Preliminary Clinical Evaluation of Customized Three-Dimensional Pre-formed Titanium Mesh for Localized Alveolar Bone Regeneration
By: Seung-Hwan Jeon, Kyung-Gyun Hwang, Chang-Joo Park
The purpose of this preliminary study is to evaluate the ability of customized three-dimensional titanium mesh (SMARTbuilder, Osstem, Korea) as a barrier membrane through investigation of clinical implant success rates and complications including crestal bone maintenance in application for localized alveolar bone regeneration.
Materials & Methods:
1. Patient selection
In a total of 8 patients, dental implants (TSIII CA, Osstem, Korea) were placed and SMARTbuilder, height, healing abutment or cover cap were applied for bone regeneration simultaneously (Table 1).
2. Surgical technique
Autogenous bone, which was harvested by Autobone Collector (Osstem, Korea) (Fig. 1) and mixed with allograft (Sure-Oss, HansBiomed co., Korea) 1 : 1 in volumetric ratio, was used as graft material (Fig. 2).
Fig. 1. Autogenous bone harvest Fig. 2. Bone graft
Fig. 3. Post operative periapical film Fig. 4. SMARTbuilder
SMARTbuilder was applied as a barrier membrane (Fig. 3).
As seen on the Fig. 4, SMARTbuilder provided the space maintenance. During healing period, SMARTbuilder cover cap was exposed (Fig. 5) and after 4 months from the operation, SMARTbuilder was removed (Fig. 6). New bone augmentation was achieved on the labial dehiscence (Fig. 7).
After uncovering operation, prosthetic procedure was performed. The complication and success rate were investigated until 6 months after the delivery of the definite prostheses.
Fig. 5. Postoperative 4 months Fig. 6. Membrane removal at postoperative 4 months
Fig. 7. Bone regeneration Fig. 8. Postoperative 4 months
Table 1. Overview of patients and surgical records
Several benefits of the use of titanium mesh have been suggested. Titanium mesh provides superior space maintenance, a fundamental prerequisite for any bone regeneration procedure. Furthermore, the pores within the titanium mesh are thought to play a critical role in maintaining blood supply to a grafted defect.
Previous studies have suggested that a barrier membrane can exclude the ingress of blood supply to a grafted defect, resulting in flap dehiscence and membrane exposure. Furthermore, Expanded polytetrafluoroethylene (ePTFE) membranes must be removed if flap dehiscence and exposure occurs to prevent infection, because exposure in these cases will not heal spontaneously.
Titanium mesh, in contrast, when exposed, might not require immediate removal, because this material does not interfere with the blood flow to the underlying tissues owing to the presence of pores within the mesh. The size of these pores could be a significant factor because small pores could block the integral vascularization process. Another advantage of titanium mesh is that it provides the most extensive space maintenance of all available materials. This results from the great plasticity of the material, which permits bending, contouring, and adaptation of the mesh to any unique bony defect. The result is the establishment of a defined space below the mesh that mimics the shape of the desired alveolar ridge.
SMARTbuilder showed the feasibility as the barrier membrane maximizing the merit of the existing titanium mesh, especially with the ease of application and removal during the augmentation procedures for localized alveolar bone defect.