A novel full digital positioning guide for autogenous bone grafting in the esthetic zone

Objectives

This study introduces a novel fully digital workflow for fabricating a positioning guide for autogenous bone grafts in the esthetic maxillary zone. The technique was applied to patients presenting with missing, mobile, or fractured anterior maxillary teeth requiring replacement with dental implants and autogenous block grafting.

Methods

Cone-beam computed tomography (CBCT) and intraoral scans were obtained and merged for virtual planning. Both harvesting and positioning guides were designed using CAD software and fabricated via 3D printing. During surgery, the autogenous bone plate was harvested using the digital harvesting guide and stabilized at the recipient site with the positioning guide. Postoperative CBCT scans and superimpositions with preoperative models were performed to evaluate accuracy.

Results

The full digital guide (FDG) enabled accurate and predictable harvesting and positioning of the autogenous bone block. The margin of difference between the planned standard tesselletion language (STL) models and the postoperative Digital Imaging and Communication in Medicine (DICOM) outcomes ranged from 0.6 mm (axial plane) to 1.0 mm (sagittal plane), demonstrating high fidelity to the digital plan.

Conclusions

Within the limitation of this study, the FDG technique provided a predictable and precise approach for harvesting and positioning autogenous block grafts in the esthetic zone. This workflow facilitates the transfer of preoperative digital planning to the clinical setting, ensuring stable fixation and minimizing intraoperative variability. Future prospective randomized trials are required to confirm these findings.

Clinical Relevance

The FDG technique enhances the accuracy, safety, and predictability of autogenous bone grafting in the esthetic zone, potentially reducing surgical time, minimizing risk of complications, and improving functional and aesthetic outcomes.