Guided bone regeneration using CAD-CAM zirconia barriers: A case series with digital evaluation of bone changes
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Published on: August 5, 2021
Roberto Ledergerber1, Javier Flores-Fraile2, Tiago Marques3
1School of Dentistry, Universidad de Especialidades Espíritu Santo, Samborondón, Ecuador.
Background:
CAD/CAM zirconia barriers represent an advanced option for guided bone regeneration (GBR) in three-dimensional defects, integrating mechanical stability, biocompatibility, and digital precision. The objectives of this case series were to evaluate, clinically, histologically, and three-dimensionally, the use of customized zirconia barriers designed using CAD/CAM technology in GBR procedures.
Methods And Results:
Three patients with severe maxillary bone atrophy were included and treated with GBR using customized zirconia barriers. Digital planning was performed based on cone beam computed tomography and intraoral scanning, followed by CAD/CAM design and fabrication of the barriers. The defects were regenerated using a mixture of autogenous bone and xenograft. After the healing period, implants were placed using guided surgery, and bone biopsies were obtained for histological analysis. Bone gains were evaluated through linear and volumetric digital analysis based on three-dimensional model superimposition. All surgeries were completed without complications, allowing implant placement in all cases without the need for additional augmentation procedures. Mean horizontal bone gains of 6.17 mm at the crestal level and mean vertical gains of 2.62 mm were recorded, with maximum values of up to 5.11 mm. Volumetric analysis revealed bone gains of 797.158 mm3 (case 1), 459.718 mm3 (case 2), and 1416.870 mm3 (case 3). Histological analysis demonstrated vital, well-vascularized newly formed bone undergoing active remodeling, with no evidence of inflammation.
Conclusions:
Customized zirconia barriers demonstrated favorable clinical and histological outcomes in GBR. The digital workflow, combined with three-dimensional analysis, allowed a precise and reproducible evaluation of bone changes.
Key Points:
This case series presents a comprehensive clinical protocol for guided bone regeneration using customized zirconia barriers, based on prosthetically driven planning, individualized barrier design, graft stability, and meticulous peri-implant soft tissue management, including histological analysis of the regenerated tissue. The incorporation of a standardized digital protocol for linear and volumetric analysis enabled an objective, reproducible, and precise evaluation of dimensional changes in the alveolar ridge.
Plain Language Summary:
Significant bone loss in the upper jaw can prevent dental implants from being placed in the correct position. In these situations, rebuilding the lost bone is necessary to achieve a stable long-term outcome. This case series describes the use of customized zirconia barriers designed to fit each bone defect and support bone regeneration. After the healing period, all treated defects showed sufficient bone gain to allow implant placement according to the original prosthetic treatment plan. Histological analysis confirmed the formation of new bone, while a standardized digital measurement protocol provided an objective and reproducible assessment of the bone changes achieved after treatment. These findings suggest that customized zirconia barriers may represent a promising alternative for the management of complex bone defects, although studies involving larger numbers of patients are needed to confirm these results.
