Minimizing risk of customized titanium mesh exposures – a retrospective analysis

Abstract

Background: Recommendations for soft tissue management associated with customized bone regeneration should be developed. The aim of this study was to evaluate a new protocol for customized bone augmentation in a digital workflow. Methods: The investigators implemented a treatment of three-dimensional bone defects based on a customized titanium mesh (Yxoss CBR®, ReOSS, Filderstadt, Germany). Patients and augmentation sites were retrospectively analysed focussing on defect regions, demographic factors, healing difficulties and potential risk factors. An exposure rate was investigated concerning surgical splint application, A®-PRF and flap design. Results: In total, 98 implants could be placed. Yxoss CBR® was removed after mean time of 6.53 ± 2.7 months. Flap design was performed as full flap preparation (27.9%), full flap and periosteal incision (39.7%), periosteal incision (1.5%), poncho/split flap (27.9%) and rotation flap (2.9%). In 25% of the cases, exposures of the meshes were documented. Within this exposure rate, most of them were slight and only punctual (A = 16.2%), like one tooth width (B = 1.5%) and complete (C = 7.4%). A®-PRF provided significantly less exposures of the titanium meshes (76.5% no exposure vs. 23.5% yes, p = 0.029). Other parameters like tobacco abuse (p = 0.669), diabetes (p = 0.568) or surgical parameters (mesh size, defect region, flap design) did not influence the exposure rate. Surgical splints were not evaluated to reduce the exposure rate (p = 0.239). Gender (female) was significantly associated with less exposure rate (78,4% female vs. 21.6% male, p = 0.043). Conclusions: The results of this study suggest that the new digital protocol including patient-specific titanium meshes, resorbable membranes and bone grafting materials was proven to be a promising technique. To improve soft tissue healing, especially A®-PRF should be recommended.

Guided bone regeneration in staged vertical and horizontal bone augmentation using platelet-rich fibrin associated with bone grafts: a retrospective clinical study

“…The L-PRF is a biodegradable scaffold consisting of fibrin, platelets, and leukocytes with the potential to boost microvascularization and epithelial cell migration [34]. Therefore, they were used on top of the collagen and d-PTFE-Ti membranes in direct contact with the periosteum and soft tissues.…”

A Review of the Applications of Additive Manufacturing Technologies Used to Fabricate Metals in Implant Dentistry

“…Research and industry concerns lie in determining where AM can substitute or generate new manufacturing systems. [53][54][55] AM technologies have been selected to manufacture Ti implants, customized subperiosteal Ti implants, [82][83][84][85][86] customized AM Ti meshes for bone grafting techniques, [87][88][89][90][91][92][93][94][95] Co-Co frameworks for implant impression procedures, 96,97 and Co-Cr and Ti implant frameworks for implant-supported prostheses. [98][99][100][101][102] With the introduction of AM technologies, different studies have analyzed the potential to manufacture Ti AM dental implants (Table 1), [55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73] customized designs that replicate the tooth's root shape (Table 2), [74]…”

“…106 With the incorporation of AM technologies, AM Ti customized mesh has been documented for bone grafting procedures (Table 4). [87][88][89][90][91][92][93][94][95] Otawa et al 89 evaluated the dimensional accuracy of customized AM Ti mesh. The thickness of the polished device was 0.3 mm with a mesh aperture of 1.0 mm.…”

“…The application of AM technologies offers several advantages to conventional techniques, namely predictable digital planning and design of the customized mesh, accurate additive manufacturing, shorter surgical times, and easy adaptation of the customized mesh. 3,[87][88][89][90][91][92][93][94][95] Nonetheless, further clinical studies are desirable to measure the feasibility, success, and complication rates of customized Ti mesh for bone augmentation procedures.…”

“…Recent publications described a method for a complete-arch implant impression technique where the Co-Cr metal framework was manufactured using AM technology (Fig 3A). 95,96 The application of AM technology provides several advantages compared to conventional implant impression techniques, namely simple digital design of the framework, an accurate manufacturing procedure to reproduce the digital design of the metal framework, the ability to control impression material thicknesses, and easy placement in the patient´s mouth with a controlled splinting procedure to the impression abutments. 96 AM technologies can also be selected to fabricate Co-Cr and Ti implant-supported prostheses.…”