Implant Site Development Using Titanium Mesh in the Maxilla: A Retrospective Study of 58 Mesh Procedures in 48 Patients.

This article presents a retrospective case series of implant site development using titanium mesh (Ti-mesh) in the maxilla. A total of 58 mesh procedures in combination with several different bone grafts (allograft, cellular allograft, and bovine xenograft) and biologics (including recombinant human platelet-derived growth factor, autogenous platelet-rich growth factor, and recombinant human bone morphogenetic protein-2) were performed in 48 patients. Ti-mesh guided bone regeneration procedures were performed 2 to 3 months after extraction of nonrestorable/hopeless teeth, and the implants were placed 6 to 8 months postaugmentation. The mean initial ridge width was 2.0 ± 1.0 mm, and the mean horizontal gain after Ti-mesh procedures was 4.7 ± 1.6 mm. The ridge width was first measured on the cross-sectional presurgical CBCT image and then confirmed clinically during surgical procedures. No statistical difference in the horizontal gain was found among different combinations of bone grafts and biomaterials. Ti-mesh exposure occurred 22% of the time. The middle-aged adults (odds ratio [OR] = 8.59; P = .046) and older adults (OR = 16.66; P = .02) had significantly higher chances of mesh exposure compared to young adults. While all implants were successfully placed, about 56% of the implants had < 2 mm of bone to the facial aspect of the osteotomy and received additional contour augmentation when placed in a prosthetically appropriate position for a screw-retained restoration. This study demonstrates that although Ti-mesh procedures result in significant bone regeneration in narrow alveolar ridges to predictably allow implant placement, the age-related mesh exposure rate and frequency of need for additional contour grafting should be discussed with patients.

Use of titanium mesh in implant site development for restorative-driven implant placement: case report. Part 2: surgical protocol for single-tooth esthetic zone sites.

There are many techniques in the dental implant literature to augment bone for implant site development. The use of rigid titanium mesh was first described by Boyne in the mid-1980s to maintain regenerative space and to aid in unimpeded bone healing. Ti-mesh was used in this case report to demonstrate the predictability of this technique in creating bone augmentation in both a lateral and vertical direction prior to the placement of a single implant in site No. 5. The article describes the surgical steps for the use of ti-mesh in a single esthetic zone site with a 3-year follow-up.

Use of titanium mesh in implant site development for restorative-driven implant placement: case report. Part 1--Restorative protocol for single-tooth esthetic zone sites.

Predictably augmenting alveolar bone is a significant challenge in implant site development. A restorative-driven approach to implant placement aids in achieving esthetic harmony in the final restoration. This case report demonstrates techniques for treating patients with significant bony defects using a titanium mesh scaffold along with prosthetic steps in molding and conditioning soft tissues with the provisional restoration and the fabrication of a custom impression coping. This case is part of a larger consecutive case series of 77 titanium mesh units in 62 patients treated in a private periodontal practice setting and restored in private restorative practices, which will be published subsequently. In this titanium mesh case series, 14 other cases (a total of 15) were treated in a similar fashion as described in this case report in the category of "single implant placement in the maxillary anterior region." This case illustrates the primary advantages of the use of titanium mesh in such clinical situations.

Prevalence of maxillary sinus pathology in patients considered for sinus augmentation procedures for dental implants.

PURPOSE: To determine the prevalence of maxillary sinus pathology in patients presenting for implant rehabilitation involving sinus augmentation procedures. MATERIALS AND METHODS: Three-dimensional images of 275 patients were evaluated. Age and gender were recorded to see if they had any relationship to the prevalence of pathology. Scans were classified into 1 of the 5 categories based on the type of sinus pathology detected: healthy, mucosal thickening > 5mm, polypoidal mucosal thickening, partial opacification and/or air fluid level, and complete opacification. RESULTS: Overall, 54.9% scans were classified as healthy, and 45.1% scans were classified as exhibiting sinus pathology. Men were more likely to exhibit pathology compared with females (P < 0.01). However, age did not seem to have any relation on the prevalence of sinus pathology. Of the patients who presented with evidence of sinus pathology, 56.5% had mucosal thickening (≥ 5 mm), 28.2% with polypoidal thickening, 8.9% partial opacification and/or air/fluid level, and 6.5% complete opacification. CONCLUSIONS: It is proposed that, based on the findings of this study, 45.1% patients would require further consultation before proceeding with maxillary sinus augmentation surgery.

Scarless healing of oral mucosa is characterized by faster resolution of inflammation and control of myofibroblast action compared to skin wounds in the red Duroc pig model.

BACKGROUND: Scar formation following skin trauma can have devastating consequences causing physiological and psychosocial concerns. Currently, there are no accepted predictable treatments to prevent scarring which emphasizes a need for a better understanding of the wound healing and scar formation process. OBJECTIVES: Previously it was shown that healing of small experimental wounds in the oral mucosa of red Duroc pigs results in significantly reduced scar formation as compared with equivalent full-thickness skin wounds. In the present study, scar formation was assessed in 17 times larger experimental wounds in both oral mucosa and skin of the red Duroc pigs. METHODS: Equivalent experimental wounds were created in the oral mucosa and dorsal skin of red Duroc pigs, and scar formation, localization and abundance of key wound healing cells, transforming growth factor-beta (TGF-beta) and phosphorylated Smad3 (pSmad3) were assessed. RESULTS: Oral mucosal wounds displayed significantly less clinical and histological scar formation than did the corresponding skin wounds. The number of macrophages, mast cells, TGF-beta and pSmad3 immunopositive cells was significantly reduced in the oral mucosal wounds as compared with skin wounds during the maturation stage of the healing process. Although the number of myofibroblasts was significantly elevated, the oral mucosal wounds showed significantly less contraction than did the skin wounds over time. CONCLUSIONS: Earlier resolution of the inflammatory reaction and reduced wound contraction may promote scarless oral mucosal wound healing. In addition, scar formation likely depends not only on the number of myofibroblasts but also on the extracellular environment which regulates their function.