Use of Titanium Mesh for Staged Localized Alveolar Ridge Augmentation: Clinical and Histologic-Histomorphometric Evaluation

Abstract

The use of titanium mesh for localized alveolar ridge augmentation was evaluated by clinical, radiographic, laboratory, and histologic-histomorphometric evaluation. Seventeen patients participated in this study. All patients required localized alveolar ridge augmentation before placement of dental implants. An equal mixture of autogenous bone graft and inorganic bovine mineral (Bio-Oss) was used as a bone graft material. Autogenous bone graft was harvested intraorally. Titanium mesh was submerged for 8.47 months (SD 2.83). Impressions were taken intraorally before bone grafting, 6 months after bone grafting, and 6 months after implant placement. Impressions were used to measure the volume of alveolar ridge augmentation and provide linear laboratory measurements regarding the results of bone augmentation. Bone quality (type II-IV) was recorded during implant surgery. Standardized linear tomographs were taken before bone grafting and before implant placement. A biopsy was harvested with a trephine bur from the grafted area during implant surgery for histologic-histomorphometric evaluation. In all cases the grafted area had adequate bone volume and consistency for placement of dental implants. Early mesh exposure (2 weeks) was observed in 2 patients, and late exposure (>3 months) was observed in 4 patients. Volumetric laboratory measurements indicated 0.86 cc (SD 0.69) alveolar augmentation 1 month after bone grafting, 0.73 cc (SD 0.60) 6 months after bone grafting, and 0.71 cc (SD 0.57) 6 months after implant placement. This indicated 15.11% resorption 6 months after bone grafting, and no further resorption occurred after implant placement. Linear laboratory measurements indicated vertical augmentation of 2.94 mm (SD 0.86) 1 month after bone grafting, 2.59 mm (SD 0.91) 6 months after bone grafting, and 2.65 mm (SD 1.14) 6 months after implant placement. The corresponding measurements for labial-buccal augmentation were 4.47 mm (SD 1.55), 3.88 mm (SD 1.43), and 3.82 mm (SD 1.47). Radiographic evaluation indicated 2.56 mm (SD 1.32) vertical augmentation and 3.75 mm (SD 1.33) labial-buccal augmentation. Histomorphometric evaluation indicated 36.47% (SD 10.05) new bone formation, 49.18% (SD 6.92) connective tissue, and 14.35% (SD 5.85) residual Bio-Oss particles; 44.65% (SD 22.58) of the Bio-Oss surface was in tight contact with newly formed bone. The use of titanium mesh for localized alveolar ridge augmentation with a mixture of autogenous intraorally harvested bone graft and Bio-Oss offered adequate bone volume for placement of dental implants. Intraorally harvested autogenous bone graft mixed with Bio-Oss under a titanium mesh offered 36.47% new bone formation, and 15.11% resorption occurred 6 months after bone grafting.

Preliminary evaluation of a three-dimensional, customized, and preformed titanium mesh in peri-implant alveolar bone regeneration

“…Proussaefs and Lozada19 demonstrated ~36% new bone formation after 8 months in a histologic study of cases augmented by mixed grafts of autologous and inorganic bovine bone (in a 1 : 1 volume ratio). Using the mesh with either a combination graft (of 70% autologous bone and 30% bovine bone matrix) or a graft of autologous bone alone produces similar amounts of total bone volume 8-9 months after grafting11.…”

Comparison of Bone Resorption Rates after Intraoral Block Bone and Guided Bone Regeneration Augmentation for the Reconstruction of Horizontally Deficient Maxillary Alveolar Ridges

“…The authors used cancellous allografts and collagen membranes without tacks in order to increase bone width and evaluated the changes in bone dimension by CBCT and 2D measurements using calipers. Proussaefs and Lozada observed a 15.11% resorption rate at 6 months after bone grafting using a composite (DBB and autogenous bone particles) and nonresorbable membrane [20], based on linear measurements made on laboratory casts derived from intraoral impressions.…”

Predictability of staged localized alveolar ridge augmentation using a micro titanium mesh

“…There would be some other important factors (grafting material, surgical approach, etc.) that would have significant impact on the success of alveolar augmentation with titanium micromesh [14][15][16][17]. Further well-designed studies and long-term follow-up to evaluate the resorption of augmented bone are required before a definitive conclusion can be reached.…”