Hard Tissue Volume Stability Effect beyond the Bony Envelope of a Three-Dimensional Preformed Titanium Mesh with Two Different Collagen Barrier Membranes on Peri-Implant Dehiscence Defects in the Anterior Maxilla: A Randomized Clinical Trial.

So-Ra Lee,Chang-Su Seo,Won-Pyo Lee,Tae-Sik Jang,In-Oh Choi

doi:10.3390/ma14195618

Abstract

This single-blinded, randomized, controlled study aimed to clinically and radiographically evaluate hard tissue volume stability beyond the bony envelope using three-dimensional preformed titanium mesh (3D-PFTM) for peri-implant dehiscence defects in the anterior maxilla. A total of 28 patients who wished to undergo implant surgery combined with guided bone regeneration (GBR) after extraction of a single maxillary anterior tooth were randomly assigned to two groups depending on the type of collagen membrane used, additionally with the 3D-PFTM—test (n = 14, cross-linked collagen membrane; CCM) and control (n = 14, non-cross-linked collagen membrane; NCCM) groups. Each implant was evaluated radiographically using CBCT at baseline, immediately after surgery, and at 6 months postoperatively. The relative position and distances from the bony envelope to the outlines of the augmented ridge were further determined immediately after GBR and 6 months after healing. At the platform level, the mean horizontal hard tissue gain (HG) at all the sites was 2.35 ± 0.68 mm at 6 months postoperatively. The mean HG rate was 84.25% ± 14.19% in the CCM group and 82.56% ± 13.04% in the NCCM group, but the difference was not significant between the groups. In all cases, HG was maintained beyond the bony envelope even after 6 months of GBR. This study suggests that 3D-PFTM should be considered a valuable option for GBR for peri-implant dehiscence defects in the anterior maxilla. In addition, 3D-PFTM may confer predictable hard tissue volume stability even after the healing period of hard tissue augmented outside the bony envelope by GBR.

Highlights

Jiang et al [14] reported that when guided bone regeneration (GBR) was performed with particulate deproteinized bovine bone mineral (DBBM) and a resorbable collagen membrane at the same time as implant placement in the maxillary anterior region, continuous horizontal volume loss occurred during the healing period, and new bone formation in the shoulder area of the fixture could be predicted only within the bony envelope
In the measurement program (OnDemand 3-DTM, Cybermed, Seoul, Korea), cross-sectional computed tomography (CT) images across the center of the implant were used to compare the amount of bone regeneration obtained from the bony defects, and the line perpendicular to the long axis of the implant was extended from the platform level to the buccal side to measure the distance from the outermost bone on the extension line (Figure 2)
After GBR was performed at the same time as the first-stage implant surgery, one patient in the test group and one in the control group were excluded from 3D-PFTM exposure in the test group and one in the control group were excluded from 3D-PFTM exposure during the healing period

Summary

Introduction

When using only particulate bone and resorbable collagen membranes, which are most commonly used in the GBR process, compromised regeneration may occur, depending on the shape of the bony defect [10] Due to their poor mechanical properties and low resistance to tissue collapse [11], compressive forces cause collapse of the membrane and downward displacement of the grafting material immediately after flap closure [12] or during the healing stage [13,14]. Jiang et al [14] reported that when GBR was performed with particulate deproteinized bovine bone mineral (DBBM) and a resorbable collagen membrane at the same time as implant placement in the maxillary anterior region, continuous horizontal volume loss occurred during the healing period, and new bone formation in the shoulder area of the fixture could be predicted only within the bony envelope

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Conclusion