Customized Bone Regeneration-A Retrospective Clinical Follow-Up Study of the Aesthetic Outcome.

Abstract

<h4>Objectives</h4>This study aimed to evaluate the long-term stability of soft tissue aesthetics as the primary outcome concerning bone levels (secondary outcome) following customized bone regeneration. Additionally, the influence of flap management techniques on aesthetic outcomes in customized bone augmentation was assessed.<h4>Material and methods</h4>21 patients (45 implants) who underwent reconstruction of three-dimensional bone defects using patient-specific titanium meshes at least 5 years prior were evaluated. The Pink Esthetic Score (PES) was used to assess aesthetic outcomes. Incision lines and flap designs were correlated with aesthetic parameters (primary outcome) and bone levels (secondary outcome). Radiographic measurements of bone levels were taken at implant placement and after more than 5 years. Changes over time in aesthetic outcomes were analyzed using Fisher's Exact Test, Mann-Whitney U-test, and Kruskal-Wallis Test.<h4>Results</h4>Crestal incisions without vertical releasing incisions showed significantly superior outcomes in aesthetics (primary outcome) and bone level mesially (p < 0.001) and distally (p = 0.001) compared to Poncho flaps or crestal incisions with vertical releasing incisions after > 5 years (secondary outcome). Across parameters, 52.6% to 69.2% of cases achieved a maximum aesthetic rating ("2"). The mean PES score was 11.09 (±3.70) across all implants. The implant survival rate was 100%.<h4>Conclusions</h4>A crestal incision line without releasing incisions was superior in preserving bone levels and achieving favorable aesthetic outcomes. The findings highlight the importance of incision and flap design in the long-term outcomes of customized bone regeneration. The 100% implant survival rate and lack of side effects further underscore the reliability of this approach.