Digitally Designed Bone Grafts for Alveolar Defects: A Scoping Review of CBCT-Based CAD/CAM Workflows.

Area of Science:

• Oral and Maxillofacial Surgery
• Biomaterials Engineering
• Digital Dentistry

Background:

• Digital workflows integrating cone-beam computed tomography (CBCT), computer-aided design (CAD), and computer-aided manufacturing (CAM) are increasingly explored for creating patient-specific bone grafts.
• Existing literature spans case reports, clinical investigations, and preclinical experiments, utilizing various customization strategies like synthetic scaffolds and milled blocks.

Purpose of the Study:

• To systematically map and review the existing literature on digital workflows for designing and fabricating customized bone grafts in oral and maxillofacial surgery.
• To identify the current capabilities, limitations, and research gaps in applying CBCT, CAD/CAM technologies for personalized bone block production.

Main Methods:

• A systematic scoping review was conducted using databases like PubMed, Web of Science, and Ovid MEDLINE, supplemented by manual searches for seminal studies.
• Included studies published between 2015-2025 (and earlier seminal works) were screened and assessed for relevance to digital bone graft fabrication.

Main Results:

• Sixteen studies published between 2015-2025, plus six older seminal studies, were included, focusing on customization strategies for bone grafts.
• Four studies documented customized CAD/CAM bone blocks clinically; others provided complementary data on digital design or preclinical validation.
• Promising short-term outcomes like graft adaptation and volumetric stability were reported, but no study presented a complete clinical workflow for biological blocks in humans.

Conclusions:

• Current digital workflows demonstrate feasibility for customized bone graft design and fabrication in oral and maxillofacial surgery.
• A significant gap exists in fully validated digital-to-biological protocols for the clinical implantation of autologous or xenogeneic blocks.
• Future research should focus on developing and validating comprehensive digital protocols for seamless integration from imaging to surgical application.