Digital Workflow with Open-Source CAD-CAM Software Aimed to Design a Customized 3D Laser-Printed Titanium Mesh for Guided Bone Regeneration

Guided bone regeneration (GBR) is a procedure used for the treatment of bone deficiencies. Computer-Aided Designed-Computer-Aided Manufacturing (CAD-CAM) allows us to design a titanium mesh (TM) for GBR directly on a 3D bone defect model (3DBM). The design and printing of TMs are often delegated to specialized 3D printing centers, thus preventing the surgeon from controlling surgical parameters such as the thickness, pore width, texture, and stiffness. Therefore, we have here proposed a personalized digital workflow for designing a TM. The 3DBM was uploaded to an open-source CAD-CAM software. Following a GBR simulation, a TM was designed as a Standard Tesselation Language (STL) file and 3D laser-printed. The TM was applied to a graft of 50/50% autologous/xenogenic bone, fixed with a bone screw, and covered with a dermal membrane. No TM exposure was observed during the healing phase. The regenerated bone volume was 970 cc, and pseudoperiosteum was class 1. At the 6-month reentry, a 4.1 × 10 standard dental implant with a primary stability of 40 N/cm was placed and after 3 months a zirconia crown screw-on implant was placed. This proposed digital workflow enabled us to successfully tackle this clinical case. However, further clinical investigations will be necessary to confirm the long-term benefits of this procedure.