Horizontal-guided Bone Regeneration using a Titanium Mesh and an Equine Bone Graft

Tent-pole technique for alveolar ridge width preservation with a compromised buccal plate: a prospective cohort study

Objectives

The aim of this study was to assess the effectiveness of the tent-pole technique for alveolar ridge preservation of compromised alveolar socket following the surgical extraction of incurable single root premolars.

Materials and methods

This study was conducted on 12 patients who presented to the department of oral and maxillofacial surgery and had alveolar ridge preservation using tent-pole technique between August 2021 and February 2022. The alveolar ridge width was analyzed using cone beam computed tomography scans taken preoperative and 6 months postoperative. Statistical analysis was performed to assess the alveolar ridge width at different levels. The alveolar ridge width differences between periods were assessed with paired t-test. The comparison of alveolar ridge width loss according to jaw, sex, and different levels were done with unpaired t-test. The level of significance considered was 5% (α=0.05).

Results

The mean alveolar ridge width before surgery was 10.03 mm. After 6 months, the mean alveolar ridge width was 8.4 mm. The range of alveolar ridge width loss was between 0.6 and 3.22 mm with a mean of 1.63 (16.25%). There was no statistically significant difference in width loss between the maxilla and mandibular whether in males or females. Alveolar bone width loss was the greatest at W1 level (26.8%).

Conclusion

According to the results of this study, the authors conclude that the tent-pole technique could preserve the alveolar bone ridge width without bone graft materials.

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.

Mechanical Properties and Corrosion Resistance of TiAl6V4 Alloy Produced with SLM Technique and Used for Customized Mesh in Bone Augmentations

Bone augmentation procedures represent a real clinical challenge. One option is the use of titanium meshes. Additive manufacturing techniques can provide custom-made devices in titanium alloy. The purpose of this study was to investigate the material used, which can influence the outcomes of the bone augmentation procedure. Specific test samples were obtained from two different manufacturers with two different shapes: surfaces without perforations and with calibrated perforations. Three-point bending tests were run as well as internal friction tests to verify the Young’s modulus. Test samples were placed in two different buffered solutions and analyzed with optical microscopy. A further SEM analysis was done to observe any microstructural modification. Three-point flexural tests were conducted on 12 specimens. Initial bending was observed at lower applied stresses for the perforated samples (503 MPa) compared to non-perforated ones (900 MPa); the ultimate flexural strength was registered at 513 MPa and 1145 MPa for perforated and non-perforated samples, respectively. Both microscopic analyses (optical and SEM) showed no significant alterations. Conclusions: A normal masticatory load cannot modify the device. Chemical action in the case of exposure does not create macroscopic and microscopic alterations of the surface.

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.

Clinical and histological evaluations of alveolar ridge augmentation using a novel bi-layered porous polyethylene barrier membrane

Guided bone regeneration (GBR) is an effective alveolar ridge reconstruction technique used before or at implant placement. The combination of various barrier membranes and bone substitutes has been employed. This study aimed to perform a preliminarily evaluation of the safety and performance of a new nonabsorbable bi-layered porous polyethylene (PPE) membrane, in combination with a freeze-dried cortical bone allograft in posterior mandibular ridge augmentation. Fifteen adults who had combined posterior mandibular defects were included for ridge augmentation via GBR using PPE membrane and allograft before implant placement. The keratinized mucosa width (KW), ridge width (RW), ridge height (RH), distance from measurement matrix to bone (DMB), and horizontal alveolar width at 14.0 mm apical to the occlusal plane (HAW) were clinically measured at 15 intended implant sites before and after the augmentation. Fifteen biopsy specimens were harvested at the implant sites for histological analysis. All the subjects completed the whole study. The KW and RH showed minor gains by 0.2 ± 1.4 mm and 0.9 ± 2.3 mm respectively; however, no statistically significant differences were found between, before, and after the augmentation (P > 0.05). In contrast, the RW and HAW significantly increased by 4.8 ± 1.6 mm and 2.3 ± 1.7 mm, respectively, (P ≤ 0.001), while DMB significantly decreased by 1.0 ± 0.8 mm after treatment (P < 0.001). Histological analysis revealed that allograft underwent active bone remodeling. The PPE membrane was adequately safe and efficient to use with allograft in GBR for the reconstruction of combined ridge defects. Although some complications were observed, these were manageable and subsequently lead to successful implant placement for all the subjects. However, further randomized controlled trials are still needed to confirm these findings.

Horizontal ridge augmentation using native collagen membrane vs titanium mesh in atrophic maxillary ridges: Randomized clinical trial

BACKGROUND

Several techniques have been proposed to reconstruct deficient alveolar ridges including bone blocks, ridge splitting and guided bone regeneration (GBR). GBR has been successfully established in restoring horizontal bone deficiency. However, yet still there is a debate regarding the ideal barrier for GBR.

PURPOSE

To evaluate the quantity and the quality of the bone gained using collagen membrane with 1:1 mixture of autogenous and anoraganic bovine bone mineral compared to titanium mesh with the same mixture of bone for GBR of horizontally deficient maxillary ridges.

MATERIALS AND METHODS

Two different grafting techniques were evaluated, 10 patients receiving GBR using native collagen membrane using 1:1 autogenous and anorganic bovine bone mineral (ABBM) bone mixture, and 10 patients receiving GBR using titanium mesh with same mixture of bone.

RESULTS

Statistical analysis showed a significant increase in alveolar bone width in both techniques with a mean bone gain of 4.0 mm for Collagen group and 3.7 mm for titanium mesh group. Bone area percent was almost 28% for both groups. For Ti-mesh group, six sites soft tissue healing was uneventfully with no signs of wound dehiscence. However, four cases showed mesh exposure first 3 patients showed this exposure 3 weeks postoperatively while the fourth patient showed exposure 4 months postoperatively. The mean graft resorption in the Collagen and mesh group 6 months postoperative was considered nonsignificant.

CONCLUSIONS

GBR with both collagen membrane and titanium mesh using a 1:1 mixture of autogenous and ABBM is a viable technique for horizontal augmentation of deficient maxillary alveolar ridges. Titanium mesh is a more technique sensitive compared to collagen membrane. Soft tissue dehiscence and difficulty during second stage removal should limit its use in augmentation of horizontally deficient maxillary ridges.

Two bone blocks sandwich technique for horizontal reconstruction of severely atrophic alveolar ridge in anterior maxilla: A case report

BACKGROUND

Severe horizontal bone deficiency of the maxillary anterior region is considered a major challenge in reconstruction and successful implant placement. Various approaches have been developed to augment bone volume. Of these approaches, onlay bone graft, alveolar bone splitting, and guided bone regeneration have been suggested.

CASE SUMMARY

A 22-year-old female patient, with no previous medical history, presented to the Department of Oral Implantology, Wuhan University due to a missing right maxillary incisor. The X-ray results showed severe horizontal bone deficiency, with an available bone width of 3.1-4.0 mm. The two bone blocks sandwich technique was performed to augment the bone volume. After 6 months healing, X-ray results showed that the newly formed alveolar ridge dimension increased to 4.7-9.5 mm horizontally. Implant insertion surgery was performed and all-ceramic restorations were fabricated. The implant was stable at the 1-year follow-up visit after restoration, and the X-ray showed a stable bone level around the dental implant. The scores for the pink esthetic score and white esthetic score were 12 and 8, respectively, and the patient was satisfied with the esthetic outcome.

CONCLUSION

The two bone blocks sandwich technique may be an alternative treatment option in augmenting severe horizontal bone deficiency of the anterior maxilla.

A Preshaped Titanium Mesh for Guided Bone Regeneration with an Equine-Derived Bone Graft in a Posterior Mandibular Bone Defect: A Case Report

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.

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

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.

Particulate Coral Hydroxyapatite Sheltered by Titanium Mesh for Localized Alveolar Rehabilitation After Onlay Graft Failure: A Case Report

Reconstruction of bone loss in the alveolar ridge has long been challenging. Autologous bone grafts are considered as the "golden standard," while little research has focused on how to repair pronounced alveolar bone defects after autologous bone graft failure. The aim of this study was to detail a method based on the titanium mesh technique coupled with particulate coral hydroxyapatite to solve the onlay graft failure. With bone deficiency in the No. 11 and No. 24-25 regions, we harvested 2 autologous bone blocks for reconstruction. Two weeks after transplantation, the graft in the No. 11 region had healed uneventfully, while the graft in the anterior mandible became infected because of soft tissue dehiscence. After removal of the failed autologous bone block, pure coral hydroxyapatite stabilized within titanium mesh was used for alveolar rehabilitation. Six months later, the width of the local alveolar bone was evaluated. After the titanium mesh was removed, a biopsy was performed to study bone regeneration by micro computerized tomography and histology, following by a standard Straumann implant insertion. Although there was wound dehiscence 14 days after bone augmentation, repeated local rinsing and anti-inflammation therapy controlled the inflammatory reaction. The total horizontal bone gain was 4.2 ± 0.5 mm. Micro computerized tomography revealed that the closer the coral hydroxyapatite was to the host bone, the more was resorbed and the more bone regenerated. Histology showed mature lamellar bone structures, with evident residual coral hydroxyapatite. A 3-year follow-up revealed stable bone around the dental implant and successful function of the implant-born prosthesis. This study proposes that the method of particulate coral hydroxyapatite sheltered by titanium mesh is a promising solution in handling alveolar bone augmentation failure. More cases are needed for further research to form an efficient treatment procedure.

Bone regeneration in aesthetic areas using titanium micromesh. Three case reports

PURPOSE

An adequate bone volume for complete circumferential coverage of the implants is very important for obtaining a long-term success of oral implants. To avoid these problems various membranes and biomaterials were used, but soft tissue pressure could cause a membrane collapse toward the defect. The present work describes a ridge augmentation with titanium mesh shaped by adapting it to a bone defect in aesthetic areas.

MATERIALS AND METHODS

Three patients with alveolar crest defects received three implants (Bone System, Milano, Italy) and the defects were filled with bone chips. The defects were covered with a titanium micromesh above which was positioned a resorbable membrane (Biogide, Geistlich, Wohlhusen, Switzerland).

RESULTS

At the re-entry procedure the titanium micromesh appeared to be surrounded by a dense connective tissue with no clinical signs of inflammation. Clinically in all patients, no residual bone defects were observed, and a significant increase of the alveolar width or height was found.

CONCLUSIONS

In conclusion the clinical results of the present study show that most certainly the space for the bone regeneration is one of the most critical factors in the success of the regenerative techniques.

Guided bone regeneration: materials and biological mechanisms revisited

Guided bone regeneration (GBR) is commonly used in combination with the installment of titanium implants. The application of a membrane to exclude non‐osteogenic tissues from interfering with bone regeneration is a key principle of GBR. Membrane materials possess a number of properties which are amenable to modification. A large number of membranes have been introduced for experimental and clinical verification. This prompts the need for an update on membrane properties and the biological outcomes, as well as a critical assessment of the biological mechanisms governing bone regeneration in defects covered by membranes. The relevant literature for this narrative review was assessed after a MEDLINE/PubMed database search. Experimental data suggest that different modifications of the physicochemical and mechanical properties of membranes may promote bone regeneration. Nevertheless, the precise role of membrane porosities for the barrier function of GBR membranes still awaits elucidation. Novel experimental findings also suggest an active role of the membrane compartment per se in promoting the regenerative processes in the underlying defect during GBR, instead of being purely a passive barrier. The optimization of membrane materials by systematically addressing both the barrier and the bioactive properties is an important strategy in this field of research.

Regenerative Medicine for Periodontal and Peri-implant Diseases

The balance between bone resorption and bone formation is vital for maintenance and regeneration of alveolar bone and supporting structures around teeth and dental implants. Tissue regeneration in the oral cavity is regulated by multiple cell types, signaling mechanisms, and matrix interactions. A goal for periodontal tissue engineering/regenerative medicine is to restore oral soft and hard tissues through cell, scaffold, and/or signaling approaches to functional and aesthetic oral tissues. Bony defects in the oral cavity can vary significantly, ranging from smaller intrabony lesions resulting from periodontal or peri-implant diseases to large osseous defects that extend through the jaws as a result of trauma, tumor resection, or congenital defects. The disparity in size and location of these alveolar defects is compounded further by patient-specific and environmental factors that contribute to the challenges in periodontal regeneration, peri-implant tissue regeneration, and alveolar ridge reconstruction. Efforts have been made over the last few decades to produce reliable and predictable methods to stimulate bone regeneration in alveolar bone defects. Tissue engineering/regenerative medicine provide new avenues to enhance tissue regeneration by introducing bioactive models or constructing patient-specific substitutes. This review presents an overview of therapies (e.g., protein, gene, and cell based) and biomaterials (e.g., resorbable, nonresorbable, and 3-dimensionally printed) used for alveolar bone engineering around teeth and implants and for implant site development, with emphasis on most recent findings and future directions.