J Korean Assoc Oral Maxillofac Surg.  2014 Aug;40(4):181-187. 10.5125/jkaoms.2014.40.4.181.

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

• Jung GU
• Jeon JY
• Hwang KG
• Park CJ

• KMID: 2005443
• DOI: http://doi.org/10.5125/jkaoms.2014.40.4.181

Abstract

OBJECTIVES
The purpose of this preliminary study is to evaluate the effectiveness of a customized, three-dimensional, preformed titanium mesh as a barrier membrane for peri-implant alveolar bone regeneration.
MATERIALS AND METHODS
Ten patients were recruited for this study. At the time of implant placement, all patients had fenestration or a dehiscence defect around the implant fixture. A mixture of particulate intraoral autologous bone and freeze-dried bone allograft was applied to the defect in a 1 : 1 volume ratio and covered by the preformed titanium mesh. 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.
RESULTS
Satisfactory bone regeneration with limited fibrous tissue was detected beneath the preformed titanium mesh. Histologic findings revealed that newly formed bones were well-incorporated into the allografts and connective tissue. 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.
CONCLUSION
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-to-use barrier membrane around peri-implant alveolar bone defect. This preformed mesh is also convenient to apply and to remove.

Keyword

Alveolar bone loss; Histology; Surgical mesh

MeSH Terms

Allografts
Alveolar Bone Loss
Biopsy
Bone Development
Bone Marrow
Bone Regeneration*
Connective Tissue
Humans
Membranes
Prostheses and Implants
Surgical Mesh
Titanium*
Titanium

Figure

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  Fig. 1 Components and types of the customized, three-dimensional, and preformed titanium mesh (SMARTbuilder; Osstem). Type I is designed for 1-wall augmentation, type II for 2-wall augmentation, and type III for 3-wall augmentation.

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  Fig. 2 After implant placement on #12 missing area, labial fenestration defect was found.

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  Fig. 3 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.

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  Fig. 4 A customized, 3-dimensional, and preformed titanium mesh (SMARTbuilder type II; Osstem) was connected to the height, placed over the graft material, and stabilized by the cover cap.

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  Fig. 5 The preformed titanium mesh was easily removed under the minimum flap elevation at postoperatively 4-month re-entry.

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  Fig. 6 Bone core biopsy was carried out on the labial regenerated bone by a trephine drill (arrow). Note that there was a superficial thin fibrous tissue layer over the regenerated bone.

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  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).

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  Fig. 8 Histological findings of the core specimen obtained from patient #2. Note that the residual allograft (RA) particles were encapsulated and incorporated with vital bone (VB). Fibrous marrow (FM) tissues were also observed (H&E staining, ×40).

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