Titanium-reinforced Membrane Research Articles

Evaluation of Guided Bone Regeneration Using Xenograft/APRF Mixture in Atrophic Posterior Mandible (Clinical and Radiographic Study)

Introduction: The rehabilitation of the posterior mandible with dental implants represents a hard challenge for clinicians today due to the lack of supporting bone. Different surgical techniques are currently being used to augment the posterior mandible, where GBR is considered the most commonly used. Materials and Methods: Fifteen patients were selected to treat mandibular alveolar ridge resorption with guided bone regeneration using a titanium-reinforced membrane and a filling mixture of xenograft bovine bone and PRF. The membrane was fixed using a Meisinger pin control kit and Profix 3mm microscrews. A PRF membrane was used to cover the Ti-d-ptfe.
 Results: Swelling, pain, and numbness were evaluated using the mixture of PRF/xenograft as well as PRF membranes. The results showed promising results in terms of primary wound healing, whereas a significant bone quantity with a mean bone volume of 5.78 ± 0.81 was reported after 6 months. The primary implant stability recorded high values and significantly increased at a period of 6 months post-insertion (p = 0.037). Conclusion: It could be concluded that the PFR/xenograft mixture can be promising when used with the titanium-reinforced d-ptfe membrane in 3D ridge reconstruction of the atrophic posterior mandible; moreover, using the PRF membrane to cover the TI-d-ptfe membrane could enhance soft tissue healing as well as prevent soft tissue dehiscence due to the concentration of growth factors that can be released during primary wound healing. The xenograft/PRf mixture can be consistently utilized for the creation of new bone in severely atrophic ridges if used in GBR. The high ISQ at primary implant placement and at a period of 6 months post-insertion, according to Osstell, can explain the successful application of this mixture in 3D bone augmentation of the atrophic posterior mandible.

Guided bone regeneration in implant dentistry: a systematic review

Introduction: The rehabilitation of the dental arch with osseointegrated implants makes it possible to improve the quality of life of patients. Guided bone regeneration (GBR) has been applied to replace lost bone to allow the implant to be fully integrated and maintained during functional loading. GBR is considered one of the most commonly applied methods to reconstruct alveolar bone and to treat peri-implant bone deficiencies. Objective: It was to develop a systematic review to highlight the main approaches of guided surgery to promote bone regeneration in implant dentistry. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from March to May 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, using articles from 1977 (Golden pattern - Bra°nemark et al. ) to 2023. Results and Conclusion: A total of 117 articles were found, 38 articles were evaluated and 28 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 22 studies with a high risk of bias and 15 studies that did not meet GRADE. It was concluded that the application of a membrane to prevent nonosteogenic tissues from interfering with bone regeneration is a fundamental principle. Membrane properties and biological outcomes drive bone regeneration in membrane-covered defects. Barrier membranes play the role of preventing the invasion of soft tissue by exiting the mucosa and creating an underlying space to support bone growth. Collagen membranes have excellent biological properties and bone regeneration results. While collagen membranes do not provide sufficient mechanical protection of the covered bone defect, titanium-reinforced membranes, and non-resorbable membranes need to be removed in a second surgery.

A Retrospective Analysis of Treatment Outcomes Following Guided Bone Regeneration at Sites Exhibiting Severe Alveolar Ridge Atrophy.

Severely atrophic alveolar ridges represent a great challenge for implant-prosthetic rehabilitations. The aim of this study was to clinically and histologically evaluate horizontal and vertical bone gain, as well as implant survival/success rate after guided bone regeneration (GBR) for the reconstruction of large bone defects. Fourteen subjects (7 males and 7 females; mean age: 48.9 ± 14.1) were enrolled in the study. They were selected according to specific inclusion criteria and all patients required GBR procedures for placing implants in severe atrophic jaws (bone height ≤6 mm). Guided bone regeneration was performed using dense polytetrafluoroethylene nonresorbable titanium-reinforced membranes associated with particulate heterologous bone grafts. Implant placement was performed 6 months after surgery at the same time as the removal of the membrane. Furthermore, a biopsy sample from the grafted sites was collected to conduct a histological analysis of the regenerated bone. Forty-seven dental implants were placed and followed up after prosthetic loading. Seventeen sites, 8 in the maxilla and 9 in the mandible, were suitable for the GBR procedure. The healing period was uneventful in 13 sites. The average value of vertical bone regeneration was 5.88 ± 1.17 mm. Postloading follow-up ranged from 24 to 59 months. During the follow-up, clinical and radiographic exams showed no significant bone resorption and, in each case, the criteria for implants' survival were respected with no signs of any complications. Histological analysis of the bone biopsy samples revealed residual graft particulate in close contact with newly formed bone. Guided bone regeneration is a reliable technique for reconstruction of severe atrophic ridges. Larger long-term follow-up studies are needed to evaluate the condition of the bone grafted over time and its ability to support functional loading of the implants.

Evaluation of Bone Gain and Complication Rates after Guided Bone Regeneration with Titanium Foils: A Systematic Review.

Guided bone regeneration techniques are increasingly used to enable the subsequent placement of dental implants. This systematic review aims to analyze the success rate of these techniques in terms of bone gain and complications rate using titanium membranes as a barrier element. Electronic and hand searches were conducted in PubMed/Medline, Scielo, Scopus and Cochrane Library databases for case reports, case series, cohort studies and clinical trials in humans published up to and including 19 September 2020. Thirteen articles were included in the qualitative analysis. Bone gain both horizontally and vertically was comparable to that obtained with other types of membranes more commonly used. The postoperative complication rate was higher that of native collagen membranes and non-resorbable titanium-reinforced membranes, and similar that of crosslinked collagen membranes and titanium meshes. The survival rate of the implants was similar to that of implants placed in native bone. Due to the limited scientific literature published on this issue, more randomized clinical trials comparing occlusive titanium barriers and other types of membranes are necessary to reach more valid conclusions.

“Customized Titanium Mesh versus Titanium Reinforced Membrane in localized Alveolar Ridge Augmentation with Simultaneously delayed implant placement” A randomized clinical study

Aim: To compare two different alveolar ridge augmentation (ARA) approaches applied in conjunction with delayed dental implants regarding the enhancement of the buccolingual alveolar ridge width and the changes in alveolar crestal level radiographically. Materials and Methods: 20 patients participated in this study; two groups received particulate bone graft simultaneously with delayed implant placement. Ten patients had received Customized titanium mesh (CTi) and ten patients had received titanium (Ti) reinforced membrane. Results: Regarding the buccolingual ridge width by CBCT. Comparing the value of pre-post percent change between groups, revealed no statistically significant difference. In both groups, comparing pre and post value of buccolingual ridge width revealed a statistically significant increase. Regarding changes in alveolar crestal level by digital periapical radiography. In both groups, comparing pre and post value of alveolar crestal bone revealed no statistically significant difference. Conclusion: Customized titanium mesh can be used successfully for ARA performed simultaneous with delayed implant placement as it enhances buccolingual alveolar ridge width and prevent alveolar crestal resorption.

D-Ptfe Cytoplast® membranes in guided bone regeneration in implantology

The vertical bone increase of alveolar rim is important to obtain good results in rehabilitation with prostheses on implants. This Literature Review sought articles that treat bone increases of alveolar edges using Cytoplast® membranes, seeking to evaluate the resistance to bacterial penetration and capacity to create and maintain space. For this, a literature review was made on the Pubmed and Google scholar search platforms. The researches analyzed found similar results between d-PTFE membrane, titanium meshes and e-PTFE membranes, both in bone gain and bone quality. The space maintenance capacity was evident in the articles in which the titanium reinforced membrane was used. The d-PTFE membrane presented a greater capacity of exposure to the oral environment without compromising the graft material. The authors researched in this study found that titanium-reinforced d-PTFE membranes for bone augamble alveolar rim increases are viable and allow a certain period of exposure to the oral environment without graft contamination. Further studies are needed with the Cytoplast® d-PTFE membrane to explore its characteristics with vertical bone augmentation procedures.

Alternativas para reabilitação com implantes dentários em mandíbula posterior atrófica

An adequate bone volume is mandatory for a favorable long-term prognosis in patients treated with dental implants. The vertical deficiency of posterior mandible is a common condition in partially edentulous patients, in which vertical bone augmentation procedures or inferior alveolar nerve transposition become necessary for the dental implant rehabilitation. Thus, the aim of this study was to discuss options of vertical bone augmentation techniques in atrophic posterior mandibles and to present, as case reports, alternatives for the rehabilitation of patients with this condition. So, three alternatives of treatment were presented: the use of Cytoplast titanium-reinforced membrane over autogenous and xenogenous particulate bone graft; sandwich osteotomy; and nerve transposition. In the three reported cases, the chosen surgical techniques showed to be appropriated and allowed the placement of longer implants. No significant complications were observed and all the patients were satisfied with the performed treatment. It is possible to conclude that the reconstruction of atrophic posterior mandible remains a challenge to the professionals, who must know the various existing techniques and choose the most suitable one to each patient.

The Use of Cytoplast Titanium Reinforced Membrane for Horizontal Guided Bone Regeneration Case Report

uccessful implant osseointegration is dependent primarily upon adequate bone quantity and quality at the desired implant site. But often times the implant candidate, after proper clinical examination and evaluation of the patient's diagnostic information, lacks adequate bone quantity or volume for implant placement. Often times, the patient's has adequate height of bone but lacks bone width. The ability to predictably generate horizontal bone or bone width in preparation for dental implants, or guided bone regeneration (GBR) is an important and necessary procedure, in implant site preparation. Successful bone regeneration depends upon several factors. The first of which is to prevent soft tissue in growth into the bone graft material.

The influence of wound closure on graft stability: An in vitro comparison of different bone grafting techniques for the treatment of one-wall horizontal bone defects.

The aim of this preclinical study was to analyze and compare different grafting techniques with respect to volume stability after wound closure. Four different grafting techniques were evaluated in vitro for volume stability in a one-wall horizontal defect configuration. Group 1: guided bone regeneration (GBR) with collagen membrane, particulated xenograft; group 2: GBR with collagen membrane, particulated xenograft, pins; group 3: GBR with titanium-reinforced membrane, particulated xenograft, pins; group 4: autogenous block graft, particulated xenograft, collagen membrane. Cone beam computed tomography scans were performed before and after wound closure, and the horizontal bone dimensions were analyzed for stability at 0-5 mm apical to the implant shoulder (H0-H5). At H0-H2, wound closure induced a statistically significant change in bone dimensions in groups 1 and 2. In group 3, only the change in H0 was significant, and for group 4, only H2 was significant. Wound closure has a significant impact on graft stability in a one-wall horizontal defect configuration. GBR with additional membrane fixation showed better results than without. Titanium-reinforced membranes and autogenous blocks showed significantly greater volume stability than GBR with collagen membrane, especially in the coronal portion.

Comparative Evaluation of Bone Formation between PRF and Blood Clot Alone as the Sole Sinus-Filling Material in Maxillary Sinus Augmentation with the Implant as a Tent Pole: A Randomized Split-Mouth Study.

The lack of bone volume in the posterior maxillary region can be augmented with sinus elevation. Since the elevated sinus is a closed cavity, a blood clot that fills the sinus space itself can aid in bone formation. The aim of this study was to compare bone formation in the elevated maxillary sinus between platelet-rich fibrin (PRF) and blood clot alone as the sole sinus-filling material with the implant as a tent pole. The study was a randomized controlled trial with a split-mouth design involving seven patients. An implant was placed on one side only and blood was allowed to fill the elevated sinus cavity; on the other side, PRF plugs were inserted. The sinus window was covered by nonresorbable titanium-reinforced membrane. The results showed that there was no statistically significant difference between the two groups, but the PRF group showed increased bone gain in the mesial, buccal, and palatal regions, and increased average height and bucco-palatal width at the height of the old and new sinus floor. A greater increase in distal bone height was seen in the control group. It was concluded that PRF may be more effective as a sole sinus-filling material in the elevated sinus cavity with an implant as a tent pole.

Mandibular Ridge Augmentation Using a Mineralized Ilium Block: A Case Letter

Mandibular Ridge Augmentation Using a Mineralized Ilium Block: A Case Letter

Implants Placed Simultaneously With Particulated Bone Graft in Patients Diagnosed With Recessive Dystrophic Epidermolysis Bullosa

To describe the rehabilitation with implants placed simultaneously with particulated bone graft in 4 patients diagnosed with recessive dystrophic epidermolysis bullosa. A retrospective study was conducted of 4 patients diagnosed with recessive dystrophic epidermolysis bullosa and treated with dental implants and simultaneous particulate bone graft from January 2005 to December 2009. All patients had marked oral involvement, with devastating alterations in the soft and hard tissues and were rehabilitated with a fixed prosthesis. Eighteen implants showed dehiscence or fenestration and were placed simultaneously with particulated bone grafts to cover exposed threads: 14 received autologous bone and 4 tricalcium betaphosphate. In 16, the bone graft was covered with resorbable collagen membranes and in 2 with a nonresorbable titanium-reinforced membrane. Of the 18 implants, 8 were placed in the maxilla combining drills and osteotomes and 10 in the mandible with the conventional drilling procedure. All implants survived after a minimum follow-up of 12 months (range 12 to 48). The results of this small-sample clinical study suggest that endosseous implants can be placed simultaneously with particulated bone graft, providing support for a fixed prosthesis in patients with recessive dystrophic epidermolysis bullosa and considerably improving these patients' quality of life.

Clinical Outcomes After Treatment of Non‐Contained Intrabony Defects With Enamel Matrix Derivative or Guided Tissue Regeneration: A 12‐Month Randomized Controlled Clinical Trial

The purpose of this study is to compare the healing of deep, non-contained intrabony defects (i.e., with a ≥80% 1-wall component and a residual 2- to 3-wall component in the most apical part) treated with either an enamel matrix derivative (EMD) or guided tissue regeneration (GTR) after 12 months. In this randomized, controlled clinical trial, 40 subjects with 40 defects affecting single-rooted teeth were treated. The defects were treated with EMD alone or with a non-resorbable titanium-reinforced membrane. No grafting materials were used. At baseline and after 12 months, clinical parameters including probing depths (PDs) and clinical attachment levels (CAL) were recorded. The difference in CAL gain was the primary outcome. At baseline, the intrabony component of the defects amounted to 8.5 ± 2.2 mm at EMD-treated sites and 8.6 ± 1.7 mm at GTR-treated sites (P = 0.47). The mean CAL gain at sites treated with GTR was significantly greater (P <0.001) than that at sites treated with EMD (4.1 ± 1.4 mm versus 2.4 ± 2.2 mm, respectively). GTR therapy, compared to EMD application alone, significantly (P = 0.01) increased the probability of CAL gain ≥4 mm (79.2% versus 11.3%, respectively) and significantly (P = 0.01) decreased the probability of residual PDs ≥6 mm (3% versus 79.3%, respectively). Although the outcomes of open-flap debridement alone were not investigated, the application of EMD alone appeared to yield less PD reduction and CAL gain compared to GTR therapy in the treatment of deep, non-contained intrabony defects.

Treatment of oroantral fistula with autologous bone graft and application of a non-reabsorbable membrane

The aim of the current report is to illustrate an alternative technique for the treatment of oroantral fistula (OAF), using an autologous bone graft integrated by xenologous particulate bone graft. Acute and chronic oroantral communications (OAC, OAF) can occur as a result of inadequate treatment. In fact surgical procedures into the maxillary posterior area can lead to inadvertent communication with the maxillary sinus. Spontaneous healing can occur in defects smaller than 3 mm while larger communications should be treated without delay, in order to avoid sinusitis. The most used techniques for the treatment of OAF involve buccal flap, palatal rotation - advancement flap, Bichat fat pad. All these surgical procedures are connected with a significant risk of morbidity of the donor site, infections, avascular flap necrosis, impossibility to repeat the surgical technique after clinical failure, and patient discomfort. We report a 65-years-old female patient who came to our attention for the presence of an OAF and was treated using an autologous bone graft integrated by xenologous particulate bone graft. An expanded polytetrafluoroethylene titanium-reinforced membrane (Gore-Tex) was used in order to obtain an optimal reconstruction of soft tissues and to assure the preservation of the bone graft from epithelial connection. This surgical procedure showed a good stability of the bone grafts, with a complete resolution of the OAF, optimal management of complications, including patient discomfort, and good regeneration of soft tissues. The principal advantage of the use of autologous bone graft with an expanded polytetrafluoroethylene titanium-reinforced membrane (Gore-Tex) to guide the bone regeneration is that it assures a predictable healing and allows a possible following implant-prosthetic rehabilitation.

Alveolar Ridge Regeneration with Equine Spongy Bone: A Clinical, Histological, and Immunohistochemical Case Series

In the case of localized ridge atrophy, a ridge augmentation procedure, with the use of bone substitutes and barrier membranes, may then be necessary. The aim of the present study was a clinical, histological, and immunohistochemical evaluation of an equine spongy bone in alveolar ridge augmentation procedures. Five patients showing horizontal mandibular ridge defects participated in this study. A ridge augmentation was performed through an onlay apposition of equine bone covered by a titanium-reinforced membrane. After 6 months of healing, five bone cores from nonaugmented sites (control) and five from augmented sites (test) were retrieved. In test sites, no postoperative complications occurred. Horizontal bone width increased from 24 to 37 mm. In control sites, the newly formed bone represented 33%, and in test sites, 35% of the total area. The mean value of the microvessel density was 25.6 +/- 3.425 per mm(2) in controls, while 33.3 +/- 2.5 vessels per mm(2) in the test sites were found (p < .05). Both groups showed a high intensity (++) of vascular endothelial growth factor expression in the newly formed bone, while a low intensity (+) was found in the mature bone. Equine bone appeared to be biocompatible and to be associated with new vessel ingrowth. Within the limits of the small sample size, the present study indicated that equine bone could be used in mandibular ridge augmentations.

Simultaneous Hard and Soft Tissue Augmentation for Implants in the Esthetic Zone: Report of 37 Consecutive Cases

A recent report documented a tissue engineering approach to simultaneously augment hard and soft tissues for implant site preparation. The technique used freeze-dried mineralized bone allograft (FDBA), recombinant human platelet-derived growth factor mixture with a titanium-reinforced membrane, and a pediculated connective tissue graft (PCTG) to simultaneously augment the hard and soft tissue. The aim of this study was to determine the effectiveness of this technique in delayed and immediate implant cases in which specific augmentation materials differed. This retrospective analysis reports on the clinical treatment of subjects requiring maxillary anterior extractions with concomitant loss of the buccal plate. In preparation for an implant-supported restoration, 37 defects were treated with FDBA, differing guided bone regeneration barrier membranes, and PCTG. Twelve subjects underwent immediate implant placement. All 37 grafted sites healed uneventfully with no complications. Thirty-six implants osseointegrated and were stable and successful at the 6- and 12-month post-restoration evaluations. One immediate implant failed to integrate. The overall success rate was 97.3%. This analysis suggested that the interpositional vascularized augmentation neogenesis (IVAN) technique can be used effectively to simultaneously augment hard and soft tissue. This technique is effective when used in conjunction with the immediate or delayed placement of dental implants in the maxillary anterior segment. Furthermore, when using this technique, the specific membrane and FDBA source can be chosen by the practitioner to treat individual defects.

Titanium-Reinforced Polytetrafluoroethylene Membrane Combined with Inorganic Polyphosphate Induces Exophytic Bone Formation in Rabbit Calvaria

The purpose of this study was to examine if the application of titanium-reinforced expanded polytetrafluoroethylene(TR-ePTFE) membrane combined with bovine bone mineral(BBM) soaked in inorganic polyphosphate promotes exophytic bone formation in rabbit calvaria. For this purpose, a total of 8 rabbits were used, and rectangular decorticated calvaria sites were created using a round carbide bur. In the control group, rectangular parallelepiped-shaped TR-ePTFE membranes (RPTPMs) were filled with BBM soaked in saline and placed on the decorticated sites and fixed with metal pins. In the experimental groups, RPTPMs were filled with BBM soaked in 4%, 8% and 16% inorganic polyphosphate prior to fixing with metal pins. Animals were sacrificed at 4 and 8 weeks after surgery, and new bone formation was assessed by histomorphometric as well as statistical analysis. The results indicated that at 8 weeks, all the experimental groups demonstrated exophytic bone formation. At 8 weeks, the 8% polyphosphate group revealed the most new bone formation (p&lt;0.05). On the basis of these findings, we conclude that inorganic polyphosphate has a promoting effect on bone regeneration, possibly by enhancing osteoinductivity of the decorticated wound area and osteoconductivity of the carrier material, but not much as we expected.

Bone formation utilizing titanium reinforced barrier membranes

Advances in bone reconstructive techniques have increased the indications for implant placement in sites previously thought to be unsuitable. This clinical study evaluated a new surgical technique for the treatment of a variety of localized bone defects in four patients utilizing a titanium-reinforced membrane. The membrane material was developed to maintain a large protected space between the membrane and the bone surface without the need for a supportive device. Healing was uneventful in all sites, and the membranes were retrieved after 6 to 12 months. No residual defects were noted, resulting in an average change of implant exposure of 8.2 +/- 2.3 mm for sites with buccal dehiscences and from 5 to 6 mm ridge enlargement in localized bone defects. The quality of the regenerated tissue under the titanium-reinforced membrane appeared as bone structure with a superficial fibrous layer. This fibrous layer was more pronounced in sites treated with a membrane alone but was more than compensated by the quantity of new bone under the soft tissue. The results demonstrated that the use of a reinforced membrane appears to be a viable alternative for the clinical treatment of non-space-maintaining implant/bone defects. Further clinical and experimental investigations are recommended.

Expanded Polytetrafluoroethylene Titanium‐Reinforced Membranes for Regeneration of Mucogingival Recession Defects. A 12‐Case Report

The regeneration of tissue to treat mucogingival recession defects is well established but these defects pose additional challenges for the clinician in the creation and maintenance of a space under the guiding membrane. We used titanium-reinforced membranes of expanded polytetrafluoroethylene (ePTFE) to facilitate the creation and maintenance of such spaces in 12 patients with mucogingival recession defects. The membranes were judged according to their ease of handling and placement and the regenerative results; the patients were evaluated for gingival recession and the quantity of attached gingiva before and for as long as 15 months after treatment. At 15 months, the average gingival recession was 1.4 mm (pretreatment = 5.3 mm), and the attached gingiva measured 3.3 mm (pretreatment = 1.4 mm). Titanium-reinforced ePTFE membranes result in a simpler, faster, and more predictable surgical procedure. Comparison of titanium-reinforced ePTFE membranes to other available procedures awaits assessment in clinical trials.