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

Abstract

Background To our acknowledgment, there were limited clinical studies about the guided bone regeneration (GBR) for both vertical and horizontal augmentation at the same time using titanium mesh (Ti‐mesh) with simultaneous implant placement in the esthetic zone. Meanwhile, studies that specially evaluate resorption and long‐term stability of the augmented labial bone after loading were also rare. Therefore, this study introduced a newly designed L‐shaped Ti‐mesh used for GBR with simultaneous implant placement and evaluated the bone augmentation effectiveness, resorption, and long‐term stability of peri‐implant bone with this newly designed L‐shaped Ti‐mesh. Materials and Methods Twelve patients (16 implants) who had underwent a GBR procedure using L‐shaped Ti‐mesh with simultaneous implants placement were reviewed in this study. Complications, implant success, and survival rate were recorded and calculated. Furthermore, the bone gain values, labial bone resorption, and remaining labial bone volume were measured by cone beam CT (CBCT) during 13‐41 months follow‐up. Results After GBR using L‐shaped Ti‐mesh, the average bone gain values were 3.61 ± 1.50 mm vertically and 3.10 ± 2.06 mm horizontally. The implant success and surviving rate were 93.75% and 100%, respectively during the longest 41 months follow‐up. The vertical labial bone resorption was −0.81 ± 1.00 mm, horizontal labial bone resorption was −0.13 ± 1.19 mm at the top of the implants. The remaining labial bone thickness was 2.24 ± 1.29 mm at the top of the implants and 2.86 ± 1.08 mm at the 2 mm apically from the implant tops after loading. There was still 1.13 ± 1.18 mm vertical labial bone remaining above the top of implants for approximately 87.5% sites. Conclusions GBR using L‐shaped Ti‐mesh with simultaneous implant placement (one‐step surgery) in the esthetic zone could achieve predictable results for vertical and horizontal bone augmentation at the same time. Meanwhile, L‐shaped Ti‐mesh could preferably reconstruct and reduce the labial bone resorption to achieve long‐term esthetics. This newly designed L‐shaped Ti‐mesh may offer predictable and excellent outcomes for the implant restoration in the esthetic zone.

Titanium mesh for bone augmentation in oral implantology: current application and progress

“…In the patients with a small or medium alveolar bone defect requiring both horizontally and vertically bone augmentation, the mean horizontal and vertical bone augmentation reached (3.10 ± 2.06) and (3.61 ± 1.50) mm, which gained enough three-dimensional bone volume, and achieved a 93.75% success rate of implantation. 28 A systematic review that analyzed simultaneous implantation after bone augmentation with titanium mesh demonstrated the survival rate of implants placed into native bone and that placed immediately after bone grafting is similar, and in the statistics of this article, no implant failure is observed. 37 Therefore, it can be concluded that under the premise of indications, the immediate implantation after bone augmentation with titanium mesh is a feasible and favorable treatment strategy.…”

“…Zhang et al showed that for a single anterior tooth defect, during the 41-month follow-up period after implant placement, the labial bone plate experienced an average of −0.81 ± 1.00 mm vertical absorption, which bone upon the implant absorbed at mean of 0.13 ± 1.19 mm in horizontal dimension. 28 And the study conducted by Poli et al showed that for a large range of GBR with titanium, the mesial and distal bone resorption were at an average of 1.743 ± 0.567 and 1.913 ± 0.71 mm, respectively, during the 88-month follow-up period after implantation. 34 Therefore, the possibility of bone resorption also needed to be considered when performing bone augmentation with titanium mesh.…”

“…10,[23][24][25][26] While in the strategy of simultaneous implantation with bone augmentation, although there are few researches about three-dimensional bone increment, the realization of~3-4 mm average bone gain in width and height seems feasible. 27,28 However, a meta-analysis about the horizontal or vertical bone augmentation effect of titanium mesh could not be performed for the heterogeneity of the data. 13 Compared to other methods, bone resorption due to infection is rare in the application of titanium mesh.…”

“…For titanium mesh bone augmentations with single tooth loss, in simultaneous implantation strategy, absorbable sutures can be used to fix titanium mesh, avoiding the impact of titanium screws placement on implants and additional incision for removing titanium mesh and screws in subsequent surgery, which reduces the patient's trauma. 28 For titanium mesh bone augmentations with single tooth loss in delayed implantation, the placement of titanium screws is not limited by the implant in two-stage implantation. Hence, titanium screws can be used to immobilize the titanium mesh, and the screws and titanium mesh can be removed at the subsequent implantation surgery.…”

A novel digital and visualized guided bone regeneration procedure and digital precise bone augmentation: A case series

“…In our previous studies, it was confirmed that the L‐shaped titanium mesh could provide both horizontal and vertical augmentations for alveolar bone in GBR 6 . At the longest follow‐up of 41 months, the thickness of the remaining labial bone at the top of the implant was approximately 2.24 mm, and there was still a vertical bone mass of 1.13 mm above the top of the implant.…”