Clinical outcome of alveolar ridge augmentation with individualized CAD-CAM-produced titanium mesh

Abstract

BackgroundThe augmentation of the jaw has been and continues to be a sophisticated therapy in implantology. Modern CAD-CAM technologies lead to revival of old and established augmentation techniques such as the use of titanium mesh (TM) for bone augmentation. The aim of this retrospective study was to evaluate the clinical outcome of an individualized CAD-CAM-produced TM based on the CT/DVT-DICOM data of the patients for the first time.MethodsIn 17 patients, 21 different regions were augmented with an individualized CAD-CAM-produced TM (Yxoss CBR®, Filderstadt, Germany). For the augmentation, a mixture of autologous bone and deproteinized bovine bone mineral (DBBM) or autologous bone alone was used. Reentry with explantation of the TM and simultaneous implantation of 44 implants were performed after 6 months. Preoperative and 6-month postoperative cone beam computed tomographies (CBCT) were performed to measure the gained bone height.ResultsThe success rate for the bone grafting procedure was 100%. Thirty-three percent of cases presented an exposure of the TM during the healing period. However, premature removal of these exposed meshes was not necessary. Exposure rate in augmentations performed with mid-crestal incisions was higher than in augmentations performed with a modified poncho incision (45.5 vs. 20%, p = 0.221). In addition, exposure rates in the maxilla were significantly higher than in the mandible (66.7 vs. 8.3%, p = 0.009). Gender, smoking, periodontal disease, gingiva type, used augmentation material, and used membrane had no significant influence on the exposure rate (p > 0.05). The mean vertical augmentation was 6.5 ± 1.7 mm, and the mean horizontal augmentation was 5.5 ± 1.9 mm. Implant survival rate after a mean follow-up of 12 ± 6 months after reentry was 100%.ConclusionWithin the limits of the retrospective character of this study, this study shows for the first time that individualized CAD-CAM TM provide a sufficient and safe augmentation technique, especially for vertical and combined defects. However, the soft tissue handling for sufficient mesh covering remains one of the most critical steps using this technique.

The application of a newly designed L‐shaped titanium mesh for GBR with simultaneous implant placement in the esthetic zone: A retrospective case series study

“…In conclusion, tension release was very important to prevent Ti‐mesh exposure, which could be achieved via optimizing incision design, tension‐free flap preparation, indication selection, and the properties like thickness of Ti‐mesh. In this study, Ti‐mesh exposure at the second week did not have significant positive effect on the osteogenetic process underneath the L‐shaped Ti‐mesh, which was in accordance with Sagheb's study . According to the literature, usually an early exposure within the first weeks showed negative impacts on bone regeneration comparing late exposure …”

“…The titanium mesh exposure is a common complication, the exposure rates for most studies were about 30% and even higher than that. For example, Sagheb et al reported that CAD/CAM Ti‐mesh exposure occurred in 33% of the augmented sites during the healing period. Sumida et al compared the exposure rate of CAD designed custom‐made Ti‐meshes and commercial Ti‐meshes, mucosal rupture occurs for 7.7% in the custom‐made group and 23.1% in the conventional group, which demonstrated better results for custom‐made group but there was not significant difference between the two group.…”

“…In this study, Ti-mesh exposure at the second week did not have significant positive effect on the osteogenetic process underneath the L-shaped Ti-mesh, which was in accordance with Sagheb's study. 54 According to the literature, usually an early exposure within the first weeks showed negative impacts on bone regeneration comparing late exposure. 57,58 Besides bone generation, peri-implant bone resorption is also an important clinical issue that is related with long-term success of implant restoration.…”

3D‐printed polycaprolactone scaffold mixed with β‐tricalcium phosphate as a bone regenerative material in rabbit calvarial defects

“…The upper soft connective tissue did not infiltrate downwards in the groups with and without membrane. If the polymer is given a resilience that can be used as a membrane through tissue engineering process and 3D‐printed as a defect‐specific membrane, it may perform the function of space making frame with macro‐porosity like titanium mesh . The previous study compared PCL membrane with collagen membrane in beagle model .…”

Minimizing risk of customized titanium mesh exposures – a retrospective analysis

“…Based on the principles of the GBR technique, individualized titanium meshes are proposed to overcome the problems of the conventional titanium meshes [13]. Literature [14][15][16] reveals the advantages of this technology such as a shortened and facilitated surgery time in sense of a modern digital work-flow. Although Sumida et al evaluated less exposures, but not statistically significant, in patient-specific titanium meshes [17], soft tissue management remains one of the most challenging targets in customized bone regeneration [18].…”