Customized bone regeneration with novel titanium mesh

Background

The biological principles that causes an alveolar bone resorption are normally the teeth loss associated to the bundle bone resorption. Mild or moderate alveolar resorption are normally treated by means of GBR technique with bone substitutes and membranes. The severe resorption usually due to a traumatic event or subsequent to implant failure can be treated with special device as titanium mesh.

Aim/Hypothesis

The aim of this case series study was to evaluate the clinical outcome of a novel 3D titanium mesh for the customized bone regeneration (CBR), either for the vertical and horizontal ridge augmentation.

Material and Methods

Eight patients were treated in the OMF Surgery and Dentistry Of the G. Rossi of Verona. The inclusion criteria-ïpresence clinically and radiographically of horizontal, vertical or mixed bone defects of the maxillary bones. The presence of residual bone <8 mm in height and <5 mm in insufficient width for the insertion of at least one standard-sized implant in a correct position from the prosthetic point of view. ïabsence of local or systemic contraindication to surgical treatment. ïplacement of the implants 8–12 months after bone regeneration. Five patients were considered, who had partial edentulism + 3 patients were treated at the upper jaw and 2 patients at the lower jaw. 12 alveolar defects were regenerated. The material used for the GBR was 50% autologous and 50% heterologous bone (Bio-Oss®). The titanium mesh has been protected by a collagen membrane (Bio-Gide®). We adopted for the flap design the poncho technique which allows a reduced exposure rate according to literature.

Results

Post-operative healing in the following 8–9 months was regular for all patients, obtaining results that allowed subsequent implant placement. In only one case there was a slight exposure of the membrane which however did not compromise the healing process of the graft, but partially reducing the amount of regenerated bone. The exposure was treated with dressings and rinses with chlorhexidine-based mouthwash. Premature removal of the titanium mesh after exposure was not necessary, as it did not compromise the clinical outcome of the procedure. From a radiographic point of view (CBTC) we obtained good results both for the horizontal and vertical augmentation -ï An average horizontal gain of 3.6 mm. ï An average vertical gain of 5.2 mm. Thanks to poncho technique we suffered only 20% of the grid exposure. A long follow-up will be needed to draw definitive conclusions.

Conclusion and Clinical Implications

The results show that this customized bone regenerative surgery (CBR), with this 3D titanium mesh, represents an alternative in GBR- the manipulation of the device is unnecessary, making immediate the placement of the mesh without adjustments and facilitating the filling operations of the bone chips. The flap design and the closure free of tension remains the critical phase of the technique + the poncho technique although more difficult eliminates at the best the presence of harmful stresses.