Porous scaffolds are designed to allow ingrowth of the surrounding bone within the internal porosity of the solid matrix. Different types of bioactive materials were mixed with zirconia to enhance bone formation. Two sizes of pores were incorporated in the structure of the fabricated scaffolds. Micro-pores in range of 50 μm constituted the majority of the entire pore volume (50 wt.%) of the fabricated scaffolds (Fig. 1a). This pore volume was expected to provide adequate housing for osteoblasts and provide a mechanism of cell attachment on a microscopic level. Larger pore sizes (500–700 μm) reduced the density (30 wt.%) of the prepared scaffolds and created internal channels that connected different surfaces together creating a pathway for blood circulation [12, 15].

Previous research studies concerned with osteointegration of zirconia material reported comparable if not superior performance compared to different types of titanium alloys. This behavior was attributed to several factors related to the mechanical, physical, and chemical properties of zirconia [18]. With optimization of surface structure and geometry using a different technique, zirconia became available today as one piece dental implant [19].

Reconstruction of atrophic alveolar ridges could be achieved using a wide variety of grafting materials. However, maintaining the required shape of the graft represents a great challenge for the surgeon especially in regions subjected to functional loads. In the field of maxillofacial and cosmetic surgery, the graft must be mechanically strong to maintain its shape when placed in the surgical site and it must resist resorption and degradation to prevent collapse of the supported tissue [11].

Customized CAD/CAM porous zirconia scaffolds could easily be fabricated with high precision to fit the demands of the required surgical site. It could be used to augment atrophic alveolar ridges, replace bone loss in the maxillofacial region, and in cosmetic surgery as well. The scaffold is designed to be osteointgrated with the surrounding boney tissue thus it could perform mechanical function as well. The internal design of the scaffold enhanced blood circulation to ensure that the structure of the scaffold does not interrupt the biology of the surrounding tissue [15]. In combination with optimized nano-porous surface produced by selective infiltration etching, the scaffold could be enriched with different bioactive agents to enhance healing and osteogenesis ability with the surrounded tissue.