Preliminary Evaluation of a Three-dimensional, Customized, and Preformed Titanium Mesh in Peri-implant Alveolar Bone Regeneration.
By Gyu-Un Jung, Jae-Yun Jeon, Kyung-Gyun Hwang, Chang-Joo
Guided bone regeneration (GBR) is the essential technique for the successful implant treatment in vertically or horizontally deficient alveolar ridge. Particularly, a variety of barrier membranes have been introduced to prevent the invasion of epithelial or gingival connective tissue in bone regeneration.
Among these barrier membranes, titanium mesh membrane is getting the limelight due to its innate space maintaining ability as well as excellent blood supply for bone regeneration. Moreover, titanium mesh has the non-negligible merit in terms of costs compared to other membranes.
The purpose of this preliminary study is to evaluate the effectiveness of a customized, three-dimensional, and preformed titanium mesh as a barrier membrane for peri-implant alveolar bone regeneration.
Materials & Methods
Ten patients were recruited for this study. At the time of implant placement (TS III CA, Osstem, Korea), all patients had fenestration or a dehiscence defect around the implant fixture. A mixture of particulate intraoral autologous bone and freeze-dried bone allograft (SureOss, Hans Biomed, Korea) was applied to the defect in a 1 : 1 volume ratio and covered by the preformed titanium mesh (SmartBuilder, Osstem).
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.
Fig. 1. After implant placement on #12 missing area, labial fenestration defect was found. Fig. 2. After connecting the height on the implant fixture, the defect was covered with a mixture of particulated autologous bone harvested from the mandibular ramus and freeze-dried bone allograft. Fig. 3. A preformed titanium mesh (SmartBuilder type II) was connected to the anchor.
Fig. 4. The preformed titanium mesh was easily removed under the minimum flap elevation at postoperatively 4-month re-entry. Fig. 5. Bone core biopsy was carried out on the labial regenerated bone by a trephine drill (arrow)
Fig. 6. A biopsy specimen was collected by a trephine bur with 2.2 mm diameter
Fig. 7. Comparison of periapical radiographs taken at the application (A) and removal (B) of the preformed titanium mesh and at 1 year after delivery of the final prosthesis (C).
Data of patients and surgery were presented in Table 1. Satisfactory bone regeneration with limited fibrous tissue was detected beneath the preformed titanium mesh.
Preliminary histologic findings revealed that newly formed bones were well-incorporated into the allografts and connective tissue. In the specimen obtained from patient #2, 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.
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-touse barrier membrane around peri-implant alveolar bone defect. This preformed mesh is also convenient to apply and to remove.