Titanium Micromesh Research Articles

Total Maxillectomy in Children: A Report Two Cases

We describe the clinical cases of two pediatric patients who were treated with a total maxillectomy and chemo/radiotherapy for suffering from malignant tumors of the maxilla. The reconstruction of the floor of the orbit was done with titanium micromesh and the defect in the maxilla and hard palate was reconstructed with free flaps.

Reconstruction of Orbital Floor Fractures with Titanium Micromesh: Our Experience.

The purpose of this study was to assess the use and accuracy of the titanium micromesh for primary internal orbital reconstruction in cases of either pure or impure orbital blowout fractures. Retrospective case series of 21 patients with a mean follow-up of 12months. Department of Dental Surgery of a teaching tertiary medical college Hospital. Twenty-one consecutive patients who underwent surgical reconstruction of orbital floor/or Combination of floor and rim fractures usingtitanium micromesh. Persistence of diplopia, orbital dystopia, implant extrusion, enophthalmos, infection, and complications. The recorded data included age, gender, cause of trauma, diplopia, enophthalmos, ocular motility, preoperative orbital PNS/CT, and postoperative paranasal sinus view skull preoperative and postoperative ophthalmological examination. Most of the patients were males and resulted from trauma inflicted during RTA, sport injuries or assault. The most Common fracture pattern was impure Blow out fractures, and commonly associated other facial fractures were midfacial fractures. Clinical examination along with diagnostic aids such as computed tomography of orbital fractures was used. Orbital floor exploration was performed in 21 cases due to functional or aesthetic deficits. All orbital floor bone defects required reconstruction. In these cases, orbital floor was reconstructed with .3mm titanium micromesh implant. We did not encounter any major complications related to the incisions or implant material, though sample size was small. The rate of complication in which correction was difficult (diplopia) was lower [4%, 1 case]. Titanium mesh gives excellent result in orbital floor fractures. Surgical anatomical landmarks knowledge is very important to prevent any intra- or postoperative complications.

Is it enough to just increase the height of sub-antral bone during maxillary sinus augmentation or dose its depth matter?

Purpose: Many techniques for maxillary sinus floor elevation have been used prior to implant placement in case of sever sinus pneumatization. Two-stage lateral-window sinus lifting using titanium micromesh without bone grafting was carried out in the present study. The purpose of the study was a trail to solve a question, if it is enough to just increase the height of sub-antral bone or it is also important to elevate the Schneiderian membrane medio-laterally as much as possible to accommodate for dental implants later. Materials and Methods: Seven patients (11 sinuses) were included. A titanium micromesh was shaped in a tick shape and placed into the sinus through a lateral window to maintain the elevated membrane in place. Immediate, 6-months and 9-months postoperative cone beam computed tomography (CBCT) were performed to evaluate the relation between the medio-lateral extension of the mesh and the amount of the gained bone. Results: When the height of the formed bone was related to the depth of the titanium mesh, no significant difference could be observed at either 6 or 9 months. However, when the depth of newly formed bone was compared against the depth of the titanium mesh, a high significant difference was noted at both 6 and 9 months. Conclusion: At least two thirds of the sinus depth must be elevated to obtain adequate bone width for future implantation.

Maxillary Sinus Augmentation Using a Titanium Mesh: A Randomized Clinical Trial.

BACKGROUND:Various attempts have been implemented using different materials and techniques to augment the maxillary sinus floor for prospect dental implant positioning.AIM:This contemplate was conducted to assess the osteogenic capability of the maxillary sinus in a two-step sinus membrane elevation using titanium mesh to keep the formed space to place dental implants in atrophic ridges.MATERIALS AND METHODS:Titanium micromesh was customized and positioned into the sinus on one side to preserve the elevated membrane in position. On the other side xenograft was applied. Instant and 6-months postoperative cone beam computed tomography (CBCT) was done to assess the gained bone height and density. Bone core biopsies were obtained during implant placement for histological and histomorphometric evaluation.RESULTS:The average bone height values increased in both groups. Meanwhile the average bone density value was higher at the graft group than the titanium mesh group. Histological and histomorphometric evaluation presented the average bone volume of the newly formed bone in the graft group which is superior to that of the titanium mesh group.CONCLUSION:The use of the titanium micromesh as a space-maintaining device after Schneiderian membrane elevation is a trustworthy technique to elevate the floor of the sinus without grafting.

A Wrapping Method for Inserting Titanium Micro-Mesh Implants in the Reconstruction of Blowout Fractures.

Titanium micro-mesh implants are widely used in orbital wall reconstructions because they have several advantageous characteristics. However, the rough and irregular marginal spurs of the cut edges of the titanium mesh sheet impede the efficacious and minimally traumatic insertion of the implant, because these spurs may catch or hook the orbital soft tissue, skin, or conjunctiva during the insertion procedure. In order to prevent this problem, we developed an easy method of inserting a titanium micro-mesh, in which it is wrapped with the aseptic transparent plastic film that is used to pack surgical instruments or is attached to one side of the inner suture package. Fifty-four patients underwent orbital wall reconstruction using a transconjunctival or transcutaneous approach. The wrapped implant was easily inserted without catching or injuring the orbital soft tissue, skin, or conjunctiva. In most cases, the implant was inserted in one attempt. Postoperative computed tomographic scans showed excellent placement of the titanium micro-mesh and adequate anatomic reconstruction of the orbital walls. This wrapping insertion method may be useful for making the insertion of titanium micro-mesh implants in the reconstruction of orbital wall fractures easier and less traumatic.

SURGICAL RECONSTRUCTION OF THE POSTERIOR MEATAL WALL BY BIOGLASS VERSUS TITANIUM MESH

Canal wall down mastoidectomy has many drawbacks including chronic otorrhea not responding to medications, granulations, dizziness on exposure to cold or hot water, and tendency of debris accumulation in the mastoid cavity, necissating periodic cleaning. Many of these proplems can be solved by reconstruction of the posterior meatal wall. Aim of work: To solve the cavity proplems after CWD mastoidectomy via reconstruction of posterior meatal wall, and to compare between the outcomes of the Bioglass versus titanium mesh in reconstruction of posterior meatal wall. Patients and methods: This study was applied on 40 patients that have chronic sappurative otitis media. All cases were subjected to canal wall down mastoid surgery with complete elimination of the disease and reconstruction of the posterior meatal wall. Patients were divided to 2 groups: group (A) was managed by canal wall down mastoidectomy with reconstruction of the posterior meatal wall by Bioglass and the group (B) was managed by canal wall down mastoidectomy with reconstruction of the posterior meatal wall by titanium micromesh; all patients were exposed to full preoperative evaluation, and full postoperative assessment of complications, appearance of the external auditory canal contour, and the hearing gain expressed by the change of the air bone gap postoperatively. Results: There is a significant difference between the two groups regarding postoperative complications mainly the postoperative granulations and discharge, the postoperative appearance of the external auditory canal contour, and the hearing gain in favor of group (A) but there is no significant difference between the 2 groups as regard the intraoperative difficulties, the other postoperative complications like wound infection, canal stenosis, extrusion or displacement of the materials and recurrence of cholesteatoma. Conclusion: Reconstruction of posterior canal wall can eliminate many of the cavity proplems after CWD mastoidectomy especially by using the Bioglass which shows better advantages than the titanium micromesh Keywords: canal wall reconstruction, Bioglass, titanium, mastoidectomy, mastoid cavity oblitration

Predictability of staged localized alveolar ridge augmentation using a micro titanium mesh.

The aim of this study is to retrospectively evaluate the success rate of staged localized alveolar ridge augmentation using titanium micromesh. In addition, the factors that influenced the success were analyzed. Twenty-three alveolar ridges (posterior mandible 12, anterior maxilla 7, anterior and posterior maxilla 3, and posterior maxilla 1) were augmented using titanium micromesh and were retrospectively assessed. Thirty sites were judged as successful with a success rate of 56.6% (posterior mandible 58.3%, anterior maxilla 57.1%, anterior and posterior maxilla 33.3%, and posterior maxilla 100%). The span of the augmentation site was significantly correlated with the success rate (goodness test of fit for chi-square, p < 0.05). The success rate was low if infection of the grafted material was observed, while the exposure of titanium mesh had no negative impact. This limited study suggested that the predictability of augmented bone volume in staged alveolar ridge augmentation using titanium micromesh was not sufficient to expect an ideal and planned implant placement. The success was influenced by the distance of the augmentation site and the infection of the graft material, which were associated with moderate to severe vertical ridge resorption and/or mechanical and functional loading on the surgical site.

Alveolar ridge augmentation with titanium mesh. A retrospective clinical study.

An adequate amount of bone all around the implant surface is essential in order to obtain long-term success of implant restoration. Several techniques have been described to augment alveolar bone volume in critical clinical situations, including guided bone regeneration, based on the use of barrier membranes to prevent ingrowth of the epithelial and gingival connective tissue cells. To achieve this goal, the use of barriers made of titanium micromesh has been advocated.A total of 13 patients were selected for alveolar ridge reconstruction treatment prior to implant placement. Each patient underwent a tridimensional bone augmentation by means of a Ti-mesh filled with intraoral autogenous bone mixed with deproteinized anorganic bovine bone in a 1:1 ratio. Implants were placed after a healing period of 6 months. Panoramic x-rays were performed after each surgical procedure and during the follow-up recalls. Software was used to measure the mesial and the distal peri-implant bone loss around each implant. The mean peri-implant bone loss was 1.743 mm on the mesial side and 1.913 mm on the distal side, from the top of the implant head to the first visible bone-implant contact, at a mean follow-up of 88 months.The use of Ti-mesh allows the regeneration of sufficient bone volume for ideal implant placement. The clinical advantages related to this technique include the possibility of correcting severe vertical atrophies associated with considerable reductions in width and the lack of major complications if soft-tissue dehiscence and mesh exposures do occur.

Vertical Ridge Augmentation Using Allograft and Synthetic Hydroxyapatites After Strategic Extraction

Introduction: Regeneration of sufficient bone mass for implant therapy is difficult in cases presenting with extensive vertical alveolar resorption, particularly when there is a severe loss of attachment at the distal surface adjacent to the area of vertical alveolar ridge resorption. In this case, sufficient bone augmentation for implant placement was achieved by strategic extraction of the canine. This allowed for vertical bone augmentation to be performed up to the alveolar crest of the distal lateral incisor.Case Presentation: Clinical and radiographic assessment indicated inadequate bone for the insertion of dental implants. Severe residual ridge bone resorption was observed from the cervical area of the mandibular left canine to the second molar region. Because of extensive resorption in the distal alveolar bone of the mandibular left canine, adequate vertical bone regeneration could not be obtained without extraction. After the site of the extracted canine had healed, non‐resorbable and resorbable hydroxyapatite as well as demineralized freeze‐dried bone allograft were grafted at a ratio of 1:2:2. This was covered with titanium micromesh. A second bone augmentation on the buccal area was performed to achieve a functionally ideal dental arch. A total of 11.8 mm of vertical bone augmentation was achieved, which is a sufficient amount for implant placement. The regenerated bone remained stable at a loading time of &gt;3 years.Conclusion: This case describes a technique using a strategic extraction to facilitate greater bone height in advanced vertical ridge augmentation without using autogenous bone grafting.

Orbital Dystopia Due to Orbital Roof Defect

We performed a retrospective review of patients who presented with delayed dystopia as a consequence of an orbital roof defect due to fractures and nontraumatic causes to search for a correlation between orbital roof defect size and surgical indications for the treatment thereof. Retrospective analyses were performed in 7 patients, all of whom presented with delayed dystopia due to orbital roof defects, between January 2001 and June 2011. The causes of orbital roof defects were displaced orbital roof fractures (5 cases), tumor (1 case), and congenital sphenoid dysplasia (1 case). All 7 patients had initially been treated conservatively and later presented with significant dystopia. The sizes of the defects were calculated on computed tomographic scans. Among the 7 patients, aspiration of cerebrospinal fluid, which caused ocular symptoms, in 1 patient with minimal displaced orbital roof and reconstruction with calvarial bone, titanium micromesh, or Medpor in 6 other patients were performed. The minimal size of the orbital roof in patients who underwent orbital roof reconstruction was 1.2 cm (defect height) x 1.0 cm (defect length), 0.94 cm(2). For all patients with orbital dystopia, displacement of the globe was corrected without any complications, regardless of whether the patient was evaluated grossly or by radiology. In this retrospective study, continuous monitoring of clinical signs and active surgical management should be considered for cases in which an orbital roof defect is detected, even if no definite symptoms are noted, to prevent delayed sequelae.

Nongrafted Sinus Floor Elevation with a Space‐Maintaining Titanium Mesh: Case‐Series Study on Four Patients

Numerous materials and techniques have been introduced to augment the maxillary sinus floor for future dental implant placement. Schneiderian membrane tenting above simultaneously placed implants proved to be a successful technique. The present study investigated the use of a titanium micromesh for lateral-window sinus floor elevation without bone grafting. Four patients indicated for two-stage sinus lifting were included. Through a lateral window, a titanium micromesh was tailored and placed into the sinus to maintain the elevated membrane in place. Immediate and 6-month postoperative cone beam computed tomography (CBCT) was performed to measure the gained bone height. During implant placement, bone core biopsies were retrieved for histomorphometry. The average residual ridge height among the eight sinuses was 3.6 mm ± 1.6 mm. Six months postoperatively, it reached 9.63 mm ± 1.47 mm. Histomorphometry revealed that the average bone volume of the native bone was 30.3% ± 9.1%, while that of the newly formed bone was 55.3% ± 11.4%. Within the limitations of this study due to the small sample size, the use of the titanium micromesh as a space-maintaining device after schneiderian membrane elevation is a reliable technique to elevate the floor of the sinus without grafting.

Management of maxillary alveolar bone fracture and severely intruded maxillary central incisor: report of a case

An 11-year-old male who injured his maxilla and right maxillary central incisor and lip during a fall was presented to our hospital. His lower lip and upper gingiva were lacerated with swelling and epistaxis, and he had a maxillary alveolar bone fracture and severe intrusion of the right maxillary central incisor, which had penetrated the floor of the nasal cavity with avulsion. Under local anesthesia, we repositioned the incisor and bone segment and fixed them with a titanium micromesh plate and self-tapping screws and splints. The incisor was also treated by root canal 3 days after the operation and was restored with a crown. We performed root canal filling 1 month later. Five months later, the plate and screws were removed. In prognosis of our case, no symptoms of inflammatory root resorption or ankylosis have observed for more than 1 year and 6 months of follow up based on both clinical and radiographic findings.

Early Reconstruction of Orbital Roof Fractures: Clinical Features and Treatment Outcomes

BackgroundOrbital roof fractures are frequently associated with a high energy impact to the craniofacial region, and displaced orbital roof fractures can cause ophthalmic and neurologic complications and occasionally require open surgical intervention. The purpose of this article was to investigate the clinical features and treatment outcomes of orbital root fractures combined with neurologic injuries after early reconstruction.MethodsBetween January 2006 and December 2008, 45 patients with orbital roof fractures were admitted; among them, 37 patients were treated conservatively and 8 patients underwent early surgical intervention for orbital roof fractures. The type of injuries that caused the fractures, patient characteristics, associated fractures, ocular and neurological injuries, patient management, and treatment outcomes were investigated.ResultsThe patients underwent frontal craniotomy and free bone fragment removal, their orbital roofs were reconstructed with titanium micromesh, and associated fractures were repaired. The mean follow up period was 11 months. There were no postoperative neurologic sequelae. Postoperative computed tomography scans showed anatomically reconstructed orbital roofs. Two of the five patients with traumatic optic neuropathy achieved full visual acuity recovery, one patient showed decreased visual acuity, and the other two patients completely lost their vision due to traumatic optic neuropathy. Preoperative ophthalmic symptoms, such as proptosis, diplopia, upper eyelid ptosis, and enophthalmos were corrected.ConclusionsEarly recognition and treatment of orbital roof fractures can reduce intracranial and ocular complications. A coronal flap with frontal craniotomy and orbital roof reconstruction using titanium mesh provides a versatile method and provides good functional and cosmetic results.

Chest Wall Reconstruction in a Patient with Sternal Fibrous Dysplasia

A patient with sternal fibrous dysplasia was treated via subtotal sternectomy using a sandwich titanium micromesh and polypropylene mesh to repair the chest wall defect. Pectoralis muscle flaps were created to cover the prosthesis. The patient had a normal postoperative course with good stability and postoperative cosmesis.

Advanced Alveolar Bone Resorption Treated With Implants, Guided Bone Regeneration, and Synthetic Grafting: A Case Report

To present a vertical ridge augmentation with a composite synthetic bone graft by the mixed bone-filling materials and autogenous bone chips retrieved from the implant osteotomy site for a case for esthetic implant prosthesis on the atrophied alveolar bone. Nonresorbable and resorbable hydroxyapatite and demineralized freeze-dried bone allograft particles were used at ratio of 1:2:2 (volume ratio). Titanium micromesh was used for alveolar ridge configuration and retention. After 8 months, implant placement and interimplant bone augmentation were performed. 15-mm vertical and 10-mm horizontal bone augmentation has been achieved. Marginal bone heights and periimplant mucosa remained stable in cases of loading after >4 years of follow-up. These results suggest that this method has the potential for use in esthetic implant rehabilitation on the highly atrophied alveolar bone.

Chest wall resection and reconstruction using titanium micromesh covered with Marlex mesh for metastatic follicular thyroid carcinoma: a case report

IntroductionThe distant metastases from differentiated thyroid carcinomas are often untreatable. In particular, bone metastasis is significantly related to poor prognosis since radioactive iodine therapy is generally less effective. Therefore, surgical resection is considered one of the treatments for patients with bone metastases. We report chest wall resection and reconstruction using titanium micromesh covered with polypropylene mesh (Marlex mesh) for metastatic rib bones as a result of follicular thyroid carcinoma.Case presentationA 51-year-old man was referred to our institution with a painful chest wall tumor. He presented with a 15 × 10 cm bony swelling on the left chest wall and multiple small lung nodules from follicular thyroid carcinoma. Completion total thyroidectomy, chest wall resection and reconstruction using titanium micromesh covered with Marlex mesh were performed. There were no critical complications associated with surgical treatments and tumor pain disappeared during the postoperative period. Then, he received radioactive iodine therapy and the uptake of radioactive iodine was well observed in bilateral lung fields.ConclusionReconstruction using titanium micromesh covered with Marlex mesh is possible for repairing the wide chest wall resection required for thyroid carcinoma metastasis. This technique would help to enhance treatment efficacy in the combination therapy of radioactive iodine and surgery in patients with large thyroid carcinoma metastasis in the chest wall.

Bifunctional Sculpturing of the Bone Graft for 3-Dimensional Augmentation of the Atrophic Posterior Mandible

Short implant procedures may suffer from fixture instability, if incorrectly planned and performed, and from an esthetically compromised rehabilitation, due to increased interarch distance and increased crown-implant ratio. Several procedures have been proposed to achieve alveolar ridge augmentation with different success and complication rates: onlay grafts, alveolar sandwich osteotomies, titanium micromesh, alveolar distraction, and alveolar nerve transposition. The edentulous posterior mandible suffers from the presence of a compact cortical layer, which tends to limit graft osteogenesis, because of a low permeability to the osteogenic elements (microvessels and cells). This report introduces a variant to the endochondral onlay bone graft, in which an external cortical layer is placed above a biologically active core of cancellous bone and platelet-rich plasma. This solution provides easy 3-dimensional conformation of the graft, enhancing its mechanical stability. The presence of the biologically active core provides better vascular support and a valid interface between graft and the osteogenetic cell lines.

Histologic and Histomorphometric Evaluation of Alveolar Ridge Augmentation Using Bone Grafts and Titanium Micromesh in Humans

Recently, the use of titanium micromesh for alveolar bone augmentation has drawn interest; however, only limited histologic data are available on the quality of the bone regenerated. Therefore, this study compared the use of 100% intraoral autogenous bone to a combination of intraoral autogenous bone (70%) and bovine porous bone mineral (BPBM) (30%) for alveolar ridge augmentation with titanium micromesh histologically and histomorphometrically. Twelve partially edentulous patients required alveolar bone augmentation before implant insertion because of ridge resorption. The defect sites, six in the maxilla and six in the mandible, were reconstructed with particulate autologous bone (control group, N = 6) or a mixture of autologous bone and BPBM (test group, N = 6) in combination with titanium micromesh. Core biopsies were taken from the defect sites 8 to 9 months after grafting at the time of implant insertion. Newly formed compact bone with a well-organized lamellar pattern was identified in all specimens. In the samples taken from the test group, the BPBM particles were surrounded completely by newly formed bone with no signs of resorption. The mean total bone volume was 62.38% +/- 13.02% in the control group and 52.88% +/- 11.47% in the test group. The soft tissue volume was 37.61% +/- 13.02% and 29.96% +/- 12.58%, respectively, and the residual BPBM volume was 17.15% +/- 2.72% in the test group. No statistical difference was observed in the histologic parameters evaluated, irrespective of graft type and site (P >0.05). Within the limits of this study, BPBM (30%) in combination with autogenous bone (70%) did not yield a lower percentage of new bone formed compared to autogenous bone alone in ridge augmentation with titanium micromesh.

O.317 Transcutaneous reduction and external fixation of isolated anterior wall frontal sinus fractures

Introduction: Reconstruction of craniofacial defects can be carried out with autogenous tissue (calvarium, rib, iliac crest), allogeneic implants (AAA-bone, lyophilized cartilage) or alloplastic material (methacrylate, hydroxyapatite, titanium implants and mesh systems). Selection of the implant material used for reconstruction is still controversial. Material and Methods: At the Department of Oral and Maxillofacial Surgery, Kantonsspital Luzern, 20 patients with defects in the craniofacial and/or orbito-ethmoidal region have been treated using titanium micro-mesh between 1991 and 1998. Two different mesh systems, micro-titanium augmentation mesh and dynamic mesh, have been used for bony reconstruction in non load-bearing areas. The defects were caused by acute trauma, osteomyelitis of the frontal bone and previous operations. The titanium micro-mesh was used with the following indications: (1) immediate reconstruction in the primary treatment of comminuted fractures with bone loss in non load-bearing areas, (2) treatment of contour irregularities (possibly in combination with bone or cartilage grafts). All patients were followed up clinically and radiographically at quarterly intervals for a year. Results: No wound infections, exposures or loss of the mesh have been observed. Long-term stability of the reconstructions was excellent. When walls of the paranasal sinuses were reconstructed complete repneumatisation took place. Conclusions: Advantages of this reconstructive technique are: (1) universal applicability (craniofacial, orbital, sinus defects, comminuted fractures); (2) stable 3-D reconstruction of complex anatomic structures were easily performed; (3) immediate availability with no donor site morbidity as bone or cartilage grafts were not necessary; (4) combination with bone or cartilage grafts is possible; and (5) very low susceptibility to infection.

Internal Fixation in Trapdoor-Type Orbital Blowout Fracture

The most common orbital blowout fracture is a trapdoor type. In many cases of trapdoor fracture, the bony segment has a stable hinge consisting of a greenstick fracture and the sinus mucoperiosteum that is attached to the intact orbital wall. If the displaced bony segment opposite the hinge is reduced into the original position and fixed on the unaffected bone, the orbital fracture may be reconstructed by internal fixation of the bony segment itself rather than requiring substitution with alloplastic implants or a bone graft. In 20 cases of orbital blowout fracture of a trapdoor type, internal fixation was performed using a cantilever fixation technique (with a piece of titanium micromesh or a titanium microplate plus a microscrew) or a ledge fixation technique (with a piece of micromesh). In all cases, the orbital wall was accurately reconstructed in its normal anatomical position. The associated ocular problems disappeared except for mild diplopia in one patient and there were no surgical complications associated with the internal fixation. The advantages of internal fixation include anatomical reconstruction of the orbital wall; preservation of the original orbital bone and the mucoperiosteum of the sinus as an osteomucoperiosteal flap resulting in rapid wound healing and normal mucus drainage function of the sinus; the simplicity of the procedure; and consequently, the absence of surgery-related complications. This technique is presented as one of the preferred treatments for trapdoor-type orbital blowout fractures.