Reinforcing Allograft Material with a Titanium Mesh?

Dr. Z., from Ohio, asks:

I am contemplating a research project to determine if one can get alveolar height gains using one of the available allograft materials reinforced with a tacked titanium or platinum mesh over the graft.

My impression is that a lot of the bone loss and graft failure is secondary to micromovement and particulate migration and that this could be circumvented with a rigid “cage” covering the graft. I feel this is similar to the techniques used by Marx for mandibular grafting of continuity defects with autogenous bone particles and titanium mesh. Is anyone immediately aware of a similar study being done? Do you think such a study would be valuable? How about the approach?

4 thoughts on “Reinforcing Allograft Material with a Titanium Mesh?

  1. Research ? That method has a tremendous amount of research already and has been in practice for decades with ti-mesh trays for reconstruction of continuity defects of the maxilla and mandible. Smaller versions of the mesh are made for the alveolar process as well as titanium reinforced PTFE or thin sheets of autogenous bone or allograft to maintain the matrix. Something has to maintain the space or the grafts (3d grafts, particulated grafts for horizontal or vertical defects, etc.) Two rules, wolff’s law applies to bone grafts—where there is movement, there is resorption (the short version), and soft tissue wins over bone every day of the week and twice on sundays

  2. The first time I saw a clinician is using Ti mesh to augment the alveolar process or maxillary sinus floor lifting AND immediate placement of implants, was when I was attending a hands-on course which was held at Halmstadt/Sweden by Professor Sten Isacsson. He used the 0.1 mm thickness and scraped the bone from the zygomatic buttress. His long term results were amazing. From then on, I have taken advantage of this technique in some cases and I am very satisfied with the results. Before that, we only had used the 0.3 mm thickness Ti mesh to reconstruct/repair the fractures of the orbital floor. The clinical advantages of this technique include: (1) the applicability to severe vertical deficit associated with large reduction in width; (2) the reduction of total time for the rehabilitation; (3) the lack of major complications if soft tissue dehiscence and mesh exposures do occur and (4) the decrease of risk of injuries to neurovascular bundle or sinus and/ or fractures. The excellent biocompatibility of titanium and the easy handling of the titanium micro-mesh systems allow their application for three-dimensional reconstruction of large bony defects. The most likely hypothesis that can explain the apparent benefits of the mesh lies in its probable protective effect during the healing time following bone grafting, as already found with non-resorbable membranes (Antoun et al. A prospective randomized study comparing two technique of bone augmentation: onlay graft alone or associated with a membrane. Clinical Oral Implants Research 12: 632–639), however, the mesh gives the flap sufficient retention to prevent dehiscence. The obvious advantages over a similar situation with e-PTFE membranes in case of exposure are evident. It seems that 0.1 mm thickness gives us the best handling opportunity in terms of the necessary stiffness for flap support and graft protection and the essential flexibility to reduce the risk of mucosal perforation and soft tissue dehiscence. The mean healing time between alveolar reconstruction surgery and implant placement would be between four to six months. Considering both waiting times together, it is remarkable to mention that successful loading of implants in autologous grafts might be possible as early as six months after bone grafting. Horizontal augmentation can also be achieved whenever clinically necessary. Vertical ridge augmentation with Ti-mesh and autogenous bone is predictable and does not go through major resorption, even if mesh exposure occurs. As it was mentioned before, implants can be inserted 4 months following surgical placement of the autograft and abutment connection can be performed and prosthesis fabricated as early as two months after implant placement. Preliminary clinical results have shown that peri-implant parameters are consistent with data reported by previous studies referring to similar implants placed in native alveolar bone (Roccuzzo, M. & Wilson, T.G. (2002) A prospective study evaluating a protocol for 6 weeks loading of SLA implants in the posterior maxilla. One year results. Clinical Oral Implants Research 13: 502–507).

  3. This is the best article I’ve found in the recent litterature:

    “The Efficacy of Various Bone Augmentation Procedures for Dental Implants: a Cochrane Systematic Review of Randomized Controlled Clinical Trials.”

    Int J Oral Maxillofac Implants 2006; 21:696-710

    Enjoy.

  4. Where can I find the most up to date DVD’s or surgical technique articles concerning timesh procedures. have many limited procedural articles. I also have several patients that will need width where expansion is limited, and where the KT is maybe 2mm wide at the most. I am planning to augment the KT first then graft. But I realize that the KT will be on top of the mesh. Any recommendations? Thanks. Bill

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