Digitally Designed Bone Grafts for Alveolar Defects: A Scoping Review of CBCT-Based CAD/CAM Workflows

This scoping review aimed to systematically map the literature on digital workflows for the design and fabrication of customized bone grafts in oral and maxillofacial surgery. The review focused on the integration of cone-beam computed tomography (CBCT), computer-aided design (CAD), and computer-aided manufacturing (CAM) techniques for the production of personalized bone blocks. A systematic search of PubMed, Web of Science, and Ovid MEDLINE identified 151 records published between 2015 and 2025; after duplicate removal, screening, and full-text assessment, 16 articles were included. Six additional seminal studies published before 2015 were considered through manual search to provide historical background. The included studies consisted of case reports, case series, prospective clinical investigations, and preclinical experiments. Customization strategies involved synthetic hydroxyapatite scaffolds, CAD/CAM-milled allogeneic blocks, xenogeneic blocks, and digitally guided autogenous grafts. Four studies provided direct clinical documentation of customized CAD/CAM bone blocks, while the others offered complementary evidence on digital design, scaffold adaptation, or preclinical validation. Outcomes included graft adaptation, volumetric stability, implant survival, and limited histological analyses. Despite promising short-term results, no study has yet described the complete clinical workflow from CBCT acquisition to milling and implantation of a biological autologous or xenogeneic block in humans. This review underscores both the feasibility and the limitations of current approaches, highlighting the absence of fully validated digital-to-biological protocols as the main gap to be addressed in future research.