As documented in case series and feasibility studies, customized bone regeneration (CBR) offers several advantages over traditional ridge augmentation techniques [3, 4]. Key advantages of CBR include improved accuracy and predictability of the augmentation result as the stable scaffold facilitates three-dimensional augmentation and helps to maintain the required space, improving the esthetics and function of the final restoration [5, 6]. The unique patient-specific fit allows for unmistakable scaffold placement during surgery, facilitating and shortening the procedure, and potentially reducing complication rates [7,8,9].

CBR procedures to date have mostly been performed with non-resorbable CAD/CAM titanium meshes requiring a second surgery to remove the hardware before implant placement, or with allografts associated with drawbacks such as variable quality, graft resorption, and ethical concerns. Resorbable patient-specific β-TCP scaffolds offer advantages over those materials [10]. The material properties can be tailored to meet specific requirements, for example by choice of pore size and microarchitecture, material composition, or coating with additives such as stem cells or growth factors, as demonstrated in preclinical studies and case series [11,12,13]. As with all alloplastic materials, β-TCP helps to avoid the disadvantages of autografts (donor-site morbidity, unpredictable resorption), allografts, and xenografts (risk of infectious disease transmission, porcine or bovine origin) [14,15,16]. Covering the scaffold with a collagen membrane further supports the barrier function during CBR and helps to limit graft exposure during wound healing [17]. Histological examination demonstrated the osteoconductive capabilities of the β-TCP scaffold in our case, which is consistent with previous studies [18].

However, there are potential disadvantages to using patient-specific β-TCP scaffolds, such as increased cost and technical requirements for design and fabrication. β-TCP scaffolds are brittle and therefore cannot be fixed with conventional titanium screws drilled directly through the implant. In the present case, the scaffold was secured with poly-lactide pins (SonicWeld® system) because of their ease of application and their documented use in ridge augmentation procedures [19]. These limitations may be overcome by further development of β-TCP material properties. Data is still scarce on the risk of dehiscence with larger β-TCP scaffolds.

Healing time with alloplastic materials may be longer than with autologous bone alone. In the present case, the dental implant was placed approximately ten months after the initial surgery to allow sufficient bone formation before re-entry [20, 21]. This makes the method inferior for patients seeking rapid dental rehabilitation. However, this ultra-slow resorption and remodeling rate can be advantageous in situations where implant placement will be delayed by some time after augmentation. The β-TCP scaffolds’ volume stability over a longer period allows more flexible timing of implant placement compared to allografts, where resorption will happen within a few months after surgery, and implants must be placed in this shorter time window. In the presented case, upon re-entry ten months after augmentation, a substantial portion of the scaffold was still discernible. Further gradual resorption is anticipated to occur over time, and the exact anatomic fit and maintenance of peri-implant health mitigate concerns associated with the presence of residual β-TCP.

This case report provides evidence of the feasibility and safety of using patient-specific β-TCP scaffolds for alveolar ridge augmentation. The use of patient-specific scaffolds is particularly beneficial in challenging cases where traditional ridge augmentation techniques may reach their limit. Given the proof-of-concept nature of this study, a straightforward patient case was selected. The next step towards clinical integration of the presented technique could be CBR for more extensive horizontal and vertical bone regeneration in the esthetic (anterior) region and in combination with soft-tissue augmentation. Future studies on biocompatibility, long-term stability, and the use of β-TCP in combination with other techniques and materials are desirable. New and improved manufacturing methods and the integration of patient-specific β-TCP scaffolds with digital planning technologies will be important areas of future research.

In conclusion, the use of patient-specific β-TCP scaffolds for alveolar ridge augmentation showed successful results in terms of esthetics and function as well as ease of surgical procedure in this case report demonstrating a medium-sized alveolar ridge defect, with high satisfaction of both the patient and the clinician. Patient-specific β-TCP scaffolds offer a promising approach for restoring complex bony defects in the oral cavity, with the potential for improved predictability and reduced morbidity compared to other materials and augmentation techniques. Based on these results, it can be recommended to consider this novel use of patient-specific β-TCP scaffolds for customized bone regeneration (CBR) in appropriate cases as an alternative option for alveolar ridge augmentation, preferably in the context of further clinical studies with larger sample sizes.