USE OF TI-MESH FOR GUIDED BONE REGENERATION IN VERTICAL AUGMENTATIONS WITH AUTOLOGOUS BONE. A RETROSPECTIVE OBSERVATIONAL STUDY OF LONG-TERM REMODELING WITH 5-YEAR FOLLOW-UP

F. Carini¹ , M. Cancelleri¹, M. Giordano², G. Porcaro²

¹ Private Practice, Monza, Italy
² Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy

Correspondence to:

Annals of Stomatology 2024 September-December; 4(3): Ahead of Print
https://doi.org/10.69129/stomatol/2024v4iss3_7

Received: 23 September 2024 Accepted: 2 November 2024

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Abstract

Numerous materials and techniques are used for guided bone regeneration in edentulous patients. Autologous bone with Ti-mesh titanium grids offers excellent osteoconductive, osteoinductive, and osteogenic properties, reducing post-operative healing times and costs compared to heterologous materials. This retrospective observational study aims to evaluate, at a 5-year follow-up, the remodeling of atrophic ridges regenerated vertically using Ti-mesh and autologous bone. Following vertical bone regeneration with autologous material and Ti-mesh, 35 implants were placed in 18 healthy, non-smoking patients (7 women and 11 men) with an average age of 53 years, who presented a Cawood and Howell grade V or VI mandibular/maxillary atrophy. Six maxillary and 12 mandibular segments were rehabilitated. All patients entered a professional oral hygiene control program scheduled every 6 months for the duration of the entire follow-up. The study involved measuring the bone increase in the vertical direction via intraoral radiographs performed with the long cone technique or using CBCT data. Each patient underwent level I or II radiographic investigations at T0 (surgical rehabilitation), T1 (prosthetic rehabilitation) and T2 (5 years after rehabilitation). The bone defects on the mesial and distal sides of the implants were measured in mm at T0, T1 and T2. The GBR Ti-Mesh technique in association with autologous bone in particulate form allowed a gain in bone height on average equal to 5.6 ± 0.65 mm at the time of removal of the titanium mesh and an average resorption after 5 years of 1.06 ± 0.45 mm. This corresponds to an average resorption after 5 years of 19% of the autogenous bone grafted at T0. Osseointegration was achieved in all 35 implants at the time of abutment connection. After a minimum of 5 years of functional loading, all 35 implants included in this study caused no pain, sensitivity or mobility and maintained stable osseointegration. Therefore, the cumulative survival and success rates of the implants at the end of the follow-up period were 100% and 88.6% respectively as 4 out of 35 implants (11.4%) presented a greater bone resorption.  The GBR Ti-Mesh technique allowed the regeneration of large vertical bone defects in patients with severe bone atrophy. It guaranteed predictability and reproducibility of results for all 35 implant sites. The use of autologous bone yielded results comparable to implants in defects regenerated with heterologous bone. Autologous bone is presented as a material of choice for its osteoinductive, osteoconductive, and osteogenetic properties, as well as its low cost and predictability. The use of autologous bone in the vertical GBR technique with Ti-mesh resulted in vertical bone resorption comparable to implants in regenerated bone with heterologous biomaterial, reduced post-operative healing times, lower costs, and bone remodeling indistinguishable from native bone. Autologous bone has proven to be a valid alternative to heterologous bone. Further studies could expand the sample size and data available.

Keywords: autologous bone, biomaterials, guided bone regeneration, Ti-mesh, vertical augmentation