Titanium mesh in bone reconstructions

Abstract

Background The use of titanium meshes is a feature used for some time in intraoral bone surgeries. Like all surgical techniques, important points should be remembered – correct incision planning, soft tissue avulsion, and suturing using appropriate materials. Such care is essential to minimize the exposure of the mesh and, consequently, to contaminate the bone graft. Aim/Hypothesis The objective of this work is to show that the technique of bone reconstruction using a titanium mesh is, when well planned, safe and with low morbidity. Material and Methods Patient J.V.G, 38 years old, attended the clinic with a large defect of soft and hard tissues in the region of element 15. Tomography shows the bony defect of the vestibular wall. After extraction of the residual root of the element, curettage was performed and bone loss was evident. A titanium mesh was customized for the region and first parsed by the vestibular. A mixture of Extra Graft bovine bone graft with platelet-rich fibrin and leukocytes (L-PRF) was then prepared. Between the titanium mesh and the bone graft mixture, a L-PRF membrane was placed, serving with a barrier, a fundamental condition for the existence of guided bone regeneration. Finally, the screen was screwed on the palatine side and a new L-PRF membrane was placed above the screen to prevent a possible recent exposure. Results After 6 months a new tomography was requested and suggested a radiopaque image of bone formation in the region in question. Tissue removal surgery was performed and an Arcsys FGM implant was placed in the grafted bone area. Conclusions and Clinical Implications The surgical technique is predictable, however some care should be taken-correct incision planning, soft tissue avulsion, and suture using correct techniques. Another important clinical implication is to understand that the titanium mesh is not part of the guided bone regeneration, because between the mesh and the regenerated area it is mandatory the presence of a membrane to serve as a barrier. The function of the titanium mesh is to maintain the bone structure of the area being neoformation.