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Cucchi A, Bettini S, Tedeschi L, Urban I, Franceschi D, Fiorino A, Corinaldesi G. Complication, vertical bone gain, volumetric changes after vertical ridge augmentation using customized reinforced PTFE mesh or Ti-mesh. A non-inferiority randomized clinical trial. Clin Oral Implants Res 2024. [PMID: 39180274 DOI: 10.1111/clr.14350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/27/2024] [Accepted: 07/30/2024] [Indexed: 08/26/2024]
Abstract
OBJECTIVE The aim of this non-inferiority randomized clinical trial was to compare the surgical and healing complications, vertical bone gain, and volumetric bone changes after vertical ridge augmentation using two different approaches: customized Ti-reinforced d-PTFE mesh versus customized CAD/CAM Ti-mesh. MATERIALS AND METHODS Fifty patients with vertical bone defects were randomly treated with Ti-reinforced d-PTFE mesh (control group) or CAD/CAM Ti-mesh (test group) and a mix of autogenous bone and deproteinized bovine bone matrix. Surgical and healing complication rates (SCR-HCR), vertical bone gain (VBG), regenerated bone volume (RBV), and regeneration rates (RR and ERR) were recorded and analysed [significance level (α) of 0.05]. RESULTS Of the 50 patients, 48 underwent bone augmentation surgery. SCR were 4% and 12% in PTFE and Ti-mesh, whereas HCR were 12.5% and 8.3%. VBG were 5.79 ± 1.71 mm (range: 3.2-8.8 mm) in the PTFE group and 5.18 ± 1.61 mm (range: 3.1-8.0 mm) in the Ti-mesh group (p = .233), whereas RBV were 1.46 ± 0.48 cc and 1.26 ± 0.55. RR was 99.5% and 87.0%, demonstrating a statistically significant difference (p = .013). Finally, the values related to pseudo-periosteum, bone density, and implant stability were similar in the two study groups. Osseointegration rates were 98.2% and 98.3%. CONCLUSIONS This study confirmed the non-inferiority of customized CAD/CAM titanium meshes with respect to reinforced PTFE meshes in terms of surgical and healing complications. Although PTFE meshes showed higher vertical bone gain and regeneration rates than Ti-meshes, no significant differences were found.
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Affiliation(s)
| | - Sofia Bettini
- Implant Center for Edentulism and Jawbone Atrophies, Maxillofacial Surgery and Odontostomatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | | | - Istvan Urban
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Debora Franceschi
- Department of Experimental and Clinic Medicine, University of Florence, Florence, Italy
| | - Antonino Fiorino
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples, Naples, Italy
| | - Giuseppe Corinaldesi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
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2
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Alazmi SO. A review on guided bone regeneration using titanium mesh. Bioinformation 2024; 20:562-565. [PMID: 39132237 PMCID: PMC11309112 DOI: 10.6026/973206300200562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/31/2024] [Accepted: 05/31/2024] [Indexed: 08/13/2024] Open
Abstract
The gold standard for bone regeneration in atrophic ridge patients is guided bone regeneration (GBR). This makes it possible to get enough bone volume for an appropriate implant-prosthetic rehabilitation. The barrier membranes must meet the primary GBR design requirements, which include adequate integration with the surrounding tissue, spaciousness and clinical manageability. Titanium mesh's superior mechanical qualities and biocompatibility have broadened the indications of GBR technology, enabling it to be used to restore alveolar ridges with more significant bone defects. GBR with titanium mesh is being used in many clinical settings and for a range of clinical procedures. Furthermore, several advancements in digitalization and material modification have resulted from the study of GBR using titanium mesh. Hence, we report a review on the various characteristics of titanium mesh and its current use in clinical settings for bone augmentation.
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Affiliation(s)
- Saad Obaid Alazmi
- Department of Periodontology and Implant Dentistry, College of Dentistry, Qassim University, Saudi Arabia
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3
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Cucchi A, Bettini S, Fiorino A, Maglio M, Marchiori G, Corinaldesi G, Sartori M. Histological and histomorphometric analysis of bone tissue using customized titanium meshes with or without resorbable membranes: A randomized clinical trial. Clin Oral Implants Res 2024; 35:114-130. [PMID: 37966057 DOI: 10.1111/clr.14202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 10/29/2023] [Accepted: 11/01/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVES To date, no clinical studies have investigated the effect of using resorbable collagen membrane in conjunction with customized titanium mesh to promote bone formation in guided bone regeneration. Therefore, a non-inferiority analysis (one-sided 95% CI approach) was designed to compare the augmented bone gained using meshes with and without collagen membranes, through histological and histomorphometric investigations. MATERIALS AND METHODS Thirty patients undergoing bone augmentation procedures at both maxillary and mandible sites were randomly treated with customized titanium meshes alone (M-, n = 15) or covered with resorbable membrane (M+, n = 15), in both cases filled with autogenous bone and xenograft. After 6 months of healing, bone tissue biopsies were taken from the augmented region. The bone tissue (B.Ar), grafting material (G.Ar), and non-mineralized tissue (NMT.Ar) areas were quantified through histomorphometric analysis, as were the osteoid area (O.Ar) and its width. RESULTS Collagen membrane did not appear to significantly influence the investigated parameters: B.Ar, G.Ar, NMT.Ar, and O.Ar were similar between Group M- (34.3%, 11.5%, 54.1%, 1.95 μm2 , respectively) and Group M+ (35.3%, 14.6%, 50.2%, and 1.75 μm2 , respectively). Considering the overall population, significantly higher rates of newly formed bone were obtained in mandibular sites, while non-mineralized and dense connective tissue rates were higher in the maxilla (p < .05). CONCLUSIONS The application of collagen membrane over titanium mesh did not lead to significant results. Bone formation appeared significantly different in the maxilla compared with the mandible. Additional studies are required to further investigate the issues observed.
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Affiliation(s)
| | - Sofia Bettini
- Implant Center for Edentulism and Jawbone Atrophies, Maxillofacial Surgery and Odontostomatology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Antonino Fiorino
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Melania Maglio
- Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gregorio Marchiori
- Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Corinaldesi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Maria Sartori
- Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Maxillary Reconstruction with Xenogeneic Bone Graft, Platelet-Rich Fibrin, and Titanium Mesh for Rehabilitation with Implants: A 5-year Follow-Up Study. Case Rep Dent 2022; 2022:3412190. [PMID: 36397751 PMCID: PMC9666031 DOI: 10.1155/2022/3412190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/20/2022] [Accepted: 10/31/2022] [Indexed: 11/10/2022] Open
Abstract
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.
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Paeng KW, Cha JK, Thoma DS, Jung RE, Jung UW, Benic GI. The effect of collagen membrane and of bone substitute on lateral bone augmentation with titanium mesh: An experimental in vivo study. Clin Oral Implants Res 2022; 33:413-423. [PMID: 35137448 DOI: 10.1111/clr.13901] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 12/20/2021] [Accepted: 02/02/2022] [Indexed: 11/03/2022]
Abstract
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.
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Affiliation(s)
- Kyeong-Won Paeng
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Jae-Kook Cha
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Daniel S Thoma
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Republic of Korea.,Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ui-Won Jung
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Goran I Benic
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.,Institute for Research and Education in Dental Medicine, Lugano, Switzerland
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Clinical performance of tooth root blocks for alveolar ridge reconstruction. Int J Oral Maxillofac Surg 2021; 51:680-689. [PMID: 34507879 DOI: 10.1016/j.ijom.2021.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/25/2021] [Accepted: 08/13/2021] [Indexed: 11/20/2022]
Abstract
This systematic literature review set out to investigate the clinical outcomes of autogenous tooth root blocks used for ridge augmentation: survival rates, block resorption, implant survival, post-surgical complications, and histology findings. This review followed PRISMA guidelines. An automated search was made in four databases, supplemented by a manual search for relevant articles published before December 2020. The quality of evidence provided was assessed with the Newcastle-Ottawa Quality Assessment Scale and the Joanna Briggs Institute Critical Appraisal tool. Seven articles fulfilled the inclusion criteria and underwent analysis. The articles included a total of 136 patients, who received 118 autogenous tooth root blocks and 26 autogenous bone blocks showing block survival rates of 99.15% and 100%, respectively. Tooth root blocks presented a mean bone gain that was similar to autologous bone blocks but showed less resorption. The implant survival rate was 98.32% for autogenous tooth root blocks. Reconstruction of alveolar crests by means of autogenous tooth root blocks appears to be a satisfactory option for single-tooth gaps and low grades of bone atrophy in terms of the survival of the bone block and the implants placed subsequently. More research providing long-term data is needed to confirm these findings.
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7
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Biomechanical Evaluation of Implant Osseointegration After Guided Bone Regeneration With Different Bone Grafts. J Craniofac Surg 2021; 32:1545-1548. [PMID: 32969936 DOI: 10.1097/scs.0000000000007102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The aim of this study was to compare the biomechanical osseointegration of titanium implants after guided bone regeneration (GBR) with a hydroxyapatite graft, deproteinized bovine bone graft, human-derived allograft, and calcium sulfate bone graft. Thirty-two female Sprague Dawley rats were divided into four groups, each containing eight (n = 8) rats: hydroxyapatide (HA), deproteinized bovine bone graft (DPBB), allograft (ALG), and calcium sulfate. Bone defects were created in the tibia of the rats, which were grafted with HA, DPBB, ALG, or CP bone grafts for the purpose of GBR. Ninety days after surgery, machine-surfaced titanium implants were inserted into the area where GBR had been undertaken. After 90 days of the surgical insertion of the implants, the rats were sacrificed, the implants with surrounding bone tissue were removed, and biomechanical osseointegration (N/cm) analysis was performed. No statistically significant differences were found among the groups in osseointegration (N/cm) three months after the GBR procedures (P > 0.05). According to the biomechanical results, none of the grafts used in this study was distinctly superior to any of the others.
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Abstract
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.
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9
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Retrospective Analysis of the Effect of Three-Dimensional Preformed Titanium Mesh on Peri-Implant Non-Contained Horizontal Defects in 100 Consecutive Cases. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11020872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This study aimed to clinically and radiographically evaluate the results of guided bone regeneration (GBR) using three-dimensional preformed titanium mesh (3-D-PFTM) for non-contained horizontal defects in 100 consecutive cases. This study involved 100 patients (129 implants) with peri-implant non-contained horizontal defects. The patients were divided into three groups: 3-D-PFTM alone (Group 1), 3-D-PFTM plus cross-linked collagen membrane (Group 2), and 3-D-PFTM plus non-cross-linked collagen membrane (Group 3). Each implant was evaluated radiographically using CBCT at baseline and 6 months postoperatively. At the platform level, the mean horizontal hard tissue gain of all the sites was 3.1 ± 1.3 mm at 6 months postoperatively. The mean rate of mesh exposure was 11.8% in Group 1, 4.2% in Group 2, and 5.0% in Group 3. The mean hard tissue gain rate was 71.0 ± 23.0% in group 1, 84.2 ± 21.5% in group 2, and 84.0 ± 22.9% in group 3. Groups 2 and 3 showed significantly higher hard tissue gain rates than group 1. However, there was no significant difference between the rates in groups 2 and 3. Within the limitations of this study, 3-D-PFTM should be considered as a valuable option for GBR for peri-implant non-contained horizontal defects. The use of an additional resorbable collagen membrane provides additional advantages.
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10
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Cohen DJ, Scott KM, Kulkarni AN, Wayne JS, Boyan BD, Schwartz Z. Acellular mineralized allogenic block bone graft does not remodel during the 10 weeks following concurrent implant placement in a rabbit femoral model. Clin Oral Implants Res 2019; 31:37-48. [PMID: 31545532 DOI: 10.1111/clr.13544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/22/2019] [Accepted: 09/08/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Due to bone loss, endosseous implants often require addition of a bone graft to support adequate primary fixation, bone regeneration, and osseointegration. The aim of this study was to compare effectiveness of autogenic and allogenic bone grafts when used during simultaneous insertion of the implant. MATERIALS AND METHODS 4-mm-diameter rabbit diaphyseal bone autografts or allografts (n = 16/group) with a 3.2-mm pre-drilled hole in the center were placed into a 4 mm defect in the proximal femur of 3.5 kg male New Zealand White rabbits. Machined 3.2 × 10 mm grit-blasted, acid-etched titanium-aluminum-vanadium (Ti6Al4V) implants were placed. Control implants were placed into progressively drilled 3.2-mm holes in the contralateral limbs. Post-insertion day 70, samples were analyzed by micro-CT and calcified histology, or by mechanical torque and push-out testing followed by decalcified histology. RESULTS Both grafts were integrated with the native bone. Micro-CT showed less bone volume (BV) and bone volume/total volume (BV/TV) in the allograft group, but histology showed no differences in BV or BV/TV between groups. Allograft lacked living cells, whereas autograft was cellularized. No difference was found in maximum removal torque between groups. Compressive loading at the graft-to-bone interface was significantly lower in allograft compared with autograft groups. CONCLUSIONS There was less bone in contact with the implant and significantly less maximum compressive load in the allograft group compared with autograft. The allograft remained acellular as demonstrated by empty lacunae. Taken together, block allograft implanted simultaneously with an implant produces a poorer quality bone compared with autograft.
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Affiliation(s)
- D Joshua Cohen
- College of Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Kayla M Scott
- College of Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Aniket N Kulkarni
- College of Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Jennifer S Wayne
- College of Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Barbara D Boyan
- College of Engineering, Virginia Commonwealth University, Richmond, VA, USA.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Zvi Schwartz
- College of Engineering, Virginia Commonwealth University, Richmond, VA, USA.,Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Di Stefano DA, Greco G, Gherlone E. A Preshaped Titanium Mesh for Guided Bone Regeneration with an Equine-Derived Bone Graft in a Posterior Mandibular Bone Defect: A Case Report. Dent J (Basel) 2019; 7:dj7030077. [PMID: 31374857 PMCID: PMC6784736 DOI: 10.3390/dj7030077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/16/2019] [Accepted: 07/22/2019] [Indexed: 01/05/2023] Open
Abstract
One of the most often used bone augmentation techniques is the guided bone regeneration procedure. The authors report the case of a 75-year-old man with an atrophic right posterior mandible who underwent bone augmentation through guided bone regeneration with a preshaped titanium mesh adapted on a stereolithographic model of the patient’s jaw. The graft volume was simulated with a light-curing resin. The actual site was grafted with a mixture of autogenous and equine-derived bone. Five months later, the mesh was retrieved, three cylindrical implants were positioned, and a bone biopsy was collected for histomorphometric analysis. A provisional prosthesis was delivered three and a half months later. Definitive rehabilitation was accomplished after one additional month. The graft allowed for effective bone formation (newly formed bone, residual biomaterial, and medullar spaces were, respectively, 39%, 10%, and 51% of the core volume). The patient has functioned successfully throughout six and a half years of follow-up. Using the preshaped titanium mesh in association with the enzyme-treated equine bone substitute provided effective bone regeneration.
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Affiliation(s)
- Danilo Alessio Di Stefano
- Dental School, Vita e Salute University and IRCCS San Raffaele, 20132 Milan, Italy.
- Private Practice, 20148 Milan, Italy.
| | | | - Enrico Gherlone
- Dental School, Vita e Salute University and IRCCS San Raffaele, 20132 Milan, Italy
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12
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Cucchi A, Sartori M, Parrilli A, Aldini NN, Vignudelli E, Corinaldesi G. Histological and histomorphometric analysis of bone tissue after guided bone regeneration with non‐resorbable membranes vs resorbable membranes and titanium mesh. Clin Implant Dent Relat Res 2019; 21:693-701. [DOI: 10.1111/cid.12814] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/16/2019] [Accepted: 06/16/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Alessandro Cucchi
- Unit of Oral and Maxillofacial Surgery, Department of Biomedical and Neuromotor Science (DIBINEM)Alma Mater Studiorum—University of Bologna Bologna Italy
| | - Maria Sartori
- Laboratorio di studi preclinici e chirurgici, Dipartimento RITIRCCS Istituto Ortopedico Rizzoli Bologna Italy
| | - Annapaola Parrilli
- Laboratorio di studi preclinici e chirurgici, Dipartimento RITIRCCS Istituto Ortopedico Rizzoli Bologna Italy
| | - Nicolò N. Aldini
- Laboratorio di studi preclinici e chirurgici, Dipartimento RITIRCCS Istituto Ortopedico Rizzoli Bologna Italy
| | - Elisabetta Vignudelli
- Unit of Oral and Maxillofacial Surgery, Department of Biomedical and Neuromotor Science (DIBINEM)Alma Mater Studiorum—University of Bologna Bologna Italy
| | - Giuseppe Corinaldesi
- Unit of Oral and Maxillofacial Surgery, Department of Biomedical and Neuromotor Science (DIBINEM)Alma Mater Studiorum—University of Bologna Bologna Italy
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13
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The Use of Titanium Mesh in Guided Bone Regeneration: A Systematic Review. Int J Dent 2019; 2019:9065423. [PMID: 30881455 PMCID: PMC6383423 DOI: 10.1155/2019/9065423] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 01/02/2019] [Indexed: 11/25/2022] Open
Abstract
Several techniques have been proposed for bone regeneration in patients with atrophic ridges. Nowadays, GBR represents the gold standard, and it allows obtaining sufficient bone volumes for a correct implant-prosthetic rehabilitation. Our goal is to perform a systematic review of the literature on the use of titanium meshes in GBR in order to evaluate the reliability of the procedure, the regeneration obtained, and the failures. Furthermore, we will evaluate the success and survival rate of the inserted implants. The selected articles concern vertical and/or horizontal regeneration of the alveolar ridge using titanium grids, in association or not with biomaterials, before and simultaneously with implant placement. Six articles were selected for the present review, including a total of 139 patients, 156 sites, and 303 implants. Titanium grids in combination with autogenous bone were used in 2 cases, 5 in combination with a mixture of autogenous bone and bone substitutes. The overall survival and success rates of implants were 98.3% and 85.25%, respectively. In conclusion, our review shows how the use of titanium mesh represented a predictable method for the rehabilitation of complex atrophic sites.
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14
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Klein Y, Fleissig O, Stabholz A, Chaushu S, Polak D. Bone regeneration with bovine bone impairs orthodontic tooth movement despite proper osseous wound healing in a novel mouse model. J Periodontol 2018; 90:189-199. [PMID: 30059146 DOI: 10.1002/jper.17-0550] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 02/20/2018] [Accepted: 02/28/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND The aim of this study was to investigate the biological mechanisms underlying alveolar bone regeneration (ABR) and orthodontic tooth movement into bovine bone (BB) regenerated sites. METHODS Two mouse models were established in C57BL/6 mice. The ABR model was based on osseous defects filled with BB. The orthodontic tooth movement-ABR model was used to move a molar into the regenerated site. Osseous morphometric analysis and tooth movement distance were evaluated with micro-CT. Histologic characteristics and osteoclast (OCS) accumulation were evaluated by hematoxylin and eosin and tartrate-resistant acid phosphatase staining (TRAP). Expression and location of the receptor activator of nuclear factor-kappa B (RANKL) and of osteoprotegerin (OPG) were evaluated by immunofluorescent staining. RESULTS Bone healing peaked at 4 weeks. The distance of the orthodontic tooth movement into the bovine bone was significantly reduced versus that of the nonbovine bone controls. BB particles accumulated along the root's pressure side during orthodontic treatment. Despite the osteoclasts' presence adjacent to the BB particles, no BB resorption was observed. Increased RANKL expression was seen at the orthodontic tooth movement pressure zone, without any change in OPG expression. CONCLUSION The two novel mouse models show that the lack of resorption of BB xenografts renders them inadequate for proper orthodontic tooth movement at a later stage.
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Affiliation(s)
- Yehuda Klein
- Department of Orthodontics, Hebrew University-Hadassah Faculty of Dental Medicine, Israel.,Department of Periodontology, Hebrew University-Hadassah Faculty of Dental Medicine, Israel
| | - Omer Fleissig
- Department of Orthodontics, Hebrew University-Hadassah Faculty of Dental Medicine, Israel
| | - Ayala Stabholz
- Department of Periodontology, Hebrew University-Hadassah Faculty of Dental Medicine, Israel
| | - Stella Chaushu
- Department of Orthodontics, Hebrew University-Hadassah Faculty of Dental Medicine, Israel
| | - David Polak
- Department of Orthodontics, Hebrew University-Hadassah Faculty of Dental Medicine, Israel
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Pervasion of beta-tricalcium phosphate with nanodiamond particles yields efficient and safe bone replacement material amenable for biofunctionalization and application in large-size osseous defect healing. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2018; 16:250-257. [PMID: 30267872 DOI: 10.1016/j.nano.2018.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 08/10/2018] [Indexed: 11/21/2022]
Abstract
Biofunctionalization of scaffold materials can enable the healing of large bone defects. In case of minimally invasive guided-bone regeneration (GBR), limitations are however hard-to-control side effects related to the potential release of biofactors into the systemic environment. Biofactors can be stably bound to nanodiamond particles (ND) through physisorption. We therefore tested the biological and clinical effects of refining beta-tricalcium phosphate (βTCP) with ND in vitro and in vivo. In vitro, βTCP carrying 4% ND resulted in enhanced attachment of mesenchymal stem cells. When assessing GBR after lateral augmentation of the mandible in sheep showed that ND in βTCP resulted in a consistently steady bone formation when compared to pure βTCP, demonstrating the biological inert behavior and the potential clinical safety of ND.
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Newly Formed Bone Induced by Recombinant Human Bone Morphogenetic Protein-2: A Histological Observation. IMPLANT DENT 2018; 26:173-177. [PMID: 28207598 DOI: 10.1097/id.0000000000000564] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To observe, histologically, bone induced by recombinant human bone morphogenetic protein-2 (rhBMP-2) in onlay grafted and sinus lifted alveolaris. MATERIAL AND METHODS Eighteen patients were treated with rhBMP-2 at concentration 1.5 mg/mL with an absorbable collagen sponge (ACS). The treated bone was harvested with small trephine bur at 5 or 7 months after surgery for the micro Computer Scanning (CT) and light microscopic observation. RESULTS Micro CT showed clearly 3-dimensional trabecular bone structure. New bone formation and bone marrow structure were observed in the observed area. Osteoblastic cells existed along the new bone, and osteopontin was localized in the bone matrix weakly. In the connective tissue around the new bone, many CD34-positive blood vessel cells were present. Some tartrate-resistant acid phosphatase (TRAP)-positive osteoclastic cells were observed around bone at this stage. CONCLUSION The application of rhBMP-2 with ACS induced a new bone accompanied by blood vessels in atrophied alveolaris. This suggests that rhBMP-2 is capable of osteoinductivity in human jaw.
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Chavda S, Levin L. Human Studies of Vertical and Horizontal Alveolar Ridge Augmentation Comparing Different Types of Bone Graft Materials: A Systematic Review. J ORAL IMPLANTOL 2018; 44:74-84. [DOI: 10.1563/aaid-joi-d-17-00053] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Alveolar ridge augmentation can be completed with various types of bone augmentation materials (autogenous, allograft, xenograft, and alloplast). Currently, autogenous bone is labeled as the “gold standard” because of faster healing times and integration between native and foreign bone. No systematic review has currently determined whether there is a difference in implant success between various bone augmentation materials. The purpose of this article was to systematically review comparative human studies of vertical and horizontal alveolar ridge augmentation comparing different types of bone graft materials (autogenous, allograft, xenograft, and alloplast). A MEDLINE search was conducted under the 3 search concepts of bone augmentation, dental implants, and alveolar ridge augmentation. Studies pertaining to socket grafts or sinus lifts were excluded. Case reports, small case series, and review papers were excluded. A bias assessment tool was applied to the final articles. Overall, 219 articles resulted from the initial search, and 9 articles were included for final analysis. There were no discernible differences in implant success between bone augmentation materials. Generally, patients preferred nonautogenous bone sources as there were fewer hospital days, less pain, and better recovery time. Two articles had industrial support; however, conclusions of whether that support influenced the outcomes could not be determined. Future comparative studies should compare nonautogenous bone sources and have longer follow-up times.
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Affiliation(s)
- Suraj Chavda
- Faculty of Medicine and Dentistry, University of Alberta, Canada
| | - Liran Levin
- Division of Periodontology, Faculty of Medicine and Dentistry, University of Alberta, Canada
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Gual-Vaqués P, Polis-Yanes C, Estrugo-Devesa A, Ayuso-Montero R, Mari-Roig A, López-López J. Autogenous teeth used for bone grafting: A systematic review. Med Oral Patol Oral Cir Bucal 2018; 23:e112-e119. [PMID: 29274156 PMCID: PMC5822533 DOI: 10.4317/medoral.22197] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 11/03/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Recently, bone graft materials using permanent teeth have come to light, and clinical and histological outcomes of this material have been confirmed by some studies. The aim of this systematic review was to evaluate the reliability of the autogenous tooth bone graft material applied to alveolar ridge augmentation procedures. MATERIAL AND METHODS A systematic review of literature was conducted analyzing articles published between 2007 and 2017. The following four outcome variables were defined: a) implant stability b) post-operative complication c) evaluation of implant survival and failure rates, and d) histological analysis. A total of 108 articles were identified; 6 were selected for review. Based on the PICO (problem, intervention, comparison, outcome) model, the chief question of this study was: Can patients with alveolar ridge deficiency be successfully treated with the autogenous teeth used as bone graft? RESULTS The mean primary stability of the placed implants was 67.3 ISQ and the mean secondary stability was 75.5 ISQ. The dehiscence of the wound was the most frequent complication with a rate of 29.1%. Of the 182 analyzed implants, the survival rate was 97.7% and the failure rate was 2.3%. In the histological analysis, most of studies reported bone formation. CONCLUSIONS There is insufficient evidence regarding the effects of autogenous teeth used for bone grafting to support any definitive conclusions, although it has been shown clinically safe and good bone forming capacity, and good results are shown about implant stability.
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Affiliation(s)
- P Gual-Vaqués
- University Campus of Bellvitge, Pabellon de Gobierno, 2nd floor, office 2:29, Feixa Llarga s/n, 08907 L´Hospitalet de Llobregat, Barcelona, Espana,
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The Mechanical Properties and Biometrical Effect of 3D Preformed Titanium Membrane for Guided Bone Regeneration on Alveolar Bone Defect. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7102123. [PMID: 29018818 PMCID: PMC5605874 DOI: 10.1155/2017/7102123] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/05/2017] [Indexed: 12/11/2022]
Abstract
The purpose of this study is to evaluate the effect of three-dimensional preformed titanium membrane (3D-PFTM) to enhance mechanical properties and ability of bone regeneration on the peri-implant bone defect. 3D-PFTMs by new mechanically compressive molding technology and manually shaped- (MS-) PFTMs by hand manipulation were applied in artificial peri-implant bone defect model for static compressive load test and cyclic fatigue load test. In 12 implants installed in the mandibular of three beagle dogs, six 3D-PFTMs, and six collagen membranes (CM) randomly were applied to 2.5 mm peri-implant buccal bone defect with particulate bone graft materials for guided bone regeneration (GBR). The 3D-PFTM group showed about 7.4 times higher mechanical stiffness and 5 times higher fatigue resistance than the MS-PFTM group. The levels of the new bone area (NBA, %), the bone-to-implant contact (BIC, %), distance from the new bone to the old bone (NB-OB, %), and distance from the osseointegration to the old bone (OI-OB, %) were significantly higher in the 3D-PFTM group than the CM group (p < .001). It was verified that the 3D-PFTM increased mechanical properties which were effective in supporting the space maintenance ability and stabilizing the particulate bone grafts, which led to highly efficient bone regeneration.
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Bahaa-Eldin K, Mostafa B, Nasry S, Reda A, Shoeib M. Maxillary Sinus Augmentation Using a Titanium Mesh: A Randomized Clinical Trial. Open Access Maced J Med Sci 2017; 5:359-369. [PMID: 28698758 PMCID: PMC5503738 DOI: 10.3889/oamjms.2017.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 04/08/2017] [Accepted: 04/09/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Various attempts have been implemented using different materials and techniques to augment the maxillary sinus floor for prospect dental implant positioning. AIM This contemplate was conducted to assess the osteogenic capability of the maxillary sinus in a two-step sinus membrane elevation using titanium mesh to keep the formed space to place dental implants in atrophic ridges. MATERIALS AND METHODS Titanium micromesh was customized and positioned into the sinus on one side to preserve the elevated membrane in position. On the other side xenograft was applied. Instant and 6-months postoperative cone beam computed tomography (CBCT) was done to assess the gained bone height and density. Bone core biopsies were obtained during implant placement for histological and histomorphometric evaluation. RESULTS The average bone height values increased in both groups. Meanwhile the average bone density value was higher at the graft group than the titanium mesh group. Histological and histomorphometric evaluation presented the average bone volume of the newly formed bone in the graft group which is superior to that of the titanium mesh group. CONCLUSION The use of the titanium micromesh as a space-maintaining device after Schneiderian membrane elevation is a trustworthy technique to elevate the floor of the sinus without grafting.
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Affiliation(s)
- Khalid Bahaa-Eldin
- Surgery and Oral Medicine Department, Oral and Dental Research Division, National Research Centre, Cairo, Egypt
| | - Basma Mostafa
- Surgery and Oral Medicine Department, Oral and Dental Research Division, National Research Centre, Cairo, Egypt
| | - Sherine Nasry
- Surgery and Oral Medicine Department, Oral and Dental Research Division, National Research Centre, Cairo, Egypt
| | - Ahmed Reda
- Oral Medicine, Periodontology and Diagnosis Department, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt
| | - Mona Shoeib
- Oral Medicine, Periodontology and Diagnosis Department, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt
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Lim HC, Kim MS, Yang C, Lee JS, Hong JY, Choi SH, Jung UW. The Effectiveness of a Customized Titanium Mesh for Ridge Preservation with Immediate Implantation in Dogs. Clin Implant Dent Relat Res 2015; 17 Suppl 2:e652-60. [DOI: 10.1111/cid.12302] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Hyun-Chang Lim
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry; Yonsei University; Seoul South Korea
| | - Min-Soo Kim
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry; Yonsei University; Seoul South Korea
| | - Cheryl Yang
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry; Yonsei University; Seoul South Korea
| | - Jung-Seok Lee
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry; Yonsei University; Seoul South Korea
| | - Ji-Youn Hong
- Department of Periodontology, School of Dentistry; Kyung Hee University; Seoul South Korea
| | - Seong-Ho Choi
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry; Yonsei University; Seoul South Korea
| | - Ui-Won Jung
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry; Yonsei University; Seoul South Korea
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Di Stefano DA, Greco GB, Cinci L, Pieri L. Horizontal-guided Bone Regeneration using a Titanium Mesh and an Equine Bone Graft. J Contemp Dent Pract 2015; 16:154-62. [PMID: 25906808 DOI: 10.5005/jp-journals-10024-1653] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
AIM The present work describes a horizontal ridge augmentation in which a titanium mesh was preshaped by adapting it to a stereolithographic model of the patient's jaw that was fabricated from CT scans. BACKGROUND Guided bone regeneration (GBR) involves covering the augmentation site with a long-lasting barrier to protect it from the invasion of surrounding soft tissues. Among barriers, titanium meshes may provide a successful outcome, but the intraoperatory time needed to shape them is a disadvantage. CASE DESCRIPTION The 54-year-old patient, missing the right mandibular second bicuspid, first molar, and second molar, had her atrophic ridge augmented with a 30:70 mixture of autogenous bone and equine, enzyme-deantigenic collagen-preserved bone substitute. Two conical implants were inserted concomitantly in the second bicuspid and first molar positions, and the site was protected with the preshaped mesh. Four months later, the titanium mesh was retrieved, a bone sample was collected, and histological and histomorphometric analyses were performed. Provisional and definitive prostheses were then delivered, and follow-up controls were performed for up to 24 months. CONCLUSION Preshaping the mesh on a model of the patient's mandible shortened the surgical time and enabled faster mesh placement. Two years after surgery, the implants were perfectly functional, and the bone width was stable over time as shown by radiographic controls. Histological analysis of the bone sample showed the heterologous biomaterial to be biocompatible and undergoing advanced remodeling and replacement with newly formed bone. CLINICAL SIGNIFICANCE Preshaping a titanium mesh over a stereolithographic model of the patient's jaw allowed for a significant reduction of the intraoperative time and may be therefore, advisable in routine practice.
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Affiliation(s)
- Danilo Alessio Di Stefano
- Professor, Department of Dentistry, Vita e Salute San Raffaele University, Milan, Italy, Phone: 390248705703, e-mail:
| | | | - Lorenzo Cinci
- Department of Neuroscience, Psychology, Drug Research and Child Health (Neurofarba), Pharmacology and Toxicology Section, University of Florence, Florence, Italy
| | - Laura Pieri
- Department of Health Sciences, Interdepartmental Forensic Medicine Section, University of Florence, Florence, Italy
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Deshpande S, Deshmukh J, Deshpande S, Khatri R, Deshpande S. Vertical and horizontal ridge augmentation in anterior maxilla using autograft, xenograft and titanium mesh with simultaneous placement of endosseous implants. J Indian Soc Periodontol 2014; 18:661-5. [PMID: 25425833 PMCID: PMC4239761 DOI: 10.4103/0972-124x.142469] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 02/24/2014] [Indexed: 11/13/2022] Open
Abstract
Endosseous implants have revolutionized the field of Implants and Periodontics. Implant placement is a viable option in the treatment of partial and full edentulism. However, placement of implants in alveolar deficiencies may lead to adverse angulations, mechanical overload and esthetic dissatisfaction. When minimum dimensions for implant placement are not present in alveolar process, it is necessary to augment the size of the ridge. This can be achieved by various methods and materials. Here we present a successful case of vertical and horizontal ridge augmentation in anterior maxilla using autograft, xenograft and titanium mesh with simultaneous placement of implants, where autograft was obtained from the same site avoiding secondary surgical site.
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Affiliation(s)
- Sudhendra Deshpande
- Department of Conservative and Endodontics, Maharaja Ganga Singh Dental College, Ganganagar, Rajasthan, India
| | - Jeevanand Deshmukh
- Department of Periodontology, Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| | - Sumeet Deshpande
- Department of Prosthodontics, Pandit Deen Dayal Upadhyay Dental College Sholapur, Maharashtra, India
| | - Richa Khatri
- Department of Periodontology, Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| | - Shubha Deshpande
- Department of Prosthodontics, Maharaja Ganga Singh Dental College, Ganganagar, Rajasthan, India
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Jung GU, Jeon JY, Hwang KG, Park CJ. Preliminary evaluation of a three-dimensional, customized, and preformed titanium mesh in peri-implant alveolar bone regeneration. J Korean Assoc Oral Maxillofac Surg 2014; 40:181-7. [PMID: 25247148 PMCID: PMC4170664 DOI: 10.5125/jkaoms.2014.40.4.181] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/13/2014] [Accepted: 07/17/2014] [Indexed: 11/16/2022] Open
Abstract
Objectives The purpose of this preliminary study is to evaluate the effectiveness of a customized, three-dimensional, preformed titanium mesh as a barrier membrane for peri-implant alveolar bone regeneration. Materials and Methods Ten patients were recruited for this study. At the time of implant placement, all patients had fenestration or a dehiscence defect around the implant fixture. A mixture of particulate intraoral autologous bone and freeze-dried bone allograft was applied to the defect in a 1 : 1 volume ratio and covered by the preformed titanium mesh. A core biopsy specimen was taken from the regenerated bone four months postoperatively. Patients were followed for 12 months after the definitive prosthesis was placed. Results Satisfactory bone regeneration with limited fibrous tissue was detected beneath the preformed titanium mesh. Histologic findings revealed that newly formed bones were well-incorporated into the allografts and connective tissue. New growth was composed of approximately 80% vital bone, 5% fibrous marrow tissue, and 15% remaining allograft. All implants were functional without any significant complications. Conclusion The use of preformed titanium mesh may support bone regeneration by maintaining space for new bone growth through its macro-pores. This preliminary study presents the efficacy of a preformed titanium mesh as a ready-to-use barrier membrane around peri-implant alveolar bone defect. This preformed mesh is also convenient to apply and to remove.
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Affiliation(s)
- Gyu-Un Jung
- Department of Periodontology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Jae-Yun Jeon
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Hanyang University College of Medicine, Seoul, Korea
| | - Kyung-Gyun Hwang
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Hanyang University College of Medicine, Seoul, Korea
| | - Chang-Joo Park
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Hanyang University College of Medicine, Seoul, Korea
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Eskan MA, Greenwell H, Hill M, Morton D, Vidal R, Shumway B, Girouard ME. Platelet-rich plasma-assisted guided bone regeneration for ridge augmentation: a randomized, controlled clinical trial. J Periodontol 2013; 85:661-8. [PMID: 23895252 DOI: 10.1902/jop.2013.130260] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Platelet-rich plasma (PRP) contains a number of biologically active growth factors, and previous studies have reported conflicting ridge augmentation results. The primary aim of this randomized, controlled, masked, clinical trial was to determine if PRP combined with a rapidly resorbing cancellous allograft would enhance the regenerative result compared with an allograft without PRP. METHODS Thirty-two patients with an edentulous ridge defect were sequentially entered into the study; four were excluded from data analysis. Fourteen patients received a cancellous allograft (CAN group) and the other 14 received a cancellous allograft mixed with PRP (PRP group). All 28 grafted sites were covered with a resorbable polylactide membrane. After elevation of a full-thickness flap, horizontal ridge dimensions were measured with a digital caliper at the crest and 5 mm apical to the crest. Vertical ridge dimensions were measured from a tooth-supported stent. All sites were reentered at 4 months, and a trephine core was obtained for histologic analysis before implant placement. RESULTS The crestal ridge width for the CAN group had a mean gain of 2.0 ± 1.2 mm, whereas the PRP group gained 2.9 ± 1.0, and the difference was statistically significant between groups (P <0.05). The percent vital bone was 36% ± 14% for the CAN group compared with 51% ± 15% for the PRP group and was statistically significant between groups (P <0.05). Loss of augmented ridge width was 34% ± 17% for the CAN group and 28% ± 17% for the PRP group (P >0.05). CONCLUSION These clinical and histologic findings suggest that PRP enhanced bone regeneration and resulted in increased horizontal bone gain and percentage vital bone.
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Full-arch vertical reconstruction of an extremely atrophic mandible with "box technique". A novel surgical procedure: a clinical and histologic case report. IMPLANT DENT 2013; 22:2-7. [PMID: 23287979 DOI: 10.1097/id.0b013e318278fa1c] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe a new augmentation procedure named "box technique" for bone reconstruction in a severely atrophic jaw with mandibular and mental nerve dehiscence. MATERIAL AND METHODS The first surgical box technique procedure was performed to augment the atrophic posterior area. Simultaneously, 2 implants were inserted into the interforaminal zone to stabilize the denture. After 6 months, 2 implants were positioned in the regenerated bone, and a second box technique procedure was performed to reconstruct the ridge in the area of fixture exposition. Six months after the second surgery, the patient was rehabilitated with a removable prosthesis retained on 4 implants. RESULTS The clinical and histologic analyses highlighted outstanding healing resulting from this vertical and horizontal allografting and included complete resorption of poly D,L-lactide meshes and substitution of the mineralized human bone allograft with an excellent quality new bone formation. CONCLUSIONS Results confirm the effectiveness of the technique, which needs a further case series study endorsing its reliability.
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Ricci L, Perrotti V, Ravera L, Scarano A, Piattelli A, Iezzi G. Rehabilitation of deficient alveolar ridges using titanium grids before and simultaneously with implant placement: a systematic review. J Periodontol 2012. [PMID: 23205918 DOI: 10.1902/jop.2012.120314] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of the present study is to perform a systematic review of the literature on the use of titanium grids for implant surgery before and simultaneously with implant placement and to assess the success rate of the procedure, as well as survival and success rates of implants placed in the regenerated areas. METHODS Medline was used to identify studies in English published from 1996 to 2011. An additional hand search was performed of the relevant journals and of the bibliographies of the papers identified. Articles retrieved by two independent authors were screened using specific inclusion criteria: randomized controlled trials (RCTs), controlled clinical trials, and prospective clinical studies regarding vertical and/or horizontal regeneration of the alveolar ridge using titanium grids, in association or not with biomaterials, before and simultaneously with implant placement. RESULTS Six articles were selected, including a total of 79 patients, 87 titanium grids, and 141 implants. Twenty-four implants were placed simultaneously with titanium grids, and 117 implants were inserted after a period of 4 to 9 months. Titanium grids in combination with autogenous bone were used in 43 cases, 25 in combination with a mixture of autogenous bone and bone substitutes, 14 in association with bone substitutes, five using only titanium grids. The overall success rate of the regenerative procedures was 98.86%; the overall survival and success rates of implants were 100% and 93.2%, respectively. CONCLUSIONS The main limit of the present systematic review is the scarcity of papers with an adequate and consistent methodology regarding the data collection and analysis and the lack of RCTs and large well-designed long-term trials. Survival and success rates of implants placed in the areas treated with titanium grids were comparable to those of implants placed in native, non-regenerated bone and of implants placed in bone regenerated with resorbable and non-resorbable membranes.
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Affiliation(s)
- Laura Ricci
- Department of Medical, Oral, and Biotechnological Sciences, Dental School, University of Chieti-Pescara, Chieti, Italy
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Reconstruction of Alveolar Defects Using Titanium-Reinforced Porous Polyethylene as a Containment Device for Recombinant Human Bone Morphogenetic Protein 2. J Oral Maxillofac Surg 2012; 70:811-20. [DOI: 10.1016/j.joms.2011.09.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 09/13/2011] [Accepted: 09/15/2011] [Indexed: 11/23/2022]
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Her S, Kang T, Fien MJ. Titanium Mesh as an Alternative to a Membrane for Ridge Augmentation. J Oral Maxillofac Surg 2012; 70:803-10. [DOI: 10.1016/j.joms.2011.11.017] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 11/15/2011] [Accepted: 11/16/2011] [Indexed: 11/29/2022]
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Schuckert KH, Jopp S, Osadnik M. The use of platelet rich plasma, bone morphogenetic protein-2 and different scaffolds in oral and maxillofacial surgery - literature review in comparison with own clinical experience. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2011; 2:e2. [PMID: 24421984 PMCID: PMC3886066 DOI: 10.5037/jomr.2011.2102] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 01/18/2011] [Indexed: 12/16/2022]
Abstract
Objectives The purpose of this article was to review and critically assess the use of
platelet rich plasma, recombinant human bone morphogenetic protein-2 and
different scaffolds (i.e. tricalciumphosphate, polycaprolactone,
demineralized bone matrix and anorganic bovine bone mineral) in oral and
maxillofacial surgery comparing the relevant literature and own clinical
experience. Material and Methods A literature review was conducted using MEDLINE, MEDPILOT and COCHRANE
DATABASE OF SYSTEMATIC REVIEWS. It concentrated on manuscripts and overviews
published in the last five years (2006-2010). The key terms employed were
platelet rich plasma, bone morphogenetic proteins and their combinations
with the above mentioned scaffolds. The results of clinical studies and
animal trials were especially emphasized. The statements from the literature
were compared with authors’ own clinical data. Results New publications and overviews demonstrate the advantages of platelet rich
plasma in bone regeneration. The results from the literature review were
discussed and compared with the publications detailing authors' own
experiences. Conclusions A favourable outcome concerning newly grown bone was achieved combining
platelet rich plasma in addition to optimal matrices with or without
recombinant human bone morphogenetic protein-2, depending on the clinical
case. As a consequence, the paradigm shift from transplantation of
autogenous bone to bone tissue engineering appears promising.
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Affiliation(s)
- Karl-Heinz Schuckert
- Institute Indente - Institute of Innovative Oral Surgery and Medicine, Centre for Tissue Engineering Hannover Germany
| | - Stefan Jopp
- Institute Indente - Institute of Innovative Oral Surgery and Medicine, Centre for Tissue Engineering Hannover Germany
| | - Magdalena Osadnik
- Institute Indente - Institute of Innovative Oral Surgery and Medicine, Centre for Tissue Engineering Hannover Germany
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Miyamoto I, Funaki K, Yamauchi K, Kodama T, Takahashi T. Alveolar Ridge Reconstruction with Titanium Mesh and Autogenous Particulate Bone Graft: Computed Tomography-Based Evaluations of Augmented Bone Quality and Quantity. Clin Implant Dent Relat Res 2011; 14:304-11. [DOI: 10.1111/j.1708-8208.2009.00257.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Torres J, Tamimi F, Alkhraisat MH, Manchón A, Linares R, Prados-Frutos JC, Hernández G, López Cabarcos E. Platelet-rich plasma may prevent titanium-mesh exposure in alveolar ridge augmentation with anorganic bovine bone. J Clin Periodontol 2011; 37:943-51. [PMID: 20796106 DOI: 10.1111/j.1600-051x.2010.01615.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Bone augmentation with the titanium-mesh (Ti-mesh) technique is susceptible to a large rate of complications such as morbidity of bone graft donor site, and mesh exposure to the oral cavity. The purpose of this study was to evaluate the effectiveness of anorganic bovine bone (ABB) in alveolar bone augmentation with the Ti-mesh technique. In addition, we investigated the effect of platelet-rich plasma (PRP) in preventing mesh exposure by using it to cover the Ti-mesh. PATIENTS AND METHODS Patients included in the clinical trial were randomly allocated by a blinded assistant into two groups. The 30 patients recruited for this study underwent 43 alveolar bone augmentation with the Ti-mesh technique using ABB as graft material in all of them. In 15 patients, the Ti-meshes were covered with PRP (PRP group) whereas in the other 15 the Ti-meshes were not (control group). After 6 months, patients were called for clinical, radiographic, and histological evaluation, and implant placement surgery. A total of 97 implants were placed in the augmented bone and their evolution was followed up for a period of 24 months. RESULTS Significant differences were found between the two study groups in terms of complications and bone formation. In the control group, 28.5% of the cases suffered from mesh exposure, while in the PRP group, no exposures were registered. Radiographic analysis revealed that bone augmentation was higher in the PRP group than in the control group. Overall, 97.3% of implants placed in the control group and 100% of those placed in the PRP group were successful during the monitoring period. We suggest that the positive effect of PRP on the Ti-mesh technique is due to its capacity to improve soft tissue healing, thereby protecting the mesh and graft material secured beneath the gingival tissues. CONCLUSIONS Alveolar bone augmentation using ABB alone in the Ti-mesh technique is sufficient for implant rehabilitation. Besides, covering the Ti-meshes with PRP was a determining factor in avoiding mesh exposure. Ti-mesh exposure provoked significant bone loss, but in most cases it did not affect the subsequent placement of implants.
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Affiliation(s)
- Jesús Torres
- Ciencias de la Salud III, Universidad Rey Juan Carlos, Alcorcón, Spain
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Schuckert KH, Jopp S, Osadnik M. Modern bone regeneration instead of bone transplantation: a combination of recombinant human bone morphogenetic protein-2 and platelet-rich plasma for the vertical augmentation of the maxillary bone-a single case report. Tissue Eng Part C Methods 2010; 16:1335-46. [PMID: 20302447 DOI: 10.1089/ten.tec.2010.0020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This publication describes the clinical case of a 75-year-old woman. She suffered from total alveolar ridge atrophy due to 20 years of wearing dentures. Bone transplantation, including harvesting of the iliac crest, was rejected by another clinic due to various existing diseases and risk of blood loss on donor side. Moreover, the minimal residual alveolar ridge did not allow bone fixation using screws nor did it allow osteodistraction. Before deciding which bone tissue engineering techniques should best be employed in this surgical treatment, cardiological and internistic consultations and treatments were carried out. In addition, anesthetic preparations were made. The surgical treatment was performed implementing special bridge flap techniques to preserve the periosteum. Tricalcium phosphate blocks soaked with recombinant human bone morphogenetic protein-2 and platelet-rich plasma were implanted on the narrow alveolar ridge. They were attached by tightening the soft tissue, including the periosteum. Four months later, after complication-free wound healing and bone regeneration, six dental implants were inserted into the new alveolar ridge. The histology of all bone samples showed vital lamellar bone. Three months after implantation, a new dental structure was fixed on the implants. The patient's quality of life improved significantly with this new situation.
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Affiliation(s)
- Karl-Heinz Schuckert
- Institute Indente-Institute of Innovative Oral Surgery and Medicine, Centre for Tissue Engineering, Hannover, Germany.
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Barone A, Varanini P, Orlando B, Tonelli P, Covani U. Deep-Frozen Allogeneic Onlay Bone Grafts for Reconstruction of Atrophic Maxillary Alveolar Ridges: A Preliminary Study. J Oral Maxillofac Surg 2009; 67:1300-6. [DOI: 10.1016/j.joms.2008.12.043] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Revised: 11/12/2008] [Accepted: 12/19/2008] [Indexed: 11/27/2022]
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Pieri F, Corinaldesi G, Fini M, Aldini NN, Giardino R, Marchetti C. Alveolar Ridge Augmentation With Titanium Mesh and a Combination of Autogenous Bone and Anorganic Bovine Bone: A 2-Year Prospective Study. J Periodontol 2008; 79:2093-103. [DOI: 10.1902/jop.2008.080061] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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