The Ti-Mesh Technique: Guided Bone Regeneration for Three-Dimensional Augmentations. Clinical Aspects: A Case Series

This article presents the surgical aspects of, and evaluates bone dimensional changes following, the application of the guided bone regeneration (GBR) technique using individualized titanium mesh on atrophied alveolar ridges to achieve an optimal crest volume for implant placement. Six patients were included and evaluated clinically and radiologically for at least 3 years. Every patient presented bone resorption affecting implant placement in a proper prosthetic position. During the regenerative procedure, customized titanium mesh was used to secure the contour of the augmented site and the stability of xenograft particles deposited on the atrophied crest. After 6 months of healing, the mesh was removed, and implants were placed in planned, prosthetic positions. CBCT scans were taken before the regenerative procedures and after 6 months, before the second-stage surgeries. This allowed for assessment of the postaugmentation vertical and horizontal bone tissue gain. The average volumetric gain of the augmented sites was 5.2 mm horizontally and 2.75 mm vertically. In 50% of cases, minor soft tissue perforation was observed after a few weeks. This complication did not influence the implant placement procedure and was treated during the second-stage procedure with the GBR technique, using a resorbable membrane and xenograft particles to compensate the localized bone defect. No implant failed during the control period. Panoramic radiographs were taken 1 to 3 years after completion of definitive prosthetic treatment to assess potential bone resorption around implants. No crestal bone resorption was observed within this period. It can be concluded that the use of customized titanium mesh is a predictable technique for bone regeneration in advanced, three-dimensional defects.