applied to the surgical site; (f) the custom-made BCP scaffold is removed from its sterile packaging; (g) the scaffold is placed in position strictly overlapping the underlying alveolar crest; (h) fixation of the scaffold is obtained by means of a small titanium screw; (i) the BCP scaffold rapidly acts as a sponge, absorbing a large amount of blood from the surgical site; (j) the surgical site is protected with a fibrin membrane; (k) care is taken to obtain a tension-free suture above the scaffold, so as to avoid ischemic damage to the mucosa and suture dehiscence; (l) 2 weeks after surgery sutures are removed.

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