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JC NO - 06

PRESENTED BY

DR. RAHUL TIWARI

FINAL YR. MDS

OMFS, SIDS

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TITLE

• PREDICTABILITY OF STAGED LOCALIZED

ALVEOLAR RIDGE AUGMENTATION USING A

MICRO TITANIUM MESH

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JOURNAL

• ORIGINAL ARTICLE

• ORAL MAXILLOFAC SURG (2015) 19:411–416

• DOI 10.1007/S10006-015-0513-6

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ARTICLE

• SHINOBU UEHARA & HIROSHI KURITA & TETSU SHIMANE & HIRONORI SAKAI &

• TAKAHIRO KAMATA & YUJI TERAMOTO & SHINICHI YAMADA

• RECEIVED: 25 NOVEMBER 2014 • ACCEPTED: 9 JUNE 2015 • PUBLISHED ONLINE: 20 JUNE 2015• SPRINGER-VERLAG BERLIN HEIDELBERG 2015

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AUTHOR• HIROSHI KURITA• HKURITA@SHINSHU-U.AC.JP

• DEPARTMENT OF DENTISTRY AND ORAL SURGERY, SHINSHU UNIVERSITY

• SCHOOL OF MEDICINE, 3-1-1 ASAHI, MATSUMOTO 390-8621, JAPAN

• DEPARTMENT OF DENTISTRY AND ORAL ANDMAXILLOFACIAL SURGERY, NAGANO

• MUNICIPAL HOSPITAL, NAGANO, JAPAN

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AIM

• RETROSPECTIVELY EVALUATE THE SUCCESS RATE OF STAGED LOCALIZED ALVEOLAR RIDGE AUGMENTATION USING TITANIUM MICROMESH.

• IN ADDITION, THE FACTORS THAT INFLUENCED THE SUCCESS WERE ANALYZED.

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INTRODUCTION• LOCALIZED REGENERATION AND ENLARGEMENT OF RESORBED

ALVEOLAR RIDGES PRIOR TO INSERTION OF DENTAL IMPLANTS IS STILL A CHALLENGING SURGICAL PROCEDURE.

• VARIOUS METHODS OF BONE GRAFTING CAN BE USED WITH VARYING DEGREES OF EXPECTED SUCCESS.

• SPLITTING OSTEOTOMY • DISTRACTION OSTEOGENESIS • ONLAY BLOCK• GRAFTS • GUIDED BONE REGENERATION (GBR)

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INTRODUCTION• SEVERAL MEMBRANES (NON-RESORBABLE AND

RESORBABLE) HAVE BEEN UTILIZED IN ORDER TO ENHANCE BONE GRAFT STABILIZATION AND TO MINIMIZE THE RISK OF COLLAPSE AND/OR SOFT TISSUE DEHISCENCE.

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INTRODUCTION

• IN RECENT YEARS, THE USE OF MICRO TITANIUM MESH IN COMBINATION WITH BONE GRAFTS AND BONE SUBSTITUTES HAS BEEN PROPOSED AND TESTED FOR GUIDED/PROTECTED BONE AUGMENTATION.

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INTRODUCTION• THE ADVANTAGE OF MICRO TITANIUM MESH

OVER OTHER NON-RESORBABLE MEMBRANES IS LESS INFECTION IN THE CASE OF SOFT TISSUE DEHISCENCE DURING HEALING.

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REVIEW

OF LITERATURE

2004 -18 Pt. – 6 months

19 mesh – 6 months – 93.1% success

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•

REVIEW

OF LITERATURE

computer-aided design technique - 26 participants

2012- 21 Pt.- 69 implants- 6 months - 100% success

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MATERIALS AND METHODS• THERE WERE 14 WOMEN AND 7 MEN • MEAN AGE OF 47.5 (SD, 11.6) YEARS• MAY 2005 TO DECEMBER 2008

• TWENTY-THREE ALVEOLAR RIDGES (64 IMPLANTS)• POSTERIOR MANDIBLE -12, • ANTERIOR MAXILLA- 7• ANTERIOR AND POSTERIOR MAXILLA - 3, • POSTERIOR MAXILLA- 1

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INCLUSION CRITERIA

• REQUIRED BONE AUGMENTATION OF MORE THAN 4 MM IN HEIGHT

AND/OR IN WIDTH

• STANDARD SIZE OF ENDOSSEOUS IMPLANT (MAXIMUM DIAMETER≥ 4

MM AND LENGTH≥10 MM).

• ALL PATIENTS WERE HEALTHY - NO LOCAL OR SYSTEMIC

CONTRAINDICATIONS TO ORAL SURGERY OR IMPLANT PLACEMENT

INCLUDING SMOKING

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EXCLUSION CRITERIA

• REQUIRED RIDGE EXPANSION,

• OSTEOTOMY,

• SINUS FLOOR ELEVATION

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CRITERIA

• INSTITUTIONAL ETHICAL COMMITTEE

• ALL SURGICAL PROCEDURES WERE PERFORMED BY THE SAME SURGEON

UNDER LOCAL ANESTHESIA WITH INTRAVENOUS SEDATION / GENERAL

ANESTHESIA.

• PRIOR TO SURGERY- CEFMETAZOLE SODIUM 1 GM.

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RIDGE PROFILE CLASSIFIED ACCORDING TO THE REPORT OF VON ARX ET AL. (1998)

A: ridge width >5 mm, no/slight vertical resorptionB: ridge width 2.5–5 mm, no slight vertical resorptionC: ridge width 2.5–5 mm, moderate vertical resorption C-H: ridge width >5 mm, extensive vertical resorptionC-W: ridgewidth <2.5mm, no/slight vertical resorptionD: ridge width >5 mm, severe atrophy

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PROCEDURE

• LOCAL ANESTHESIA

• MID CRESTAL AND VERTICAL RELEASING INCISIONS

• MUCO-PERIOSTEAL FLAPS IN BUCCAL AND LINGUAL ASPECTS

• PERFORATIONS INTO THE MARROW SPACE WERE MADE IN THE CORTICAL BONE USING SMALL ROUND SURGICAL BURS TO FACILITATE BLEEDING AND THE INCORPORATION OF GRAFT MATERIALS

• AUTOGENOUS CORTICAL/CANCELLOUS BONE GRAFT WAS HARVESTED

• THE DONOR SITE WAS THE CHIN IN 20, MANDIBULAR RAMUS IN 2, AND ILIAC CREST IN 1 CASE

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PROCEDURE• AT 15 SITES, AUTOGENOUS BONE GRAFT WAS MIXED WITH

HYDROXYAPATITE PARTICLES IN A 50:50 MIXTURE AT MAXIMUM

• 0.1-MM-THICK MICRO TITANIUM MESH WAS TRIMMED AND PARTIALLY SECURED WITH SELF-DRILLING TITANIUM MICRO-SCREWS IN THE BUCCAL ASPECT

• GRAFT MATERIAL WAS THEN PLACED UNDERNEATH TITANIUM MESH WAS THEN COVERED OVER THE GRAFT MATERIAL AND SECURED USING TITANIUM MICRO-SCREWS.

• PERIOSTEAL FENESTRATIONS WERE MADE ALONG THE BUCCAL FLAP TO EXTEND THE FLAP CORONALLY OVER THE MESH AS FAR AS NECESSARY AND TENSION-FREE, TIGHT WOUND CLOSURE WAS ACCOMPLISHED

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• ALVEOLAR RIDGE AUGMENTATION USING TITANIUM MICROMESH. A MUCO-PERIOSTEAL FLAP WAS ELEVATED.

• GRAFT MATERIAL WAS THEN PLACED UNDERNEATH A PARTIALLY FIXED TITANIUM MESH TO COMPLETELY FILL THE AUGMENTED SPACE.

• TITANIUM MESH WAS THEN COVERED OVER THE GRAFT MATERIAL.

• TENSION-FREE AND TIGHT WOUND CLOSURE WITH EXTENDED MUCO-PERIOSTEAL FLAP

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ASSESSMENT

• EACH ALVEOLAR AUGMENTATION WAS ASSESSED AT THE TIME

OF IMPLANT PLACEMENT, ABUTMENT CONNECTION, FINAL

RESTORATION, AND FOLLOW-UP (MEDIAN FOLLOW-UP OF 40

MONTHS, RANGE 15–77 MONTHS).

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EACH ALVEOLAR AUGMENTATION WAS CLASSIFIED ASSUCCESSFUL ACCORDING TO THE FOLLOWING CRITERIA:

• A STANDARD SIZE (MAXIMUM DIAMETER≥4 MM AND LENGTH≥ 10 MM) ENDOSSEOUS IMPLANT WAS SUCCESSFULLY PLACED.

• THERE IS NO NEED FOR ADDITIONAL BONE GRAFT.• THERE IS NO BONE DEHISCENCE OR MARGINAL LOSS AT THE

TIME OF ABUTMENT CONNECTION.• CLINICALLY GOOD OSSEOINTEGRATION WAS OBTAINED, AND

DEFINITIVE RESTORATION WAS ACHIEVED.• ACCEPTABLE ESTHETIC RESULTS WITHOUT GINGIVAL

PROSTHESIS, ESPECIALLY IN THE ESTHETIC ZONE.

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ANALYSIS• IN ADDITION, THE SUCCESS RATE WAS COMPARED BETWEEN

THE DIFFERENT CLINICAL AND SURGICAL CONDITIONS OF THE

AUGMENTATION SITE.

• THE DIFFERENCE WAS TESTED USING THE CHI-SQUARE TEST,

GOODNESS

• TEST OF FIT FOR CHI-SQUARE, OR THE MANN–WHITNEY U TEST.

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RESULTS

• MESH REMOVED AFTER 6 MONTHS

• SUCCESS - 56.6 %

• THE SUCCESS RATE WAS LOW IF INFECTION OF THE GRAFTED MATERIAL WAS OBSERVED - 10 SITES (44 %)

• THE EXPOSURE (70%) OF TITANIUM MESH HAD NO NEGATIVE IMPACT.

• EARLY REMOVAL – 6 SITES- 3 MONTHS

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DISCUSSION

• THE RESULTS OF THIS STUDY SHOWED THAT IF THE STAGED

ALVEOLAR AUGMENTATION USING TITANIUM MICROMESH WAS JUDGED

ACCORDING TO OUR SUCCESS CRITERIA, THE SUCCESS RATE WAS

ESTIMATED AS 56.6 %.

• THE PREDICTABILITY OF THIS AUGMENTATION TECHNIQUE IS NOT SO

HIGH.

• 23 SITES – 64 IMPLANTS – 40 MONTHS FOLLOW UP – 98.4% SUCCESS.

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+/-• RESULTS WERE CONTRAST TO PREVIOUS STUDIES

• INSUFFICIENT SAMPLES FOR MULTIVARIATE ANALYSIS

• NO CONTROL

• NO CRITICAL DATA CONCERNING BONE VOLUME

• SHORT-TERM FOLLOW-UP.

• OTHER IMPORTANT FACTORS (GRAFTING MATERIAL, SURGICAL

APPROACH, ETC.)

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CONCLUSION• 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 LENGTH OF THE

SPAN OF THE AUGMENTATION SITE AND INFECTION OF THE

GRAFT MATERIAL, WHICH WERE ASSOCIATED WITH

MODERATE TO SEVERE VERTICAL RIDGE RESORPTION

AND/OR MECHANICAL AND FUNCTIONAL LOADING AT THE

SURGICAL SITE.

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THANK YOU