(1) Background: Bone tissue engineering is a promising tool to develop new smart solutions for regeneration of complex bone districts, from orthopedic to oral and maxillo-facial fields. In this respect, a crucial characteristic for biomaterials is the ability to fully integrate within the patient body. In this work, we developed a novel radiological approach, in substitution to invasive histology, for evaluating the level of osteointegration and osteogenesis, in both qualitative and quantitative manners. (2) SmartBone®, a composite xeno-hybrid bone graft, was selected as the base material because of its remarkable effectiveness in clinical practice. Using pre- and post-surgery computed tomography (CT), we built 3D models that faithfully represented the patient’s anatomy, with special attention to the bone defects. (3) Results: This way, it was possible to assess whether the new bone formation respected the natural geometry of the healthy bone. In all cases of the study (four dental, one maxillo-facial, and one orthopedic) we evaluated the presence of new bone formation and volumetric increase. (4) Conclusion: The newly established radiological protocol allowed the tracking of SmartBone® effective integration and bone regeneration. Moreover, the patient’s anatomy was completely restored in the defect area and functionality completely rehabilitated without foreign body reaction or inflammation.

Total hip arthroplasty (THA) is a surgical procedure for the replacement of hip joints with artificial prostheses. Several approaches are currently employed in the treatment of this kind of defect. Overall, the most common method involves using a quite invasive metallic support (a Burch–Schneider ring). Moreover, valid alternatives and less invasive techniques still need to be supported by novel material development. In this work, we evaluated the performance of SmartBone^®, a xenohybrid bone graft composed of a bovine bone matrix reinforced with biodegradable polymers and collagen, as an effective support in acetabular prosthesis reconstruction. Specifically, the material’s mechanical properties were experimentally determined (E = ~1.25 GPa, E_f = ~0.34 GPa, and Et = ~0.49 GPa) and used for simulation of the hip joint system with a SmartBone^® insert. Moreover, a comparison with a similar case treated with a Burch–Schneider ring was also conducted. It was found that it is possible to perform THA revision surgeries without the insertion of an invasive metal support and it can be nicely combined with SmartBone^®’s osteointegration characteristics. The material can withstand the loads independently (σ_max = ~12 MPa) or be supported by a thinner titanium plate in contact with the bone in the worst cases. This way, improved bone regeneration can be achieved.

The case of a 59-year-old woman lacking bone in the lower left side of her mandible, and treated with two different biomaterials for bone regeneration, is reported here. Specifically, two different anatomical sites damaged by two different pathologies were studied: a radicular fracture and peri-implantitis. The sites were treated via xenograft bone substitute and calcium phosphosilicate, respectively. Follow-up evaluations showed that the two different methodologies employing different materials in the same organism undergoing the same metabolic processes achieved the same good results. This represents a significant change in current surgical strategies for the dental region: instead of focusing on a single gold-standard technique, it is possible to follow a hybrid approach by adapting the biomaterial and the protocol used to the specificities of the defect.

Background: Maxillofacial bone defects present considerable challenges in oral and reconstructive surgery. While autologous bone grafts are the gold standard, their limitations, such as donor site morbidity and limited availability, have driven the search for alternative biomaterials. SmartBone^®, a xeno-hybrid graft, offers potential advantages due to its bioactivity and remodeling capacity. Methods: This analysis of a series of clinical cases, evaluated the performance of SmartBone^® in 10 patients presenting with various maxillofacial bone defects. The patient follow-up period spanned from 2017 to 2019, with a maximum duration of 30 months. Bone grafting was performed, and integration was monitored using Cone-Beam Computed Tomography at multiple timepoints. Bone density changes (ΔCT values) in selected anatomical sites were analyzed to assess graft transformation and integration. Results: SmartBone^® supported effective bone regeneration and selective remodeling in all cases. One patient required a revision procedure, after which successful integration was observed. Cellular colonization began within weeks, with complete remodeling into mature bone occurring between 6–12 months. Evidence of cortical wall resorption and reformation on the graft’s external surface confirmed this transformation. ΔCT values progressively aligned with native bone densities, indicating structural and functional integration. Conclusions: SmartBone^® demonstrates strong osteointegrative and site-specific remodeling capabilities, offering a reliable and predictable alternative for maxillofacial bone reconstruction. The study presents several limitations, including the small sample size, inter-patient variability, possible imaging artifacts due to metallic elements in Cone-Beam Computed Tomography scans and the lack of histological confirmation.

The presence of non-sufficient bone height and width requires an increase in the amount of bone available to insert an implant. Different materials are described in the literature, and the “custom-made bone graft approach” is a modern option which currently requires a preoperative stage of studying the bone defect and designing the implant. SmartBone^® (SB^®) mimics the characteristics of healthy human bone. Thanks to the strong performance, high workability, resistance and shape retention of SB^®, it is possible to obtain SmartBone^® on Demand^TM, a bone graft uniquely shaped exactly to patient specifications, produced by following the data precisely and contoured to the bone defect site. The aim of this study was to determine the success over 7 years following a customized SmartBone^® on Demand^TM, a xeno-hybrid bone graft and installation of implants in a maxillary horizontal and vertical atrophy. This case study presents the diagnosis for a 60-year-old male patient requesting the rehabilitation of his edentulous maxilla with dental implants. Preoperative evaluation included the study of photographs, a radiological examination and 3D reconstruction to assess the missing bone, implant size, positioning of implants and anatomical landmarks. Rehabilitation included the insertion of a custom-made xeno-hybrid bone block into the maxilla in order to restore the anatomy prior to the implants’ placement. The newly developed bone substitute SB^® is a safe and effective material, and its custom-made variant SmartBone^® on Demand^TM has been shown to be a valid alternative to traditional autologous bone grafting techniques in terms of accuracy, absence of infection/rejection and overall clinical outcome.

Background: The management of bone defects in pediatric oncology represents a major challenge in orthopedics, as it requires preserving both joint function and skeletal growth. Traditional reconstructive approaches, such as autografts and allografts, are limited by availability, complications, and incomplete biological integration. In this context, xeno-hybrid bone substitutes have emerged as a promising alternative. The aim of this study was to evaluate the safety and effectiveness of SmartBone^® ORTHO in the reconstruction of post-oncological bone defects in children. Methods: Twelve pediatric patients treated at the Centro Traumatologico Ortopedico (CTO) and OIRM Hospital, AOU Città della Salute e della Scienza of Turin (Italy), between 2016 and 2019 were retrospectively analyzed. Lesions included simple and aneurysmal bone cysts, non-ossifying fibroma, chondroblastoma, and other benign conditions. All patients underwent curettage followed by defect filling with SmartBone^® ORTHO. Results: At clinical and radiological follow-up, nine patients (75%) showed stable graft integration and complete functional recovery. Three patients (25%) developed local recurrence, which was managed with revision surgery and re-implantation of SmartBone^®, with all achieving stable outcomes. Radiographs demonstrated progressive increases in bone density and trabecular thickness, reaching values comparable to those of native bone within 6–12 months. Conclusions: SmartBone^® ORTHO proved to be a safe and effective biomaterial for pediatric post-oncological bone reconstruction, promoting rapid osteointegration and physiological bone remodeling without infection or intolerance.