Prof. Chiapasco, what convinced you to try Yxoss CBR®?
Prof. Chiapasco: The available titanium meshes can be difficult to manipulate and fixate. Therefore, titanium meshes produced with CAD/CAM technology immediately fascinated me. I hoped that Yxoss CBR® could simplify the surgical procedure.
What is the concept of Yxoss CBR®?
Prof. Chiapasco: The surgeon creates a CBCT or CT image of a bony defect, be it a small or even an extensive one. Then they send the image in DICOM format to ReOss, the company manufacturing Yxoss CBR®. Based on the digital data, the company develops a three-dimensional model of the bone defect and creates a customized titanium mesh that subscribes exactly the bone contour needed for later implant placement. The surgeon receives a 3D printed titanium scaffold that is already perfectly shaped and adapted to the specific defect.
How do you fill the scaffold?
Prof. Chiapasco: With autologous bone particles mixed with a reliable biomaterial, such as deproteinated bovine bone, in an approximately 1:1 ratio. Particulate material, unlike bone blocks, quickly vascularizes, supporting new bone formation. And the autologous bone particles have not only osteoconductive but also osteoinductive and osteogenic potential.
The bone / bone substitute mixture is compressed into the grid outside the oral cavity, and then the grid is applied most easily and stabilized by a minimum number of titanium micro-screws. The stability and accuracy of the reconstruction are amazing.
Have you changed your approach with Yxoss CBR®?
Prof. Chiapasco: I didn’t have to make any radical changes. I obtain autologous bone from intra-oral sites with a bone scraper in the majority of cases. Only in case of extremely extended and severe atrophy, autogenous bone chips may require harvesting from extra-oral sites through small incisions. I avoid more traumatic harvesting and sampling of bone blocks. The recipient site is prepared in the same manner as for block grafting: removing any connective tissue residues, creating micro-perforations to accelerate revascularization, and releasing the access flaps with care to obtain a tension-free suture. This remains the key to success, independent of the reconstructive technique used. Lack of hermetic tightness in the suture sets the scene for failure.
Where do you see advantages for your clinical practice?
Prof. Chiapasco: I have significantly reduced operating times. Another advantage is that you can visualize the reconstruction in three dimensions before you start surgery. You can even have the manufacturer calculate the amount of graft material needed in cubic centimeters. With this, you will not find yourself with too little or, paradoxically, too much bone.
You also treated patients with extensive defects or even edentulous ridges with Yxoss CBR®. What is your experience in these cases?
Prof. Chiapasco: I was surprised by the simplicity of managing really “vast” defects without using huge autogenous blocks. This simplified the whole procedure and shortened the surgery time. However, to be honest, this kind of surgery should be performed by very experienced surgeons. Knowledge about anatomy, management of soft tissues and tension-free sutures is key. So far, I have treated almost ten sub-totally or totally edentulous patients with extreme atrophy. In some cases, I treated four edentulous sites including maxilla and mandible on both sides in one surgery.
Do you also experience complications?
Prof. Chiapasco: One sort of complication can clearly be avoided by the surgeon. Don’t load the regenerated area with a removal prosthesis. This really jeopardizes the treatment result.
A partial exposure of the titanium mesh, however, may occur even in very “experienced hands” and despite perfect soft tissue release and tension-free, hermetic suture. I have experienced limited titanium mesh exposures in eight percent of the cases (unpublished data), but with no relevant consequences. I checked this when I removed the titanium mesh and placed the implant. There was no significant infection and only insignificant bone loss.
How do you act in case of exposure?
Prof. Chiapasco: If exposure occurs, optimal oral hygiene with the aid of chlorhexidine mouth rinse and frequent clinical controls are essential. I must stress, however, that a complication rate of eight percent is still lower than that reported for other regeneration procedures. And the consequences are less severe. A wide exposure of a block graft or other non-resorbable barriers may even be followed by the total loss of the graft.
What would you say to a colleague to convince him or her to try Yxoss CBR®?
Prof. Chiapasco: While it is important to be an expert in GBR, this technique reduces the difficulties to less than half and is predictable, effective, and precise. Try it to believe it.
Do you want to learn more? Follow this link to get to the BioBrief of Prof. Matteo Chiapasco & Dr. Grazia Tommasato!