The Use of Titanium Mesh in Guided Bone Regeneration: A Systematic Review

Titanium mesh for guided bone regeneration: a systematic review

This systematic review aimed to evaluate results reported in the literature regarding the success rate of the titanium mesh technique for the placement of dental implants. The topic focused on titanium mesh used as a physical barrier for ridge reconstruction in cases of partial or total edentulism. The authors conducted an electronic search of four databases up to October 2023. Six articles fulfilled the inclusion criteria and were analysed. A total of 100 titanium meshes with a minimum of 4.6 months follow up after surgery were studied, and 241 implants were placed. The review shows that the use of titanium mesh is a predictable method for the rehabilitation of complex atrophic sites. Further investigation generating long-term data is needed to confirm these findings.

Digital planning and bone regenerative technologies: A narrative review

OBJECTIVES

The aim of this narrative review was to explore the application of digital technologies (DT) for the simplification and improvement of bone augmentation procedures in advanced implant dentistry.

MATERIAL AND METHODS

A search on electronic databases was performed to identify systematic reviews, meta-analyses, randomized and non-randomized controlled trials, prospective/retrospective case series, and case reports related to the application of DT in advanced implant dentistry.

RESULTS

Seventy-nine articles were included. Potential fields of application of DT are the following: 1) the use of intra-oral scanners for the definition of soft tissue profile and the residual dentition; 2) the use of dental lab CAD (computer-aided design) software to create a digital wax-up replicating the ideal ridge and tooth morphology; 3) the matching of STL (Standard Triangulation Language) files with DICOM (DIgital COmmunication in Medicine) files from CBCTs with a dedicated software; 4) the production of stereolithographic 3D models reproducing the jaws and the bone defects; 5) the creation of surgical templates to guide implant placement and augmentation procedures; 6) the production of customized meshes for bone regeneration; and 7) the use of static or dynamic computer-aided implant placement.

CONCLUSIONS

Results from this narrative review seem to demonstrate that the use of a partially or fully digital workflow can be successfully used also in advanced implant dentistry. However, the number of studies (in particular RCTs) focused on the use of a fully digital workflow in advanced implant dentistry is still limited and more studies are needed to properly evaluate the potentials of DT.

Horizontal GBR with anorganic equine bone combined with a customized titanium mesh

This case report describes the fixed rehabilitation of the lower left arch in a patient following an horizontal GBR procedure by means of a customized titanium mesh and a new slow resorption bone substitute of equine origin.

Recombinant bone matrix maintains the graft space, induces vascularized bone regeneration and preserves canine tooth extraction socket structure

AIM

Recombinant bone matrix (RBM) is a newly conceived and engineered porous bone graft granule of average size 600 μm composed of purified recombinant collagen peptide. We sought to examine the behaviour with time of RBM that was grafted in the canine tooth extraction socket.

MATERIALS AND METHODS

The canine tooth extraction socket of the hemisectioned mandibular third premolar distal root was grafted with RBM granules, whereas the opposite side extraction socket served as non-grafted control. The mandibular samples were harvested at 1, 3 and 6 months of healing and subjected to micro-CT imaging and decalcified paraffin-embedded histology. Separately, the effect of RBM was compared with that of deproteinized cancellous bovine bone (DCBB) and bovine atelocollagen plug (BACP) in the canine tooth extraction model at 3 months of healing.

RESULTS

RBM maintained the grafted space in the socket and the gingival connective tissue until new bone was formed within its porous space. The regenerated bone was highly vascularized and continued to mature, while RBM was completely bioresorbed by 6 months. The buccal and lingual alveolar ridge heights of the RBM-grafted extraction socket was better preserved than those of non-grafted control sockets. The degree of socket preservation by RBM was equivalent to that by DCBB, although their healing mechanisms were different.

CONCLUSIONS

This study demonstrated that RBM induced controlled active bone regeneration and preserved the extraction socket structure in a canine model. Bioresorbable RBM engineered without animal or human source materials presents a novel bone graft category with robust bone regenerative property.

Dental implant placement with simultaneous localized ridge augmentation using L-shaped titanium mesh in the esthetic zone: a case report

The aim of this case report is to illustrate a successful technique for dental implant placement in the esthetic zone using simultaneous localized ridge augmentation with L-shaped titanium mesh. A 35-year-old patient presented with a single missing tooth in the esthetic zone requiring dental implant placement. The treatment plan was made to place a dental implant in conjunction with a guided bone regeneration procedure using a prefabricated L-shaped titanium mesh. The procedure achieved successful reconstruction of the deficient ridge, providing ample volume and contour for implant placement. Implant osteointegration was achieved, resulting in a satisfactory functional and esthetically pleasing outcome. The use of L-shaped titanium mesh offers superior stability and biocompatibility, ensuring optimal support and containment of graft material. This case report highlights the feasibility and clinical effectiveness of dental implant placement with simultaneous localized ridge augmentation using L-shaped titanium mesh in the esthetic zone. Further studies are warranted to assess the long-term success and esthetic outcomes of this technique.

Application of CAD-CAM Technologies for Maxillofacial Bone Regeneration: A Narrative Review of the Clinical Studies

The application of regenerative methods in treating maxillofacial defects can be categorized as functional bone regeneration in which scaffolds without protection are used and in-situ bone regeneration in which a protected healing space is created to induce bone formation. It has been shown that functional bone regeneration can reduce surgical time and obviate the necessity of autogenous bone grafting. However, studies mainly focused on applying this method to reconstruct minor bone effects, and more investigation concerning the large defects is required. In terms of in situ maxillofacial bone regeneration with the help of CAD-CAM technologies, the present data have suggested feasible mesh rigidity, perseverance of the underlying space, and apt augmentative results with CAD-CAM-based individualized Ti meshes. However, complications, including dehiscence and mesh exposure, coupled with consequent graft loss, infection and impeded regenerative rates have also been reported.

Horizontal and Vertical Defect Management with a Novel Degradable Pure Magnesium Guided Bone Regeneration (GBR) Membrane-A Clinical Case

Background and objectives: In guided bone regeneration (GBR), large defects comprising both horizontal and vertical components usually require additional mechanical support to stabilize the augmentation and preserve the bone volume. This additional support is usually attained by using non-resorbable materials. A recently developed magnesium membrane presents the possibility of providing mechanical support whilst being completely resorbable. The aim of this case report was to describe the application and outcome of the magnesium membrane in combination with a collagen pericardium membrane for GBR. Materials and methods: A 74 year old, in an otherwise good general health condition, was presented with stage 2 grade A periodontitis and an impacted canine. After extraction of the impacted canine, a defect was created with both vertical and horizontal components. The defect was augmented using the magnesium membrane to create a supportive arch to the underlying bone graft and a collagen pericardium membrane was placed on top to aid with the soft tissue closure. Results: Upon reentry at 8 months, complete resorption of the magnesium devices was confirmed as there were no visible remnants remaining. A successful augmentation outcome had been achieved as the magnesium membrane in combination with the collagen membrane had maintained the augmented bone well. Two dental implants could be successfully placed in the healed augmentation. Conclusions: In this case, the magnesium membrane in combination with a collagen pericardium membrane presented a potentially viable alternative treatment to titanium meshes or titanium-reinforced membranes for the augmentation of a defect with both horizontal and vertical components that is completely resorbable. It was demonstrated that it is possible to attain a good quality and quantity of bone using a resorbable system that has been completely resorbed by the time of reentry.

Advanced Techniques for Bone Restoration and Immediate Loading after Implant Failure: A Case Report

The objective of this study was to report a clinical case of dental implant failure with significant bone loss that was treated using reconstructive surgical techniques. We present a 58-year-old man with a history of implant surgery and implant failure on the mandible. Data collected using cone beam computed tomography (CBCT) and intraoral scans were exported into Exoplan (exocad GmbH, Darmstadt, Germany), from which a standard tessellation file was obtained. To create a customized mandible mesh design, DentalCAD 3.0 Galway software (exocad GmbH, Darmstadt, Germany) was used. Based on guided bone regeneration, the method involved bone reconstruction and the application of a custom titanium mesh. The bone mix was obtained by combining a xenograft (Cerabone, Bottis biomaterials Gmbh, Zossen, Germany), an allograft (Max Graft, granules Bottis biomaterials Gmbh, Zossen, Germany), and an autograft. The titanium meshes were fixed to the bone using self-drilling screws and covered with a resorbable membrane. Immediately after surgery, an impression was recorded, and the next day, the patient received a milled polymethyl methacrylate interim denture. Based on our case study, the presented custom-made implant can be considered a temporary solution, during which guided bone regeneration is expected to take place.

Full-Digital Customized Meshes in Guided Bone Regeneration Procedures: A Scoping Review

Meshes, especially titanium ones, are being widely applied in oral surgery. In guided bone regeneration (GBR) procedures, their use is often paired with membranes, being resorbable or non-resorbable. However, they present some limitations, such as difficulty in the treatment of severe bone defects, alongside frequent mesh exposure. Customized meshes, produced by a full-digital process, have been recently introduced in GBR procedures. Therefore, the focus of the present review is to describe the main findings in recent years of clinical trials regarding patient-specific mesh produced by CAD/CAM and 3D printing workflow, made in titanium or even PEEK, applied to GBR surgeries. The purpose is to analyze their clinical management, advantages, and complications. This scoping review considered randomized clinical trials, observational studies, cohort studies, and case series/case reports studies. Studies that did not meet inclusion criteria were excluded. The preferred reporting items for scoping reviews (PRISMA-ScR) consensus was followed. A total of 15 studies were selected for this review. Based on the studies included, the literature suggests that meshes produced by a digital process are used to restore complex and severe bone defects. Moreover, they give satisfactory aesthetic results and fit the defects, counteracting grid exposure. However, more clinical trials should be conducted to evaluate long-term results, the rate of complications, and new materials for mesh manufacturing.

Evaluation of bone gain in horizontal ridge augmentation using titanium mesh in combination with different flap advancement techniques: a randomized clinical trial

The aim of this study was to investigate and compare the clinical and radiographic bone gain in guided bone regeneration with titanium mesh, for four different advancement techniques: periosteal releasing incision (PRI), double flap incision (DFI), modified periosteal releasing incision (MPRI), and coronally advanced lingual flap (CALF). Forty patients with a partially edentulous mandible were allocated randomly to four study groups (PRI, DFI, MPRI, CALF; 10 patients in each). Clinical bone gain (primary outcome) and radiographic bone gain were evaluated. In addition, correlations between study variables (clinical and radiographic bone gain, flap advancement, mesh exposure area and percentage exposure, pain, and swelling) were explored. CALF exhibited the highest mean clinical bone gain (4.12 ± 1.37 mm) and PRI the lowest (2.60 ± 1.36 mm); the mean clinical bone gain differed significantly among the groups (P < 0.001). The highest mean radiographic bone gain was seen in the CALF group (3.54 ± 1.65 mm) and the lowest in the PRI group (2.06 ± 1.11 mm); the mean radiographic bone gain also differed significantly among the groups (P < 0.001). The correlation analysis revealed positive correlations between flap advancement and radiographic bone gain (P = 0.003) and between swelling and pain (P = 0.007). An inverse correlation was found between flap advancement and swelling (P = 0.049), mesh exposure area and clinical bone gain (P = 0.022), and mesh exposure percentage and clinical bone gain (P = 0.017). In summary, the highest clinical and radiographic bone gain was observed for CALF, while the lowest was observed for PRI.

The potential therapeutic role of extracellular vesicles in critical-size bone defects: Spring of cell-free regenerative medicine is coming

In recent years, the incidence of critical-size bone defects has significantly increased. Critical-size bone defects seriously affect patients' motor functions and quality of life and increase the need for additional clinical treatments. Bone tissue engineering (BTE) has made great progress in repairing critical-size bone defects. As one of the main components of bone tissue engineering, stem cell-based therapy is considered a potential effective strategy to regenerate bone tissues. However, there are some disadvantages including phenotypic changes, immune rejection, potential tumorigenicity, low homing efficiency and cell survival rate that restrict its wider clinical applications. Evidence has shown that the positive biological effects of stem cells on tissue repair are largely mediated through paracrine action by nanostructured extracellular vesicles (EVs), which may overcome the limitations of traditional stem cell-based treatments. In addition to stem cell-derived extracellular vesicles, the potential therapeutic roles of nonstem cell-derived extracellular vesicles in critical-size bone defect repair have also attracted attention from scholars in recent years. Currently, the development of extracellular vesicles-mediated cell-free regenerative medicine is still in the preliminary stage, and the specific mechanisms remain elusive. Herein, the authors first review the research progress and possible mechanisms of extracellular vesicles combined with bone tissue engineering scaffolds to promote bone regeneration via bioactive molecules. Engineering modified extracellular vesicles is an emerging component of bone tissue engineering and its main progression and clinical applications will be discussed. Finally, future perspectives and challenges of developing extracellular vesicle-based regenerative medicine will be given. This review may provide a theoretical basis for the future development of extracellular vesicle-based biomedicine and provide clinical references for promoting the repair of critical-size bone defects.

Polyetherketoneketone Mesh for Alveolar Bone Augmentation: Geometric Parameter Design and Finite Element Analysis

Objective

To evaluate the mechanical properties of porous polyetherketoneketone (PEKK) meshes with different thicknesses, pore sizes, and porosities through finite element analysis to provide an optimal PEKK design for alveolar bone augmentation in the posterior mandibular region.

Methods

A three-dimensional evaluation model of severe alveolar bone defects in the mandibular posterior was constructed based on cone beam computerized tomography (CBCT) data. Then, PEKK meshes with different structural designs were obtained. Two key parameters were set with different values: five levels of thickness (0.2 mm, 0.3 mm, 0.4 mm, 0.5 mm, and 0.6 mm) and three levels of pore size (1 mm, 2 mm, and 3 mm) with a corresponding porosity of 19.18%-42.67%. A 100 N physiological force was simultaneously loaded by finite element analysis (FEA), and the deformation and stress data were outputted for further analysis.

Results

The deformation and stress of the PEKK meshes are negatively correlated with the changes in thickness and positively correlated with the changes in pore size. The FEA results show that the maximum deformation, equivalent stress, and maximum principal stress of the PEKK meshes are 0.168 mm-0.478 mm, 49.243 MPa-124.890 MPa, and 31.549 MPa-104.200 MPa, respectively. The PEKK mesh group with a thickness of 0.2 mm, pore size of 3 mm, and porosity of 42.67% is in danger of plastic deformation or even fracture during use.

Conclusion

According to the FEA results, the PEKK meshes with larger thicknesses and smaller pore sizes and porosities behave better. In consideration of reducing soft tissue stimulation and promoting bone regeneration, an ultrathin porous PEKK mesh with a pore size of no more than 3 mm, porosity of no more than 42.67%, and thickness of 0.2 mm can be used clinically to meet the mechanical performance requirements of the guided bone regeneration (GBR) structure.

Titanium Mesh Exposure After Bone Grafting: Treatment Approaches-A Systematic Review

Study Design

A systematic review according to PRISMA statement has been designed to answer the preliminary question: "In titanium mesh exposures, is there a treatment alternative which leads to an increased graft maintenance?" and fill the PICO assessment out.

Objective

To review studies published in the past 20 years (1999-2019) in which mesh exposure has occurred, detecting the suitable approaches to treat exposure allowing the graft maintenance.

Methods

Initial search on PUBMED, SCOPUS, and COCHRANE databases resulted in 777 articles, and hand-searching identified 6 articles. After removing duplicates and unrelated articles, eligibility criteria were applied, and 31 studies were selected (randomized clinical trials, retrospective/prospective clinical trials, and case series).

Results

A total of 677 surgical sites and 225 cases of mesh exposure were identified. Eleven treatments have been identified. Chlorhexidine was the primary approach in 46% of cases, followed by oral hygiene instructions and follow-up with 22.5% of occurrences. In 21% of clinical situations, titanium mesh removal was the treatment of choice, associated with other measures (i.e., antibiotic prescription). There seems to be a consensus in cases of infection. When this complication was associated with tissue dehiscence, the primary treatment was mesh removal. The same does not occur when the site needs to be cleaned for long-term periods.

Conclusion

In 2 decades of use of titanium meshes, the available treatments do not seem to have evolved, and there is not enough data to establish a guideline.

The effect of bone defect size on the 3D accuracy of alveolar bone augmentation performed with additively manufactured patient-specific titanium mesh

OBJECTIVE

Additively manufactured (3D-printed) titanium meshes have been adopted in the dental field as non-resorbable membranes for guided bone regeneration (GBR) surgery. However, according to previous studies, inaccuracies between planned and created bone volume and contour are common, and many reasons have been speculated to affect its accuracy. The size of the alveolar bone defect can significantly increase patient-specific titanium mesh design and surgical difficulty. Therefore, this study aimed to analyze and investigate the effect of bone defect size on the 3D accuracy of alveolar bone augmentation performed with additively manufactured patient-specific titanium meshes.

METHODS

Twenty 3D-printed patient-specific titanium mesh GBR surgery cases were enrolled, in which 10 cases were minor bone defect/augmentation (the planned bone augmentation surface area is less than or equal to 150 mm² or one tooth missing or two adjacent front-teeth/premolars missing) and another 10 cases were significant bone defect/augmentation (the planned bone augmentation surface area is greater than 150 mm² or missing adjacent teeth are more than two (i.e. ≥ three teeth) or missing adjacent molars are ≥ two teeth). 3D digital reconstruction/superposition technology was employed to investigate the bone augmentation accuracy of 3D-printed patient-specific titanium meshes.

RESULTS

There was no significant difference in the 3D deviation distance of bone augmentation between the minor bone defect/augmentation group and the major one. The contour lines of planned-CAD models in two groups were basically consistent with the contour lines after GBR surgery, and both covered the preoperative contour lines. Moreover, the exposure rate of titanium mesh in the minor bone defect/augmentation group was slightly lower than the major one.

CONCLUSION

It can be concluded that the size of the bone defect has no significant effect on the 3D accuracy of alveolar bone augmentation performed with the additively manufactured patient-specific titanium mesh.

The Outcomes of Vertical Alveolar Bone Augmentation by Guided Bone Regeneration with Titanium Mesh: A Systematic Review

AIM

This study aimed to systematically review the published studies on vertical alveolar bone augmentation (VABA) by guided bone regeneration (GBR) with titanium mesh (TM).

BACKGROUND

Guided bone regeneration is a procedure that can be used for VABA of the alveolar ridge. Titanium mesh is used as a barrier due to its ability to maintain a space that the newly formed bone will occupy.

MATERIALS AND METHODS

A computerized literature search was conducted on the databases PubMed, SCOPUS, Science Direct, and Cochrane Library to review the published article on VABA by TM from 2011 to 2021.

REVIEW RESULTS

Eight out of 574 retrieved articles were included in the qualitative analysis, three randomized clinical trials, two prospective clinical trials, and three retrospective trials. They were assessed for risk of bias using the critical appraisal skills program checklist. Titanium mesh was utilized as a barrier in three different ways, adapted directly on the alveolar bone, bent preoperatively on three-dimensional (3D) models, and 3D-printed. Two randomized clinical trials (RCTs) reported 20.8% bone gain, while the other studies reported the means ranging from 2.56 to 4.78 mm. All studies reported TM exposure that ranged from 7.69 to 66.66%. Exposure during the four postoperative weeks led to inadequate bone regeneration. However, late exposure had no effect or caused only slight bone resorption. Early TM removal was performed in two studies, one case per each, ranging from 2.4 to 11.1%. Infection was presented in three studies, one case per each, and the percentages were 5, 11.1, and 25%.

CONCLUSION

All types of TM had exposure, which was the most common complication, but early removal was indicated only in a few cases. Titanium mesh showed reliability and efficacy as a barrier for VABA by GBR.

CLINICAL SIGNIFICANCE

By this procedure, bone height can be restored, however, meticulous follow-up is recommended for the detection and management of TM exposures.

Maxillary Reconstruction with Xenogeneic Bone Graft, Platelet-Rich Fibrin, and Titanium Mesh for Rehabilitation with Implants: A 5-year Follow-Up Study

Aim

Alveolar deficiency is considered one of the main limitations for placement of osseointegrated implants, as well as for their long-term success, especially in the anterior region of the maxilla.

Objective

To report a clinical case of reconstruction of atrophic maxilla with deproteinized bovine bone associated with platelet-rich fibrin (PRF) and titanium mesh and to assess the linear and volumetric bone gains and rehabilitation with implants in a 5-year follow-up.

Case

Patient with bone deficiency in the anterior maxilla region underwent bone reconstruction with deproteinized bovine bone associated with PRF and titanium mesh. After six months, the necessary bone height and volume were obtained for placement of implants, and the bone contour was restored in the anterior region, providing functional and aesthetic improvement. The amount of linear and volumetric bone gains was compared to baseline computed tomography scans. Three implants were placed in the grafted region, and a bone tissue sample was obtained at the time of their placement. Histological analysis showed neo-formed bone tissue in contact with the remaining particles of the biomaterial. After six months, the implants were activated, and the prosthesis was placed on the implants, which were monitored for five years.

Conclusion

Implants can be placed predictably in regions with vertical and horizontal bone augmentations by using xenogeneic bone grafts associated with titanium mesh and PRF.

Customized Titanium Mesh for Guided Bone Regeneration in the Posterior Mandible in a Patient Previously Treated with Bisphosphonates

We describe the restorative treatment of an 86-year-old female patient who was referred to our specialist prosthodontics clinic. Due to secondary osteoporosis, she underwent oral antiresorptive therapy with ibandronic acid for 10 years. Although she was classified as a patient at increased risk of drug-induced osteonecrosis of the jaw, she eventually signed a consent form for fixed implant-supported prosthetic rehabilitation in her 4th sextant. However, after tooth extraction, the bone ridge was too small at the intended implant positions. Therefore, guided bone regeneration was performed with a computer-aided design/computer-aided manufacturing three-dimensional printed titanium mesh. Finally, a continuous augmented hard tissue ridge above 7 mm was found, and three implants were inserted. Eventually, after four months of submerged healing, the implants were loaded with single crowns. Now, the patient is seen regularly for supportive peri-implant therapy.

The Stages and Grades of Periodontitis Are Risk Indicators for Peri-Implant Diseases-A Long-Term Retrospective Study

The aim of this study is to evaluate the factors of implant failure in patients with periodontitis and their impact on the prognosis of having a peri-implant disease and/or implant failure. Data regarding 325 implants among 84 patients with periodontitis were retrospectively examined. Patients were classified by Stage (I, II, III, IV) and Grade (A, B, C), implant failures for peri-implant disease and lack of osseointegration. Clinical data, including implant- and patient-related variables were evaluated by principal components analysis (PCA) and two-step cluster analysis (CA). Survival and success rates were 96.3% and 87.1%, respectively. Prevalence of peri-implant disease was significantly higher in Stage IV patients (p < 0.05), and incidence of lost implant due to peri-implantitis was significantly higher in patients with bone augmentation (BA) (p < 0.05). PCA and CA revealed five of eleven variables and four clusters at patient level, and six of fourteen variables and three clusters at implant level. Stage and Grade are useful indicators for the development of peri-implant diseases in which BA and the number of implants are involved.

Custom Bone Regeneration (CBR): An Alternative Method of Bone Augmentation-A Case Series Study

We performed this clinical study in order to evaluate the reliability of the Guided Bone Regeneration (GBR) surgical technique through the use of customized CAD CAM titanium meshes (Yxoss CBR^® Reoss) in order to show an alternative method of bone augmentation.

MATERIALS AND METHODS

Nine patients presenting 10 bone defects were referred to solve oral dysfunction due to edentulous atrophic ridges. Guided bone regeneration was performed with titanium meshes combined with autogenous bone grafting and heterologous bovine bone mineral grafting, and exclusively a "poncho technique" soft tissue approach for all the cases. After a mean 9 months of graft healing (range 6-12 months), titanium meshes were removed, and implant surgery was subsequently performed. The results we obtained were positive in terms of volumetric increases in height, length and thickness of the atrophic ridges without biological complications detectable before implant surgery.

RESULTS

Out of nine, one site met titanium mesh exposure: however, in all 10 sites a three-dimensional volumetric bone implementation was obtained. The statistical results were estimated by uploading and superimposing cbct scans before and after CBR surgery for each patient, so it was possible evaluate the maximum linear vertical and horizontal bone gain through dedicated Cad Cam software (Exocad GmbH^®). The average horizontal gain was 6.37 ± 2.17 mm (range 2.78-9.12 mm) and vertical gain was 5.95 ± 2.06 mm (range 2.68-9.02 mm). A total of 18 implants were placed into the grafted sites with a 100% survival rate (clearly they are relative percentages to be compared to the short time elapsed).

CONCLUSIONS

The results we obtained in this study suggest that this CBR procedure (Yxoss^® by Reoss) is reliable and safe for bone regeneration to allow implant-prosthetic restoration in horizontal, vertical and combined bone defects. The soft tissue management is diriment: all the cases were managed with a "poncho" flap approach to decrease exposure complication.

Guided Bone Regeneration using Titanium Mesh to Augment 3-dimensional alveolar defects prior to implant placement. A Pilot Study

Objectives

To evaluate the outcomes of bone regeneration using a customized titanium mesh scaffold to cover a bone graft for reconstruction of complex defects of the jaws.

Materials and Methods

19 large defects were digitally reconstructed using CT scans according to the prosthetic requirements. A titanium mesh scaffold was designed to cover the bone (autologous/bovine bone particulate) graft. At least 6 months after surgery, a new cone‐beam CT was taken. The pre‐ and postoperative CT datasets were then converted into three‐dimensional models and digitally aligned. The actual mesh position was compared to the virtual position to assess the reliability of the digital project. The reconstructed bone volumes (RBVs) were calculated according to the planned bone volumes (PBVs), outlining the areas under the mesh. These values were then correlated with the number of exposures, locations of atrophy, and virtually planned bone volume.

Results

The mean matching value between the planned position of the mesh and the actual one was 82 ± 13.4%. 52.3% (40% early and 60% late) exposures were observed, with 15.8% exhibiting infection. 26.3% resulted as failures. The amount of reconstructed bone volume (RBV) in respect to PBV was 65 ± 40.5%, including failures, and 88.2 ± 8.32% without considering the failures. The results of the exposure event were statistically significant (p = .006) in conditioning the bone volume regenerated.

Conclusions

This study obtained up to 88% of bone regeneration in 74% of the cases. The failures encountered (26%) should underline the operator's expertise relevance in conditioning the final result.

Biocompatible Materials for Orbital Wall Reconstruction-An Overview

The reconstruction of an orbit after complex craniofacial fractures can be extremely demanding. For satisfactory functional and aesthetic results, it is necessary to restore the orbital walls and the craniofacial skeleton using various types of materials. The reconstruction materials can be divided into autografts (bone or cartilage tissue) or allografts (metals, ceramics, or plastic materials, and combinations of these materials). Over time, different types of materials have been used, considering characteristics such as their stability, biocompatibility, cost, safety, and intraoperative flexibility. Although the ideal material for orbital reconstruction could not be unanimously identified, much progress has been achieved in recent years. In this article, we summarise the advantages and disadvantages of each category of reconstruction materials. We also provide an update on improvements in material properties through various modern processing techniques. Good results in reconstructive surgery of the orbit require both material and technological innovations.

Quantification of the Bimodal Plate-Specific Complication Profile Associated With Reconstruction of Segmental Mandibular Defects With Reconstruction Plate and Soft Tissue Flap: Evidence From Systematic Review

ABSTRACT

Reconstruction of segmental mandibular defects with a mandibular reconstruction plate and separate soft tissue flap can be indicated in certain patients. Whilst this technique can provide acceptable results, its exact longevity and timing of associated complications is poorly understood. This study was designed to quantify and plot in time the complication profile associated with this technique of mandibular reconstruction.A search of the Medline and PubMed Central databases was conducted using the terms "Mandibulectomy" and "Reconstruction Plate." Articles reporting total number of plate extrusions and fractures and their postoperative timing were included.Nine articles were included, representing 265 patients with mandibulectomy defects reconstructed using mandibular reconstruction plates. Of these, 135 were male (62%) and 82 were female (38%). The mean age was 59 years. The predominant pathology was oral cavity Squamous Cell Carcinoma (SCC) (80%). Seventy-three patients (28%) experienced complications (mean follow-up: 24 months), with median time to complication of 3 months. Forty-three plate extrusions (16%), 20 plate fractures (8%) and 10 cases of loosened screws (4%) were reported. A bimodal temporal distribution of complications was found.Overall, a plate-specific complication rate of 28% was found, confirming a higher incidence of complications in comparison to osseous free flap reconstruction. These occur over a bimodal time distribution, with extrusion occurring earlier than fracture. Interference with speech, swallow and dental rehabilitation, and delay of adjuvant therapy are potential consequences. These findings indicate that patients may be better served by more complex reconstructive procedures, to minimize exposure to a frequent and prolonged complication profile.

The effect of collagen membrane and of bone substitute on lateral bone augmentation with titanium mesh: An experimental in vivo study

AIM

The aim of this study was to identify the additional effects of collagen membrane (CM) and of synthetic bone substitute (BS) on lateral bone augmentation of chronic peri-implant defect with titanium mesh (TM).

MATERIALS AND METHODS

Atrophic alveolar ridge was induced in 6 canine mandibles and 5 peri-implant defects were achieved in each hemi-mandible. Bone augmentation was attempted using the following randomly allocated modalities: 1) Control: no treatment, 2) TM only group: blood clot covered by TM, 3) TM+BS group: BS covered by TM, 4) TM+CM group: blood clot covered by TM and CM, and 5) TM+BS+CM group: BS covered by TM and CM. After 16 weeks of submerged healing, micro-CT and histomorphometric analyses were performed.

RESULTS

TM exposure occurred in one case in the TM only group, one case in the TM+CM group, and two cases in the TM+BS+CM group. Histologically, pseudo-periosteum was observed along the inner and outer surfaces of TM, and the directions of the collagen fiber within the pseudo-periosteum differed according to the additional use of CM. In general, the TM only group rendered higher values in vertical defect fill and dimension of the augmented hard tissue in comparison to the other treatment groups.

CONCLUSIONS

Due to the small sample size, this pilot study remains inconclusive. Within the limitations of the study, the use of CM and/or BS did not appear to have an additional benefit on lateral bone augmentation of peri-implant defect with TM.

Enhancement of Biofunctionalization by Loading Manuka Oil on TiO2 Nanotubes

Metallic implants (mesh) for guided bone regeneration can result in foreign body reactions with surrounding tissues, infection, and inflammatory reactions caused by micro-organisms in the oral cavity after implantation. This study aimed to reduce the possibility of surgical failure caused by microbial infection by loading antibacterial manuka oil in a biocompatible nanostructure surface on Ti and to induce stable bone regeneration in the bone defect. The manuka oil from New Zealand consisted of a rich β-triketone chemotype, leptospermone, which showed strong inhibitory effects against several bacteria, even at very low oil concentrations. The TiO₂ nanotubular layer formed by anodization effectively enhanced the surface hydrophilicity, bioactivity, and fast initial bone regeneration. A concentration of manuka oil in the range of 0.02% to less than 1% can have a synergistic effect on antibacterial activity and excellent biocompatibility. A manuka oil coating (especially with a concentration of 0.5%) on the TiO₂ nanotube layer can be expected not only to prevent stenosis of the connective tissue around the mesh and inflammation by microbial infection but also to be effective in stable and rapid bone regeneration.

3D-based buccal augmentation for ideal prosthetic implant alignment—an optimized method and report on 7 cases with pronounced buccal concavities

Objectives

Screw-retained restoration of implants is advantageous for biological and esthetic reasons. Due to buccal concavities, however, this preferred type of restoration can only be used in about half of the anterior indications. Based on case series, an optimized method for the treatment of such indications is to be described; the clinical reliability is to be ascertained by means of measurements (before and after augmentation) and assigned to the current literature.

Material and methods

A case series of seven cases with buccal concavities of the anterior alveolar ridge were treated with optimized method, which is presented step-by-step until the prosthetic restoration. The depths of the bone concavities were measured and related to the bone gain after augmentation procedure respectively after implantation.

Results

Linear measurements of the buccal concavities showed an average undercut of 4 mm [SD ± 1.13]. After healing period of six months, the buccal concavities could be compensated bony to such an extent that implants could be inserted in correct position and angulation. On average, there was a horizontal bone gain of 3.7 mm [SD ± 0.59]. Even after implantation and another six months of healing, stable bone dimensions could be assumed with an average of 4.3 [SD ± 0.83] mm of bone gain compared to baseline. In six of the seven cases, the favorite screw-retained, one-piece full-ceramic restoration could be fixed on the implants. Due to the implant axis, one case had to be treated with a cemented two-part full-ceramic system.

Conclusions

With the described optimized method the most favorable screw-retained restoration can also be used in situations with unfavorable concavities of buccal bone. Especially for this indication, a special form of the horizontal deficit, the customized bone regeneration with titanium meshes is highly reliable in terms of healing and extent of augmentation. However, long-term results and a study/control group are required to evaluate the effectiveness of the presented protocol.

Clinical relevance.

Since these situations require an augmentation that is up to 5 mm thick and a procedure that is as minimally invasive as possible appears to be necessary in the visible area, an optimized method is described in this publication.

Finding the Perfect Membrane: Current Knowledge on Barrier Membranes in Regenerative Procedures: A Descriptive Review

Guided tissue regeneration (GTR) and guided bone regeneration (GBR) became common procedures in the corrective phase of periodontal treatment. In order to obtain good quality tissue neo-formation, most techniques require the use of a membrane that will act as a barrier, having as a main purpose the blocking of cell invasion from the gingival epithelium and connective tissue into the newly formed bone structure. Different techniques and materials have been developed, aiming to obtain the perfect barrier membrane. The membranes can be divided according to the biodegradability of the base material into absorbable membranes and non-absorbable membranes. The use of absorbable membranes is extremely widespread due to their advantages, but in clinical situations of significant tissue loss, the use of non-absorbable membranes is often still preferred. This descriptive review presents a synthesis of the types of barrier membranes available and their characteristics, as well as future trends in the development of barrier membranes along with some allergological aspects of membrane use.

Finding the Perfect Membrane: Current Knowledge on Barrier Membranes in Regenerative Procedures: A Descriptive Review

Guided tissue regeneration (GTR) and guided bone regeneration (GBR) became common procedures in the corrective phase of periodontal treatment. In order to obtain good quality tissue neo-formation, most techniques require the use of a membrane that will act as a barrier, having as a main purpose the blocking of cell invasion from the gingival epithelium and connective tissue into the newly formed bone structure. Different techniques and materials have been developed, aiming to obtain the perfect barrier membrane. The membranes can be divided according to the biodegradability of the base material into absorbable membranes and non-absorbable membranes. The use of absorbable membranes is extremely widespread due to their advantages, but in clinical situations of significant tissue loss, the use of non-absorbable membranes is often still preferred. This descriptive review presents a synthesis of the types of barrier membranes available and their characteristics, as well as future trends in the development of barrier membranes along with some allergological aspects of membrane use.

Recent Advances in Synthetic and Natural Biomaterials-Based Therapy for Bone Defects

Synthetic and natural biomaterials are a promising alternative for the treatment of critical-sized bone defects. Several parameters such as their porosity, surface, and mechanical properties are extensively pointed out as key points to recapitulate the bone microenvironment. Many biomaterials with this pursuit are employed to provide a matrix, which can supply the specific environment and architecture for an adequate bone growth. Nevertheless, some queries remain unanswered. This review discusses the recent advances achieved by some synthetic and natural biomaterials to mimic the native structure of bone and the manufacturing technology applied to obtain biomaterial candidates. The focus of this review is placed in the recent advances in the development of biomaterial-based therapy for bone defects in different types of bone. In this context, this review gives an overview of the potentialities of synthetic and natural biomaterials: polyurethanes, polyesters, hyaluronic acid, collagen, titanium, and silica as successful candidates for the treatment of bone defects.

Hard tissue stability after guided bone regeneration: a comparison between digital titanium mesh and resorbable membrane

Guided bone regeneration (GBR) uses resorbable and non-resorbable membranes as biological barriers. This study compared the differences in hard tissue stability between GBR using evidence-based digital titanium mesh and resorbable collagen membranes during implant placement. A total of 40 patients (65 implant sites) were enrolled and divided into two groups: resorbable membrane and digital titanium mesh groups. The alveolar bone was analyzed at two- and three-dimensional levels using cone-beam computed tomography and by reconstructing and superimposing the hard tissues at four time points: preoperatively, postoperatively, before second-stage surgery, and 1 year after loading. The use of digital titanium mesh showed less alveolar bone resorption in vertical and horizontal directions two-dimensionally before the second-stage surgery and 1 year after loading. Regarding volumetric stability, the percentage of resorption after 6 months of healing with resorbable membrane coverage reached 37.5%. However, it was only 23.4% with titanium mesh. Although postoperative bone volume was greater at all labial sites with resorbable membrane than with digital titanium mesh, after substantial bone resorption within 1 year of loading, the labial bone thickness at the upper part of implants was thinner with resorbable membrane than with digital titanium mesh. Furthermore, digital titanium meshes made according to ideal bone arch contour reduced soft tissue irritation, and the exposure rate was only 10%. Therefore, although both resorbable membrane and digital titanium mesh in GBR were able to successfully reconstruct the bone defect, digital titanium meshes were better at maintaining the hard tissue volume in the osteogenic space.

Deformation of polyetheretherketone, PEEK, with different thicknesses

In order to determine a suitable thickness of polyetheretherketone (PEEK) for manufacturing of surgical membranes, the purpose was to evaluate how different thicknesses of PEEK influence the mechanical properties under flexure and tension. In total 20 specimens in PEEK with two different thicknesses, 0.5 mm and 1.0 mm were fabricated and tested in a three-point flexural strength test and tensile strength test (n = 5 specimens). Statistical analysis was done with non-parametric Mann-Whitney test with level of significance α = 0.05, for both material tests, respectively. The 1.0 mm-thick samples resulted in higher values in elastic limit and conventional deflection (S_c-value) in the flexural strength test compared to 0.5 mm-thick samples. In the tensile strength test, the results did not show any significant difference in elastic limit depending on the thickness evaluated. However, PEEK with thickness of 1.0 mm received significantly higher maximum value at fracture. Within the limitations of this study, PEEK with a thickness of 0.5 mm-1.0 mm shows mechanical properties that are appropriate thickness and can meet the complex demands for dimensioning of surgical membranes.

Sequential Treatment of Extreme Maxillary Hypoplasia: A Historical Patient Report of an Edentulous Adult Patient With Ankyloglossia

INTRODUCTION

The management of multiple dimensions in orthognathic surgery often requires careful planning. Too large discrepancies could require a sequential procedure to make alignment of the archs possible.

REPORT OF CASE

The authors report a case of a 30-year-old partially edentulous man with severe maxillary hypoplasia caused by an untreated ankyloglossia. The transverse deficiency was estimated at more than 15 mm and the sagittal discrepancy shows a negative overjet of 11.5 mm. These wide deficits needed a 2-step surgery and the use of computed-aided design/computed-aided manufacturing. The first step was a palatal expansion by a fan-shaped Le Fort I osteotomy. The second step treated sagittal discrepancy and re-expanded the maxilla.At the end, the sagittal dimension got normal and the maxilla have been widened to almost 7 mm.

CONCLUSION

Custom-made surgery is very useful for uncommon cases, in particular for toothless patients. It facilitates complex operations and allows precise results.

Primary bone augmentation leads to equally stable marginal tissue conditions comparing the use of xenograft blocks infused with BMP-2 and autogenous bone blocks: A 3D analysis after 3 years

Objectives

To test whether or not primary bone augmentation using xenograft blocks infused with BMP‐2 or autogenous bone blocks lead to similar results regarding the implant survival and 3D marginal soft tissue contours.

Methods

Twenty‐four patients with an insufficient ridge width for implant placement in need of primary augmentation were randomly assigned to either a block of deproteinized bovine bone mineral infused with rhBMP‐2 (BMP) or an intraorally harvested block of autogenous bone (ABB). At 4 months, 1–4 dental implants were placed in the regenerated area. After crown insertion and at 3 years, peri‐implant tissue parameters, two‐ and three‐dimensional radiographic parameters, and soft tissue contour changes were evaluated. Explorative mixed model analyses were performed. The level of significance was set at 5%.

Results

At the 3‐year follow‐up, 23 patients with 40 implants were evaluated. The implant survival rate was 100% in both groups. At baseline, the marginal hard tissue levels amounted to −0.4 ± 0.8 mm (mean ± standard deviation) in the BMP group and −0.7 ± 1.0 mm in the ABB group. At 3 years, these values were −0.2 ± 0.4 mm (BMP) and −0.6 ± 1.0 mm (ABB). At baseline, the thickness of the buccal hard tissue at the level of the implant shoulder measured 1.1 ± 1.1 mm (BMP) and 1.4 ± 1.0 mm (ABB). At 3 years, it measured 0.9 ± 0.9 mm (BMP) and 0.7 ± 0.6 mm (ABB).

Conclusions

The present study demonstrated excellent implant survival rates and stable marginal hard tissue levels in both augmentation groups, 3 years after crown insertion. In addition, the clinical stability of soft and hard tissues was demonstrated in both groups.

Peri-implant tissue augmentation by volume-stable collagen matrix transplantation: a study of dog mandibles

The aim of this study was to investigate histologically the amount of peri-implant tissue augmentation after volume-stable porcine collagen matrix transplantation. Six male beagle dogs were used in the experiment. P2, P4, and M1 distal roots were extracted under general anesthesia. After 6 months, implants were placed in the same sites, and volume-stable porcine collagen matrix transplantation was performed. Impressions were taken at 1 and 2 weeks and at 1, 2, and 3 months after transplantation. The dogs were euthanized at 3 months, and their mandibles were removed and scanned using micro-computed tomography. Standard Triangulated Language data were also obtained. Using preoperative models as a reference, the data for all time points were compared, and changes in the thickness of the cross-section of the implant sites were measured. The model created at 3 months was then compared with the mandible data, and the thickness of collected peri-implant soft tissue was measured under optical microscopy. Increased thickness was found at some of the sites on the buccal side. Regarding the peri-implant soft tissue, the thickness of the measured sites on the buccal side was significantly increased at 3 months in the experimental group. Histological observations of the internal structures of the tissue in the experimental group revealed irregular collagen fibers and a remnant collagen matrix. Endogenous tissue was observed within the collagen matrix, indicating good fusion with the surrounding autologous tissue. These results suggest that volume-stable porcine collagen matrix transplantation promotes peri-implant tissue augmentation on the buccal side.

Clinical outcomes and biological and mechanical complications of immediate fixed prostheses supported by zygomatic implants: A retrospective analysis from a prospective clinical study with up to 11 years of follow-up

BACKGROUND

Zygomatic implants alone or in combination with conventional implants have been used for severe atrophic maxillary arches. Long-term outcomes of extramaxillary technique need validations.

PURPOSE

To retrospectively assess the clinical outcomes and the prevalence of surgical, biological, and prosthetic complications of implant-fixed complete dental prostheses (IFCDPs) supported by zygomatic implants up to 11 years of follow-up.

MATERIALS AND METHODS

Dental records of 34 subjects treated between October 2008 and June 2019 were reviewed. Patients received an immediate fixed full-arch prosthesis supported solely by zygomatic implants or by a combination of zygomatic and conventional implants.

RESULTS

A total of 90 zygomatic implants and 53 standard implants were placed. Up to 11 years of follow-up, two conventional implants were lost, leading to 96.2% success rate for conventional implants and 100% for zygomatic implants. Marginal bone loss for conventional implants averaged 0.85 ± 0.17 mm after the first year and 1.36 ± 0.12 mm after 10 years, resulting in full implant success. No prosthesis was lost. The main surgical complication was the perforations of the Schneiderian membrane, occurring in five patients and in seven sinus cavities. Considering the biological complications, mucositis for standard and zygomatic implants ranged between 21%-35% and 26%-40%, respectively. No peri-implantitis were reported. Soft tissue hypertrophy ranged between 1.8% and 30% for conventional implants and 1.1%-35% for zygomatic implants. Inflammation under the prosthesis ranged between 33% and 50%. For the mechanical complications, abutment loosening was recorded in 5.8% of cases (two patients), tooth debonding and fracture of the prosthesis happened in five subjects (14.7%), and loosening of the prosthetic screws was reported in one patient (2.9%).

CONCLUSIONS

Immediate rehabilitation of the severely atrophic maxilla with zygomatic implants alone or in combination with standard implants could be considered a viable treatment modality.

Effect of Exposure Rates with Customized versus Conventional Titanium Mesh on Guided Bone Regeneration: A Systematic Review and Meta-Analysis

Titanium mesh exposure is the main complication of bone regeneration. In this study, a meta-analysis and performed to clarify the effect of customized titanium mesh versus conventional titanium mesh complications and the time of mesh exposure on edentulous alveolar ridge GBR. Databases, including PubMed, EMBASE, Web of Science and Cochrane Central Register Controlled Trials, were searched by two independent reviewers to retrieve articles published from January 2010 to March 2020, regarding the incidence of complications after GBR surgery, with language limited to English articles. A total of 705 articles were found, and 9 articles were quantitatively analyzed. A funnel plot was made for 10 comprehensive datasets. The combined value of the total exposure rate of titanium mesh was 0.44 (44%, 95% CI=0.30~0.58). The results of subgroup analysis showed that the combined value of the customized titanium mesh exposure rate was 0.31 (31%, 95% CI=0.15~0.51), and the combined value of the conventional titanium mesh exposure rate was 0.51 (51%, 95% CI=0.33~0.69). Based on the findings of the present study, the exposure rate of customized titanium mesh is lower than that of conventional titanium mesh. The design of 3D printing customized titanium mesh avoids nerves and blood vessels, which is of great significance to improve the accurate reconstruction of GBR and provides enough space for implantation and reducing the exposure rate. Soft tissue management (i.e., technical sensitivity) is also an important factor to avoid soft tissue fractures.

Bone Grafts and Substitutes in Dentistry: A Review of Current Trends and Developments

After tooth loss, bone resorption is irreversible, leaving the area without adequate bone volume for successful implant treatment. Bone grafting is the only solution to reverse dental bone loss and is a well-accepted procedure required in one in every four dental implants. Research and development in materials, design and fabrication technologies have expanded over the years to achieve successful and long-lasting dental implants for tooth substitution. This review will critically present the various dental bone graft and substitute materials that have been used to achieve a successful dental implant. The article also reviews the properties of dental bone grafts and various dental bone substitutes that have been studied or are currently available commercially. The various classifications of bone grafts and substitutes, including natural and synthetic materials, are critically presented, and available commercial products in each category are discussed. Different bone substitute materials, including metals, ceramics, polymers, or their combinations, and their chemical, physical, and biocompatibility properties are explored. Limitations of the available materials are presented, and areas which require further research and development are highlighted. Tissue engineering hybrid constructions with enhanced bone regeneration ability, such as cell-based or growth factor-based bone substitutes, are discussed as an emerging area of development.

Polybutylene-adipate-terephthalate and niobium-containing bioactive glasses composites: Development of barrier membranes with adjusted properties for guided bone regeneration

This study aimed to develop bioactive guided bone regeneration (GBR) membranes by manufacturing PBAT/BAGNb composites as casting films. Composites were produced by melt-extrusion, and BAGNb was added at 10 wt%, 20 wt%, and 30 wt% concentration. Pure PBAT membranes were used as a control (0wt%BAGNb). FTIR and thermogravimetric analysis characterized the composites. Barrier membranes were produced by solvent casting, and their mechanical and surface properties were assessed by tensile strength test and contact angle analysis, respectively. The ion release and cell behavior were evaluated by pH, cell proliferation, and mineralization. Composites were successfully produced, and the chemical structure showed no interference of BAGNb in the PBAT structure. The addition of BAGNb increased the stiffness of the membranes and reduced the contact angle, increasing the roughness in one side of the membrane. Sustained pH increment was observed for BAGNb-containing membranes with increased proliferation and mineralization as the concentration of BAGNb increases. The incorporation of up to 30 wt% of BAGNb into PBAT barrier membranes was able to maintain adequate chemical-mechanical properties leading to the production of materials with tailored surface properties and bioactivity. Finally, this biomaterial class showed outstanding potential and may contribute to bone formation in GBR procedures.

Scientometric Analysis of Dental Implant Research over the Past 10 Years and Future Research Trends

BACKGROUND

We conducted a bibliometrics analysis to explore the recent trends in dental implant research which could help researchers have a clear grasp of the relevant research hotspots and prospects. Material and Methods. Altogether, 15,770 articles on dental implants, from January 1, 2010, to October 31, 2019, were selected from the Web of Science Core Collection. We used BICOMB software to extract the high-frequency MeSH terms and construct binary and coword matrices. gCLUTO software was used for biclustering and visual analysis, Ucinet 6 software for social network analysis, SCIMAT software for strategic diagram building, Citespace 5.5 software to form timeline visualization, and VOSviewer software, eventually, for bibliometrics cocitation network.

RESULTS

Altogether, 72 high-frequency keywords were extracted from the selected articles and 4 clusters and 7 subcategories were identified through biclustering analysis in the dental implant research field. The use of the strategic diagram also enabled us to find the research hotspot and development trends.

CONCLUSIONS

The survival rate of dental implants and subsequent restoration have always been the core focus of research. Sinus floor elevation and guided bone regeneration are worthy of constant exploration owing to their reliability. With continuous improvement in technology, immediate loading could become a future research hot spot.

Titanium Meshes in Guided Bone Regeneration: A Systematic Review

The presence of satisfactory bone volume is fundamental for the achievement of osseointegration. This systematic review aims to analyse the use of titanium meshes in guided bone regeneration in terms of bone gain, survival and success rates of implants, and percentages of exposure. An electronic search was conducted Articles were selected from databases in MEDLINE (PubMed), SCOPUS, Scielo, and Cochrane Library databases to identify studies in which bone regeneration was performed through particulate bone and the use of titanium meshes. Twenty-one studies were included in the review. In total, 382 patients, 416 titanium meshes, and 709 implants were evaluated. The average bone gain was 4.3 mm in horizontal width and 4.11 mm in vertical height. The mesh exposure was highly prevalent (28%). The survival rate of 145 simultaneous implants was 99.5%; the survival rate of 507 delayed implants was 99%. The success rate of 105 simultaneous implants was 97%; the success rate of 285 delayed implants was 95.1%. The clinical studies currently available in the literature have shown the predictability of this technique. It has a high risk of soft tissue dehiscence and membrane exposure although the optimal management of membrane exposition permits obtaining a sufficient bone regeneration volume and prevents compromising the final treatment outcome.

Customized CAD/CAM titanium meshes for the guided bone regeneration of severe alveolar ridge defects: Preliminary results of a retrospective clinical study in humans

OBJECTIVES

To present the results of guided bone regeneration (GBR) of atrophic edentulous ridges with customized CAD/CAM titanium meshes.

MATERIAL AND METHODS

Forty-one patients, presenting with 53 atrophic sites, were enrolled between 2018 and 2019. GBR was obtained with titanium meshes filled with autogenous bone chips and bovine bone mineral (BBM). After a mean of 7 months (range: 5-12 months), meshes were removed and 106 implants placed. After a mean of 3.5 months (range: 2-5 months), implants were uncovered and prosthetic restorations started. The outcomes were vertical and horizontal bone augmentation changes, biological complications and implant survival.

RESULTS

Out of 53 sites, 11 underwent mesh exposure: eight of them were followed by uneventful integration of the graft, while three by partial bone loss. The mean vertical and horizontal bone gain after reconstruction was 4.78 ± 1.88 mm (range 1.00-8.90 mm) and 6.35 ± 2.10 mm (range 2.14-11.48 mm), respectively. At the time of implant placement, mean changes of initial bone gain were -0.39 ± 0.64 mm (range -3.1 to + 0.80 mm) and -0.49 ± 0.83 mm (range -3.7 to +0.4 mm), in the vertical and horizontal dimensions, respectively. Reduction of bone volume was significantly higher (p < .001 for both dimensions) in the exposed sites. The mean follow-up of implants after loading was 10.6 ± 6.5 months (range: 2-26 months). The survival rate of implants was 100%.

CONCLUSION

Customized titanium meshes can represent a reliable tool for GBR of severely atrophic sites, with simplification of the surgical phases.

Biological Oriented Immediate Loading: A New Mathematical Implant Vertical Insertion Protocol, Five-Year Follow-Up Study

One of the current major challenges in implant therapy is to minimize marginal bone loss around implants, since it can trigger bacterial colonization of the implant’s neck, leading to its failure. The present study aimed (1) to scientifically validate a new mathematical rule based on soft tissues thickness, for choosing the correct implant position with respect to the bone level, in order to provide a better tissue adaptation to the abutment/implant surface to avoid bacterial invasion, and (2) to apply this mathematical rule to the Biological Oriented Immediate Loading (B.O.I.L.) surgical protocol, avoiding peri-implant bone resorption. N. 127 implants were inserted following B.O.I.L. protocol: implants were placed according to the mathematical rule Y = X − 3, which correlates the position of the implant from the bone crest level (Y) with the thickness of the soft tissues (X). All the implants were inserted in fresh extraction sockets, and immediately loaded with temporary abutments and prostheses. Bone levels were evaluated through radiographic examination just after surgical procedure (T0), and after 10 days (10D), 6 months (6M), 1 year (1Y), and 5 years (5Y). After 5 years, the implant survival rate was 100%, with a medium marginal bone loss around implants of 0.0704 mm (SD = 0.169 mm). One-way ANOVA, followed by Tukey’s multiple comparison test was performed for statistical evaluations (p < 0.05). This protocol provided a safe and successful procedure, with a good soft tissue seal against bacterial challenge. The application of the mathematical rule allows the implant placement in a correct vertical position from the bone crest, avoiding bone resorption and bacterial infiltrations. Moreover, the use of Multi Unit Abutment (MUA) determined a stable biological seal, favouring the implant healing and preserving the adhesion of hemidesmosomes to the titanium of MUA.

Titanium mesh for bone augmentation in oral implantology: current application and progress

Guided bone regeneration (GBR) is an effective and simple method for bone augmentation, which is often used to reconstruct the alveolar ridge when the bone defect occurs in the implant area. Titanium mesh has expanded the indications of GBR technology due to its excellent mechanical properties and biocompatibility, so that the GBR technology can be used to repair alveolar ridges with larger bone defects, and can obtain excellent and stable bone augmentation results. Currently, GBR with titanium mesh has various clinical applications, including different clinical procedures. Bone graft materials, titanium mesh covering methods, and titanium mesh fixing methods are also optional. Moreover, the research of GBR with titanium mesh has led to multifarious progresses in digitalization and material modification. This article reviews the properties of titanium mesh and the difference of titanium mesh with other barrier membranes; the current clinical application of titanium mesh in bone augmentation; common complications and management and prevention methods in the application of titanium mesh; and research progress of titanium mesh in digitization and material modification. Hoping to provide a reference for further improvement of titanium mesh in clinical application and related research of titanium mesh.

Research on the dimensional accuracy of customized bone augmentation combined with 3D-printing individualized titanium mesh: A retrospective case series study

BACKGROUND

Few studies have focused on the dimensional accuracy of customized bone grafting by means of guided bone regeneration (GBR) with 3D-Printed Individual Titanium Mesh (3D-PITM).

PURPOSE

Digital technologies were applied to evaluate the dimensional accuracy of customized bone augmentation with 3D-PITM with a two-stage technique.

MATERIALS AND METHODS

Sixteen patients were included in this study. The CBCT data of post-GBR (immediate post-GBR) and post-implantation (immediate post-implant placement) were 3D reconstructed and compared with the pre-surgical planned bone augmentation. The dimensional differences were evaluated by superimposition using the Materialize 3-matic software.

RESULTS

The superimposition analysis showed that the maximum deviations of contour between were 3.4 mm, and the average differences of the augmentation contour were 0.5 ± 0.4 and 0.6 ± 0.5 mm respectively. The planned volume of bone regeneration was approximately equal to the amount of regenerated bone present 6 to 9 months after the surgical procedure. On average, the vertical gain in bone height was about 0.5 mm less than planned. And, the horizontal bone gain on the straight buccal of the dental implants and 2 to 4 mm apical of the platform fell also about a 0.5 mm short on average. Statistically significant differences were observed between the augmented volume of virtual and post-GBR, and the horizontal bone gain of post-implantation on the level of 4 mm apical to the implant platform (P < .05).

CONCLUSIONS

The dimensional accuracy of customized bone augmentation with the 3D-PITM approach needs further improvement and compared to other surgical approaches of bone augmentation.

A novel digital and visualized guided bone regeneration procedure and digital precise bone augmentation: A case series

BACKGROUND

Although the traditional bone augmentation technology can basically meet the clinical needs at present, the effect of bone augmentation in most cases is related to the experience of the operator.

PROPOSE

This study commits to providing a digital solution for precise bone augmentation in the field of oral implantology.

MATERIALS AND METHODS

After collecting the data of patients' intraoral scanning and DICOM (digital imaging and communications in medicine), the implant position is digitally designed, and the alveolar bone is digitally augmented around the ideal implant position. On the premise of ensuring that the thickness of labial bone is 2 mm, and there is sufficient alveolar bone 3 to 4 mm apically from the ideal gingival margin for implant placing, we carry out excessive augmentation of 0.5 and 1 mm on the labial bone and alveolar crest, respectively, to compensate for possible bone resorption after 6 months. After 3D printing the reconstructed alveolar bone model, the titanium mesh is trimmed and preformed on the alveolar bone model. Outcomes are reported in terms of mean values (5%-95% percentile values).

RESULTS

Thirty implant sites have accepted this novel virtually designed alveolar bone augmentation. Before the second-stage surgery, the average vertical bone gain was 2.48 mm (0.29-6.32), the average horizontal bone gain was 4.11 mm (1.19-8.74), the average height of the residual alveolar bone above the implant platform was 1.44 mm (0.59-2.92), the average thickness of the labial bone width at the implant platform was 2.00 mm (0.93-3.64), the average thickness of the labial bone width at 2 mm apically from the implant platform was 2.74 mm (1.40-5.46). The virtual augmentation of each tooth position was 349.41 mm³ (165.70-482.70), while the actual augmentation of each tooth position was 352.94 mm³ (159.24-501.78), the accuracy of the final actual augmentation reached 95.82% (range from 88.53% to 99.15%).

CONCLUSION

This case series suggests that a virtually digital guided bone regeneration (GBR) workflow is precise and controllable. The practicality, safety and effectiveness of this procedure needs to be compared to other bone augmentation procedures in randomized controlled trials.

Regeneration of critical-sized mandibular defect using a 3D-printed hydroxyapatite-based scaffold: An exploratory study

BACKGROUND

Three-dimensional (3D) printing has become an available technology to fabricate customized tissue engineering scaffolds with delicate architecture. This exploratory study aimed to evaluate the potential of a 3D-printed hydroxyapatite-based scaffold as a biomaterial for obtaining guided bone regeneration (GBR) in vivo.

METHODS

Scaffolds composed of 90% hydroxyapatite and 10% poly(lactic-co-glycolic acid) were printed using a microextrusion process to fit 4 mm diameter and 0.5 mm thick through-and-through osseous defects on the mandibular ramus of rats, with unfilled defects serving as controls. Specimens were analyzed for regeneration-associated gene expression on day 7, and micro-computed tomography (micro-CT) and histology assessments were carried out on day 28.

RESULTS

The scaffolds were 3.56 ± 0.43 mm (x-axis) and 4.02 ± 0.44 mm (y-axis) in diameter and 0.542 ± 0.035 mm thick (z-axis), with a mean pore size of 0.420 ± 0.028 × 0.328 ± 0.005 mm² . Most scaffolds fit the defects well. Type I collagen, VEGF, and Cbfa1 were upregulated in the scaffold-treated defects by day 7. By day 28, de novo osteogenesis and scaffold-tissue integration were evident in the scaffold-treated defects, and entire mineralized tissue, as well as newly formed bone, was significantly promoted, as seen in the micro-CT and histologic analyses.

CONCLUSION

The 3D-printed hydroxyapatite-based scaffold showed acceptable dimensional stability and demonstrated favorable osteoregenerative capability that fulfilled the need for GBR.

Visible Light-Enhanced Antibacterial and Osteogenic Functionality of Au and Pt Nanoparticles Deposited on TiO2 Nanotubes

This study aimed at evaluating the visible light mediated antimicrobial and osteogenic applications of noble metal, such as gold (Au) and platinum (Pt) coated titania (TiO₂) nanotubes (NTs). In this study, the Au and Pt nanoparticles (NPs) were deposited on anodized 100 nm TiO₂ NTs by ion plasma sputtering. The Au and Pt NPs were mainly deposited on the top surface layer of TiO₂ NTs and showed light absorbance peaks around the 470 and 600 nm visible light region used in this study, as seen from the surface characterization. From the results of antibacterial activity test, Au and Pt NPs that were deposited on TiO₂ NTs showed excellent antibacterial activity under 470 nm visible light irradiation due to the plasmonic photocatalysis based on the localized surface plasmon resonance effect of the Au and Pt NPs. In addition, alkaline phosphate activity test and quantitative real-time PCR assay of osteogenic related genes resulted that these NPs promoted the osteogenic functionality of human mesenchymal stem cells (hMSCs) under 600 nm visible light irradiation, because of the synergic effect of the photothermal scattering of noble metal nanoparticles and visible light low-level laser therapy (LLLT). Therefore, the combination of noble metal coated TiO₂ NTs and visible light irradiation would be expected to perform permanent antibacterial activity without the need of an antibacterial agent besides promoting osteogenic functionality.

Clinical and Radiographic Evaluation of Simultaneous Alveolar Ridge Augmentation by Means of Preformed Titanium Meshes at Dehiscence-Type Peri-Implant Defects: A Prospective Pilot Study

Background: bone augmentation by means of manually shaped titanium mesh is an established procedure to regenerate atrophic alveolar ridges and recreate a proper contour of the peri-implant bone anatomy. Conversely, current literature on the use of preformed titanium meshes instead of traditional grids remains lacking. Therefore, the aim of the present prospective study was to evaluate the use of preformed titanium mesh to support bone regeneration simultaneously to implant placement at dehiscence-type defects from clinical, radiological, and patient-related outcomes. Methods: 8 implants showing buccal dehiscence defects were treated with preformed titanium mesh directly fixed to flat abutments screwed to the implant. Intrasurgical clinical measurements and radiographic evaluations by means of cone-beam computed tomography scans were performed to assess the horizontal bone gain after 8 months from the augmentation surgery. Biological and patient-centered outcomes were also evaluated.; Results: clinically, a mean horizontal bone gain of 4.95 ± 0.96 mm, and a mean horizontal thickness of the buccal plate of 3.25 ± 0.46 mm were found. A mean horizontal bone gain of 5.06 ± 0.88 mm associated with a mean horizontal thickness of the buccal plate of 3.45 ± 0.68 mm were observed radiographically. From a macroscopic aspect, the remodeled graft appeared well integrated with the host bone. Well vascularized newly formed bone-like tissue was observed in intimate contact with the implants. Conclusions: preformed titanium mesh may be effective in supporting simultaneous horizontal bone regeneration at dehiscence-type peri-implant defects. Titanium mesh exposure still remain an issue in this type of surgery.

Horizontal Ridge Augmentation and Contextual Implant Placement with a Resorbable Membrane and Particulated Anorganic Bovine Bone-Derived Mineral

Alveolar ridge deficiency is considered a major limitation for successful implant placement. Various approaches have been developed to horizontal augmentation of bone volume. This case report presents the medium-term results of one-stage guided bone augmentation using an anorganic bovine bone (70%) and autologous bone (30%), placed in layers, in association with resorbable collagen membrane for a subsequent implant placement. The patient presented with a localized horizontal ridge defect in the posterior zone of the jaw. The clinical and radiographic presentations, as well as relevant literature, are presented.