USE OF PTFE MEMBRANES AND TITANIUM MESH IN VERTICAL BONE AUGMENTATION

Abstract

Inadequate alveolar bone height and width, which is a common problem in the field of implant surgery, is caused by trauma, tooth extraction or age-related changes. To achieve a predictable and successful outcome in terms of aesthetics and function, adequate volume and quality of alveolar bone are required. Augmentation techniques are employed to increase the thickness and width of the existing alveolar bone. Commonly preferred augmentation methods include ridge split osteotomy, distraction osteogenesis, block grafts harvested from intraoral or extraoral sites, the use of resorbable and non-resorbable membranes, or guided bone regeneration with titanium mesh. Various membranes are available for use in hard tissue augmentation. Each membrane has advantages and disadvantages. The properties, benefits and limitations of membranes need to be understood in order to make the most appropriate choice for the clinical application. Recently, systematic reviews on the effectiveness of vertical ridge augmentation using different techniques have confirmed that guided bone regeneration is the most predictable approach for increasing bone volume for implant and prosthetic restorations. Many authors consider autogenous bone grafts to be the gold standard for alveolar bone augmentation applications due to their osteogenic, osteoinductive, and osteoconductive properties. The technique of harvesting autogenous grafts requires sensitivity and a lot of complications may result during surgery. In addition, pain, infection, bleeding and prolonged surgical operation time are common. The risks associated with the use of autogenous bone have forced researchers to find alternative materials. The aim of this review is to understand the physical properties of non-resorbable materials used in alveolar bone augmentation procedures, discuss their advantages and disadvantages, and examine related materials.

Keywords

• Guided bone regeneration
• PTFE membrane
• Non-resorbable membrane
• Vertical ridge augmentation
• Autogenous bone

VERTİKAL KEMİK OGMENTASYONUNDA PTFE MEMBRANLAR VE TİTANYUM MESH KULLANIMI

Abstract

İmplant cerrahisi alanında yaygın bir sorun olarak karşımıza çıkan, yetersiz alveolar kemik miktarı; travma, diş çekimi veya yaşa bağlı değişiklikler nedeniyle meydana gelmektedir. İmplant tedavilerinde estetik ve fonksiyon açısından öngörülebilir, başarılı bir sonuç elde etmek için yeterli hacim ve kalitede alveoler kemik bulunması gerekmektedir. Mevcut alveoler kemiğin kalınlığını ve genişliğini arttırmak amacıyla çeşitli ogmentasyon yöntemlerine başvurulmaktadır. Kret split osteotomisi, distraksiyon osteogenezisi, intraoral veya ekstraoral bölgelerden alınan blok greftler, rezorbe olan ve olmayan membranların kullanımı veya titanyum mesh ile yönlendirilmiş kemik rejenerasyonu (YKR) en sık tercih edilen ogmentasyon yöntemlerindendir. Sert doku ogmentasyonunda çeşitli membranlar kullanılmaktadır. Her membranın avantajları ve dezavantajları bulunmaktadır. Klinik uygulamadaki gereksinime en uygun seçimin yapılması için membranların özellikleri, sağladıkları faydalar ve sınırlamaların anlaşılması gerekmektedir. Son zamanlarda yapılan sistematik incelemeler, vertikal kret ogmentasyonunun kemik hacmini artırmaya yönelik en öngörülebilir yaklaşım olduğunu doğrulamıştır. Çeşitli yazarlar osteojenik, osteoindüktif ve osteokondüktif özelliklerinden dolayı, alveoler kemik ogmentasyonu uygulamaları için otojen kemik greftlerinin kullanımının altın standart olduğunu düşünmektedir. Otojen greftlerin elde edilme tekniği hassasiyet gerektirmekte ve cerrahi esnasında birtakım komplikasyonlar oluşabilmektedir. Buna ek olarak ağrı, enfeksiyon, kanama görülmekte ve cerrahi operasyon süresi uzamaktadır. Otojen kemiğin kullanımıyla ilişkili riskler araştırmacıları alternatif materyaller bulmaya zorlamıştır. Bu derlemenin amacı, alveoler kemik ogmentasyonu prosedürlerinde kullanılan rezorbe olmayan materyallerin fiziksel özelliklerinin kavranması, avantaj ve dezavantajlarının tartışılması ve ilgili materyallerin incelenmesidir.

Keywords

• Yönlendirilmiş Kemik Rejenerasyonu
• PTFE membran
• Rezorbe olmayan membran
• vertikal kret ogmentasyonu
• Otojen Kemik

References

1. 1. Soldatos NK, Stylianou P, Koidou VP, Angelov N, Yukna R, Romanos GE. Limitations and options using resorbable versus nonresorbable membranes for successful guided bone regeneration. Quintessence Int. 2017;48(2):131-47.
2. 2. Terheyden H, Raghoebar GM, Sjostrom M, Starch-Jensen T, Cawood J. Preprosthetic Surgery-Narrative Review and Current Debate. J Clin Med. 2023;12(23).
3. 3. Cucchi A, Sartori M, Aldini NN, Vignudelli E, Corinaldesi G. A Proposal of Pseudo-periosteum Classification After GBR by Means of Titanium-Reinforced d-PTFE Membranes or Titanium Meshes Plus Cross-Linked Collagen Membranes. Int J Periodontics Restorative Dent. 2019;39(4):e157-e65.
4. 4. Poli PP, Beretta M, Cicciu M, Maiorana C. Alveolar ridge augmentation with titanium mesh. A retrospective clinical study. Open Dent J. 2014;8:148-58.
5. 5. Cucchi A, Vignudelli E, Fiorino A, Pellegrino G, Corinaldesi G. Vertical ridge augmentation (VRA) with Ti-reinforced d-PTFE membranes or Ti meshes and collagen membranes: 1-year results of a randomized clinical trial. Clinical oral implants research. 2021;32(1):1-14.
6. 6. Simion M, Dahlin C, Rocchietta I, Stavropoulos A, Sanchez R, Karring T. Vertical ridge augmentation with guided bone regeneration in association with dental implants: an experimental study in dogs. Clinical oral implants research. 2007;18(1):86-94.
7. 7. Ronda M, Rebaudi A, Torelli L, Stacchi C. Expanded vs. dense polytetrafluoroethylene membranes in vertical ridge augmentation around dental implants: a prospective randomized controlled clinical trial. Clinical oral implants research. 2014;25(7):859-66.
8. 8. Xie Y, Li S, Zhang T, Wang C, Cai X. Titanium mesh for bone augmentation in oral implantology: current application and progress. Int J Oral Sci. 2020;12(1):37.

9. 9. Sasaki JI, Abe GL, Li A, Thongthai P, Tsuboi R, Kohno T, et al. Barrier membranes for tissue regeneration in dentistry. Biomater Investig Dent. 2021;8(1):54-63.
10. 10. Fontana F, Santoro F, Maiorana C, Iezzi G, Piattelli A, Simion M. Clinical and histologic evaluation of allogeneic bone matrix versus autogenous bone chips associated with titanium-reinforced e-PTFE membrane for vertical ridge augmentation: a prospective pilot study. Int J Oral Maxillofac Implants. 2008;23(6):1003-12.
11. 11. Finkemeier CG. Bone-Grafting and Bone-Graft Substitutes. JBJS. 2002;84(3):454-64.
12. 12. Kumar VV, Ebenezer S, Thor A. Bone Augmentation Procedures in Implantology. In: Bonanthaya K, Panneerselvam E, Manuel S, Kumar VV, Rai A, editors. Oral and Maxillofacial Surgery for the Clinician. Singapore: Springer Nature Singapore; 2021. p. 407-26.
13. 13. Canullo L, Malagnino VA. Vertical ridge augmentation around implants by e-PTFE titanium-reinforced membrane and bovine bone matrix: a 24- to 54-month study of 10 consecutive cases. Int J Oral Maxillofac Implants. 2008;23(5):858-66.
14. 14. Caldwell G, Mills M, Finlayson R, Mealey B. Lateral Alveolar Ridge Augmentation Using Tenting Screws, Acellular Dermal Matrix, and Freeze-Dried Bone Allograft Alone or with Particulate Autogenous Bone. The International journal of periodontics & restorative dentistry. 2015;35:75-83.
15. 15. Maiorana C, Beretta M, Salina S, Santoro F. Reduction of autogenous bone graft resorption by means of bio-oss coverage: A prospective study. The International journal of periodontics & restorative dentistry. 2005;25:19-25.
16. 16. Proussaefs P, Lozada J. The use of intraorally harvested autogenous block grafts for vertical alveolar ridge augmentation: A human study. The International journal of periodontics & restorative dentistry. 2005;25:351-63.
17. 17. Keestra J, Barry O, Jong L, Wahl G. Long-term effects of vertical bone augmentation: A systematic review. Journal of Applied Oral Science. 2016;24:3-17.
18. 18. Meloni SM, Jovanovic SA, Urban I, Canullo L, Pisano M, Tallarico M. Horizontal Ridge Augmentation using GBR with a Native Collagen Membrane and 1:1 Ratio of Particulated Xenograft and Autologous Bone: A 1-Year Prospective Clinical Study. Clinical implant dentistry and related research. 2017;19(1):38-45.
19. 19. Gottlow J. Guided tissue regeneration using bioresorbable and non-resorbable devices: initial healing and long-term results. J Periodontol. 1993;64(11 Suppl):1157-65.
20. 20. Roccuzzo M, Ramieri G, Spada MC, Bianchi SD, Berrone S. Vertical alveolar ridge augmentation by means of a titanium mesh and autogenous bone grafts. Clinical oral implants research. 2004;15(1):73-81.
21. 21. Kirsch A, Ackermann KL, Hurzeler MB, Durr W, Hutmacher D. Development and clinical application of titanium minipins for fixation of nonresorbable barrier membranes. Quintessence Int. 1998;29(6):368-81.
22. 22. Zhang M, Zhou Z, Yun J, Liu R, Li J, Chen Y, et al. Effect of Different Membranes on Vertical Bone Regeneration: A Systematic Review and Network Meta-Analysis. Biomed Res Int. 2022;2022:7742687.
23. 23. Fontana F, Maschera E, Rocchietta I, Simion M. Clinical classification of complications in guided bone regeneration procedures by means of a nonresorbable membrane. Int J Periodontics Restorative Dent. 2011;31(3):265-73.
24. 24. Urban IA, Montero E, Monje A, Sanz‐Sánchez I. Effectiveness of vertical ridge augmentation interventions: A systematic review and meta‐analysis. Journal of clinical periodontology. 2019;46:319-39.
25. 25. Assenza B, Piattelli M, Scarano A, Lezzi G, Petrone G, Piattelli A. Localized ridge augmentation using titanium micromesh. J Oral Implantol. 2001;27(6):287-92.
26. 26. Nyman S, Lindhe J, Karring T, Rylander H. New attachment following surgical treatment of human periodontal disease. Journal of clinical periodontology. 1982;9(4):290-6.
27. 27. Gottlow J, Nyman S, Karring T, Lindhe J. New attachment formation as the result of controlled tissue regeneration. Journal of clinical periodontology. 1984;11(8):494-503.
28. 28. Carbonell JM, Martin IS, Santos A, Pujol A, Sanz-Moliner JD, Nart J. High-density polytetrafluoroethylene membranes in guided bone and tissue regeneration procedures: a literature review. Int J Oral Maxillofac Surg. 2014;43(1):75-84.
29. 29. Hammerle C, Jung R. Bone augmentation by means of barrier membranes. Periodontology 2000. 2003;33:36-53.
30. 30. Barboza EP, Stutz B, Ferreira VF, Carvalho W. Guided bone regeneration using nonexpanded polytetrafluoroethylene membranes in preparation for dental implant placements--a report of 420 cases. Implant dentistry. 2010;19(1):2-7.
31. 31. Rakhmatia Y, Ayukawa Y, Furuhashi A, Koyano K. Current barrier membranes: Titanium mesh and other membranes for guided bone regeneration in dental applications. Journal of prosthodontic research. 2013;57.
32. 32. Maiorana C, Fontana F, Dal Polo MR, Pieroni S, Ferrantino L, Poli PP, et al. Dense Polytetrafluoroethylene Membrane versus Titanium Mesh in Vertical Ridge Augmentation: Clinical and Histological Results of a Split-mouth Prospective Study. J Contemp Dent Pract. 2021;22(5):465-72.
33. 33. Jovanovic SA, Nevins M. Bone formation utilizing titanium-reinforced barrier membranes. Int J Periodontics Restorative Dent. 1995;15(1):56-69.
34. 34. Dere K. Horizontal ve Vertikal Yönde Yapılan Kemik Augmentasyon Yöntemleri. 2023. p. 293-307.
35. 35. Stamp R, Fox P, O’neill W, Jones E, Sutcliffe C. The development of a scanning strategy for the manufacture of porous biomaterials by selective laser melting. Journal of Materials Science: Materials in Medicine. 2009;20:1839-48.
36. 36. Aerts E, Li J, Van Steenbergen MJ, Degrande T, Jansen JA, Walboomers XF. Porous titanium fiber mesh with tailored elasticity and its effect on stromal cells. Journal of Biomedical Materials Research Part B: Applied Biomaterials. 2020;108(5):2180-91.
37. 37. Briguglio F, Falcomata D, Marconcini S, Fiorillo L, Briguglio R, Farronato D. The Use of Titanium Mesh in Guided Bone Regeneration: A Systematic Review. Int J Dent. 2019;2019:9065423.
38. 38. Rakhmatia Y, Ayukawa Y, Furuhashi A, Koyano K. Microcomputed Tomographic and Histomorphometric Analyses of Novel Titanium Mesh Membranes for Guided Bone Regeneration: A Study in Rat Calvarial Defects. The International journal of oral & maxillofacial implants. 2014;29:826-35.
39. 39. Jung G-U, Jeon J-Y, Hwang K-G, Park C-J. Preliminary evaluation of a three-dimensional, customized, and preformed titanium mesh in peri-implant alveolar bone regeneration. Journal of the Korean Association of Oral and Maxillofacial Surgeons. 2014;40:181-7.
40. 40. Otawa N, Sumida T, Kitagaki H, Sasaki K, Fujibayashi S, Takemoto M, et al. Custom-made titanium devices as membranes for bone augmentation in implant treatment: Modeling accuracy of titanium products constructed with selective laser melting. Journal of Cranio-Maxillofacial Surgery. 2015;43.
41. 41. Polo M, Poli P, Rancitelli D, Beretta M, Maiorana C. Alveolar ridge reconstruction with titanium meshes: A systematic review of the literature. Medicina oral, patología oral y cirugía bucal. 2014;19:e639-46.
42. 42. Chan H-L, Benavides E, Tsai C-Y, Wang H-L. A Titanium Mesh and Particulate Allograft for Vertical Ridge Augmentation in the Posterior Mandible: A Pilot Study. International Journal of Periodontics & Restorative Dentistry. 2015;35(4).
43. 43. Toscano N, Shumaker N, Holtzclaw D. The art of block grafting: A review of the surgical protocol for reconstruction of alveolar ridge deficiency. JIACD. 2010;2.
44. 44. Esposito M, Grusovin M, Felice P, Karatzopoulos G, Worthington H, Coulthard P. The Efficacy of Horizontal and Vertical Bone Augmentation Procedures for Dental Implants. European journal of oral implantology. 2009;2:167-84.
45. 45. Donos N, Mardas N, Chadha V. Clinical outcomes of implants following lateral bone augmentation: systematic assessment of available options (barrier membranes, bone grafts, split osteotomy). Journal of clinical periodontology. 2008;35:173-202.
46. 46. Santos P, Gulinelli J, Telles C, Júnior W, Okamoto R, Buchignani V, et al. Bone Substitutes for Peri-Implant Defects of Postextraction Implants. International journal of biomaterials. 2013;2013:307136.
47. 47. Caballe-Serrano J, Abdeslam-Mohamed Y, Munar-Frau A, Fujioka-Kobayashi M, Hernandez-Alfaro F, Miron R. Adsorption and release kinetics of growth factors on barrier membranes for guided tissue/bone regeneration: A systematic review. Arch Oral Biol. 2019;100:57-68.
48. 48. Aprile P, Letourneur D, Simon‐Yarza T. Membranes for guided bone regeneration: a road from bench to bedside. Advanced healthcare materials. 2020;9(19):2000707.
49. 49. Simion M, Jovanovic SA, Trisi P, Scarano A, Piattelli A. Vertical ridge augmentation around dental implants using a membrane technique and autogenous bone or allografts in humans. Int J Periodontics Restorative Dent. 1998;18(1):8-23.
50. 50. Retzepi M, Donos N. Guided Bone Regeneration: biological principle and therapeutic applications. Clinical oral implants research. 2010;21(6):567-76.
51. 51. Wessing B, Lettner S, Zechner W. Guided bone regeneration with collagen membranes and particulate graft materials: a systematic review and meta-analysis. Int J Oral Maxillofac Implants. 2018;33(1):87-100.
52. 52. Marouf HA, El-Guindi HM. Efficacy of high-density versus semipermeable PTFE membranes in an elderly experimental model. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89(2):164-70.
53. 53. Zellin G, Linde A. Effects of different osteopromotive membrane porosities on experimental bone neogenesis in rats. Biomaterials. 1996;17(7):695-702.
54. 54. Lamb JW, 3rd, Greenwell H, Drisko C, Henderson RD, Scheetz JP, Rebitski G. A comparison of porous and non-porous teflon membranes plus demineralized freeze-dried bone allograft in the treatment of class II buccal/lingual furcation defects: a clinical reentry study. J Periodontol. 2001;72(11):1580-7.
55. 55. Lundgren AK, Lundgren D, Taylor Å. Influence of barrier occlusiveness on guided bone augmentation. An experimental study in the rat. Clinical oral implants research. 1998;9(4):251-60.
56. 56. Cucchi A, Ghensi P. Vertical guided bone regeneration using titanium-reinforced d-PTFE membrane and prehydrated corticocancellous bone graft. The open dentistry journal. 2014;8:194.
57. 57. Barber HD, Lignelli J, Smith BM, Bartee BK. Using a dense PTFE membrane without primary closure to achieve bone and tissue regeneration. Journal of Oral and Maxillofacial Surgery. 2007;65(4):748-52.
58. 58. Matumoto EK, Corrêa MG, Couso‐Queiruga E, Monteiro MF, Graham Z, Braz SHG, et al. Influence of partially exposed nonabsorbable membrane for alveolar ridge preservation: a randomized controlled trial. Clinical implant dentistry and related research. 2023;25(3):447-57.
59. 59. Krauser J. High-density PTFE membranes: uses with root-form implants. Dental Implantology Update. 1996;7(9):65-9.
60. 60. Rodriguez I, Selders G, Fetz A, Gehrmann C, Stein S, Evensky J, et al. Barrier membranes for dental applications: A review and sweet advancement in membrane developments. Mouth Teeth. 2018;2(1):1-9.
61. 61. Gutta R, Baker RA, Bartolucci AA, Louis PJ. Barrier membranes used for ridge augmentation: is there an optimal pore size? Journal of Oral and Maxillofacial Surgery. 2009;67(6):1218-25.
62. 62. Celletti R, Davarpanah M, Etienne D, Paecora G, Tecucianu J-F, Djukanovic D, et al. Guided tissue regeneration around dental implants in immediate extraction sockets: comparison of e-PTFE and a new titanium membrane. International Journal of Periodontics & Restorative Dentistry. 1994;14(3).
63. 63. Park SH, Wang HL. Clinical significance of incision location on guided bone regeneration: human study. Journal of periodontology. 2007;78(1):47-51.
64. 64. Konstantinidis I, Kumar T, Kher U, Stanitsas PD, Hinrichs JE, Kotsakis GA. Clinical results of implant placement in resorbed ridges using simultaneous guided bone regeneration: a multicenter case series. Clinical oral investigations. 2015;19:553-9.
65. 65. Cucchi A, Vignudelli E, Napolitano A, Marchetti C, Corinaldesi G. Evaluation of complication rates and vertical bone gain after guided bone regeneration with non‐resorbable membranes versus titanium meshes and resorbable membranes. A randomized clinical trial. Clinical implant dentistry and related research. 2017;19(5):821-32.
66. 66. Ricci L, Perrotti V, Ravera L, Scarano A, Piattelli A, Iezzi G. Rehabilitation of deficient alveolar ridges using titanium grids before and simultaneously with implant placement: a systematic review. Journal of Periodontology. 2013;84(9):1234-42.
67. 67. Miron RJ, Zucchelli G, Pikos MA, Salama M, Lee S, Guillemette V, et al. Use of platelet-rich fibrin in regenerative dentistry: a systematic review. Clinical oral investigations. 2017;21:1913-27.
68. 68. Merli M, Merli I, Raffaelli E, Pagliaro U, Nastri L, Nieri M. Bone augmentation at implant dehiscences and fenestrations. A systematic review of randomised controlled trials. Eur J Oral Implantol. 2016;9(1):11-32.
69. 69. Cucchi A, Chierico A, Fontana F, Mazzocco F, Cinquegrana C, Belleggia F, et al. Statements and recommendations for guided bone regeneration: Consensus report of the guided bone regeneration symposium held in Bologna, October 15 to 16, 2016. Implant dentistry. 2019;28(4):388-99.