Immediate implant and GBR treatment with titanium mesh

Effect of simultaneous immediate implant placement and guided bone reconstruction with ultra-fine titanium mesh membranes on radiographic and clinical parameters after 18 months of loading

By: Marco Tallarico, Francesco Mattia Ceruso, Leonardo Muzzi, Silvio Mario Meloni, Yong-Jin Kim, Marco Gargari, Matteo Martinolli


The aim of the present prospective case series study was to evaluate the implant and prosthetic survival rates, complications, marginal bone loss, using ultra-fine titanium mesh membrane and simultaneous implant placement, to provide space maintenance necessary for bone augmentation of alveolar bone defects. This trial followed the provisions of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement.

Materials & Methods

Study design : A prospective case series study Subjects and Outcomes of the study

Period : From March 2016 to October 2017 (followed up for a minimum period of 18 months after loading -mean of 20.85±42.84 months; range of 18-24 months).

Implants : 10 self-tapping tapered TSIII implants.

Patients : 7 (5 female, 2 male, mean age: 52.7±20.3 years).

Outcome measures : implant and prosthetic failure, biological and mechanical complications, marginal and volumetric bone level changes, esthetic evaluation performed according to the pink aesthetic score (PES). Inserted at torque : 40±5 using a computed-based.

Self-tapping tapered implants were placed through a computer-guided template-assisted approach. Autogenous bone was placed alone over the exposed implant surface, then mixed with inorganic bovine bone material. Finally, the membrane was connected and shaped in order to securely enclose the graft area, and the healing cap was connected and screwed onto the height connector.

Intraoral image of placed implant

Fig. 2. Clinical view at implant placement. The ultra-fine titanium mesh after bone graft. The healing cap was used to anchor the titanium mesh to the height connector


Patients received 10 self-tapping tapered implants and simultaneous guided bone regeneration(GBR) with ultra-fine titanium mesh membranes (OssBuilder; Osstem Implant). No implants and no prostheses failed during the entire follow-up period. One slightly membrane exposure was observed one month after implant placement in one patient.

Table 1. Implant follow-up

  Implant Loading 18-Month Follow-Up
Mean Marginal bone loss(mm 0.13±0.09 (95% CI 0.08-0.19) 0.28±0.33 (95% CI 0.07-0.50)
Mean horizontal alveolar ridge(mm 2.92±0.48 (95% CI 2.68-3.16) 8.29±2.14 (95% CI 7.59-8.99)
PES (mm) 8.2±0.8 (95% CI 7.7-8.7) 12.0±0.7 (95% CI 11.5-12.5)

The mean bone gain was 5.06±1.13 mm (95% CI 4.68-5.44 mm; P = 0.000). The mean volume of the grafted bone calculated using the superimposition technique was 0.99±0.38 CC (95% CI 0.75-1.23 CC).


With the limitation of the present prospective study, the guided bone reconstruction(GBR) using an ultra-fine titanium mesh membrane with simultaneous implant placement, to provide space maintenance necessary for bone augmentation of alveolar bone defects seems to provide implant/prosthesis success. Further research with a higher sample size and longer follow-up are needed to confirm these preliminary results.



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