Dense Polytetrafluoroethylene Membrane versus Titanium Mesh in Vertical Ridge Augmentation: Clinical and Histological Results of a Split-mouth Prospective Study
Carlo Maiorana, Filippo Fontana, Marco Rasia dal Polo, Stefano Pieroni, Luca Ferrantino, Pier Paolo Poli, Massimo Simion
Bone atrophy, Bone regeneration, Dental implants, Histology, Nonresorbable membranes, Prospective cohort study, Titanium mesh
Citation Information :
Maiorana C, Fontana F, dal Polo MR, Pieroni S, Ferrantino L, Poli PP, Simion M. 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):465-472.
Aim and objective: The aim of the present split-mouth prospective study was to evaluate clinically and histologically the bone regeneration obtained following preprosthetic vertical bone augmentation performed with titanium-reinforced dense polytetrafluoroethylene membrane (d-PM) compared to titanium mesh (TM).
Materials and methods: Healthy adult patients presenting with bilateral partial edentulism in the posterior mandible requiring vertical ridge augmentation for implant placement purposes were consecutively included. One side of the mandible was randomly assigned to the use of d-PM, the other to TM. The graft consisted in a mixture of autogenous bone harvested nearby the surgical site and deproteinized bovine bone mineral particles in a 1:1 ratio. On each side during bone augmentation surgery, a 2-mm diameter mini-implant was inserted for clinical and histological analyses. After a healing period of 8 months, the second surgical phase was carried out to remove the nonresorbable barriers, to evaluate clinically the vertical bone gain, and to collect a bone biopsy that included the mini-implant. During the same surgical session, dental implants were inserted in a prosthetically guided position.
Results: A total of five patients were enrolled. Eight out of 10 sites healed uneventfully. In the remaining two sites, premature exposure of the TM was observed. Mean vertical bone gain of 4.2 and 1.5 mm was achieved in d-PM and TM groups, respectively (p = 0.06). A mean mineralized tissue of 48.28 and 35.54% was observed in d-PM and TM groups, respectively (p = 0.51).
Conclusion: The vertical bone gain, although not significantly, was higher in the d-PM group. Similar histological outcomes were noticed if exposure did not occur. In case of wound dehiscence, major resorption was observed.
Clinical significance: Both d-PM and TM can be used to augment atrophic localized ridges vertically. The outcome of bone regeneration seems to be impaired by exposure of the device.
Beretta M, Cicciu M, Poli PP, et al. A retrospective evaluation of 192 implants placed in augmented bone: long-term follow-up study. J Oral Implantol 2015;41(6):669–674. DOI: 10.1563/aaid-joi-D-14-00123.
Schwartz-Arad D, Levin L, Sigal L. Surgical success of intraoral autogenous block onlay bone grafting for alveolar ridge augmentation. Implant Dent 2005;14(2):131–138. DOI: 10.1097/01.id.0000165031.33190.0d.
Cano J, Campo J, Moreno LA, et al. Osteogenic alveolar distraction: a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101(1):11–28. DOI: 10.1016/j.tripleo.2005.04.015.
Poli PP, Beretta M, Cicciu M, et al. Alveolar ridge augmentation with titanium mesh. A retrospective clinical study. Open Dent J 2014;8:148–158. DOI: 10.2174/1874210601408010148.
Rocchietta I, Fontana F, Simion M. Clinical outcomes of vertical bone augmentation to enable dental implant placement: a systematic review. J Clin Periodontol 2008;35(8 Suppl.):203–215. DOI: 10.1111/j.1600-051X.2008.01271.x.
Esposito M, Grusovin MG, Felice P, et al. Interventions for replacing missing teeth: horizontal and vertical bone augmentation techniques for dental implant treatment. Cochrane Database Syst Rev 2009(4):Cd003607. DOI: 10.1002/14651858.CD003607.pub3.
Simion M, Jovanovic SA, Tinti C, et al. Long-term evaluation of osseointegrated implants inserted at the time or after vertical ridge augmentation. A retrospective study on 123 implants with 1-5 year follow-up. Clin Oral Implants Res 2001;12(1):35–45. DOI: 10.1034/j.1600-0501.2001.012001035.x.
Urban IA, Monje A, Lozada JL, et al. Long-term evaluation of peri-implant bone level after reconstruction of severely atrophic edentulous maxilla via vertical and horizontal guided bone regeneration in combination with sinus augmentation: a case series with 1 to 15 years of loading. Clin Implant Dent Relat Res 2017;19(1):46–55. DOI: 10.1111/cid.12431.
Urban IA, Lozada JL, Jovanovic SA, et al. Vertical ridge augmentation with titanium-reinforced, dense-PTFE membranes and a combination of particulated autogenous bone and anorganic bovine bone-derived mineral: a prospective case series in 19 patients. Int J Oral Maxillofac Implants 2014;29(1):185–193. DOI: 10.11607/jomi.3346.
Ronda M, Rebaudi A, Torelli L, et al. Expanded vs. dense polytetrafluoroethylene membranes in vertical ridge augmentation around dental implants: a prospective randomized controlled clinical trial. Clin Oral Implants Res 2014;25(7):859–866. DOI: 10.1111/clr.12157.
Boyne PJ. Restoration of osseous defects in maxillofacial casualities. J Am Dent Assoc 1969;78(4):767–776. DOI: 10.1016/s0002-8177(69)84023-7.
Boyne PJ, Cole MD, Stringer D, et al. A technique for osseous restoration of deficient edentulous maxillary ridges. J Oral Maxillofac Surg 1985;43(2):87–91. DOI: 10.1016/0278-2391(85)90054-0.
Gongloff RK, Cole M, Whitlow W, et al. Titanium mesh and particulate cancellous bone and marrow grafts to augment the maxillary alveolar ridge. Int J Oral Maxillofac Surg 1986;15(3):263–268. DOI: 10.1016/s0300-9785(86)80083-7.
Maiorana C, Santoro F, Rabagliati M, et al. Evaluation of the use of iliac cancellous bone and anorganic bovine bone in the reconstruction of the atrophic maxilla with titanium mesh: a clinical and histologic investigation. Int J Oral Maxillofac Implants 2001;16(3):427–432.
Pieri F, Corinaldesi G, Fini M, et al. Alveolar ridge augmentation with titanium mesh and a combination of autogenous bone and anorganic bovine bone: a 2-year prospective study. J Periodontol 2008;79(11):2093–2103. DOI: 10.1902/jop.2008.080061.
Corinaldesi G, Pieri F, Marchetti C, et al. Histologic and histomorphometric evaluation of alveolar ridge augmentation using bone grafts and titanium micromesh in humans. J Periodontol 2007;78(8):1477–1484. DOI: 10.1902/jop.2007.070001.
Proussaefs P, Lozada J. Use of titanium mesh for staged localized alveolar ridge augmentation: clinical and histologic-histomorphometric evaluation. J Oral Implantol 2006;32(5):237–247. DOI: 10.1563/1548-1336(2006)32[237:UOTMFS]2.0.CO;2.
Lozada J, Proussaefs P. Clinical radiographic, and histologic evaluation of maxillary bone reconstruction by using a titanium mesh and autogenous iliac graft: a case report. J Oral Implantol 2002;28(1):9–14. DOI: 10.1563/1548-1336(2002)028<0009:CRAHEO>2.3.CO;2.
Roccuzzo M, Ramieri G, Spada MC, et al. Vertical alveolar ridge augmentation by means of a titanium mesh and autogenous bone grafts. Clin Oral Implants Res 2004;15(1):73–81. DOI: 10.1111/j.1600-0501.2004.00998.x.
von Arx T, Hardt N, Wallkamm B. The TIME technique: a new method for localized alveolar ridge augmentation prior to placement of dental implants. Int J Oral Maxillofac Implants 1996;11(3): 387–394.
Cucchi A, Vignudelli E, Napolitano A, et al. 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. Clin Implant Dent Relat Res 2017;19(5):821–832. DOI: 10.1111/cid.12520.
Cucchi A, Sartori M, Parrilli A, et al. Histological and histomorphometric analysis of bone tissue after guided bone regeneration with non-resorbable membranes vs resorbable membranes and titanium mesh. Clin Implant Dent Relat Res 2019;21(4):693–701. DOI: 10.1111/cid.12814.
O‘Leary TJ, Drake RB, Naylor JE. The plaque control record. J Periodontol 1972;43(1):38. DOI: 10.1902/jop.1918.104.22.168.
Fontana F, Santoro F, Maiorana C, et al. 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):1003–1012.
Rasia-dal Polo M, Poli PP, Rancitelli D, et al. Alveolar ridge reconstruction with titanium meshes: a systematic review of the literature. Med Oral Patol Oral Cir Bucal 2014;19(6):e639–e646. DOI: 10.4317/medoral.19998.
Tinti C, Parma-Benfenati S, Polizzi G. Vertical ridge augmentation: what is the limit? Int J Periodontics Restorative Dent 1996;16(3): 220–229.
Ricci L, Perrotti V, Ravera L, et al. Rehabilitation of deficient alveolar ridges using titanium grids before and simultaneously with implant placement: a systematic review. J Periodontol 2013;84(9):1234–1242. DOI: 10.1902/jop.2012.120314.
Fontana F, Maschera E, Rocchietta I, et al. Clinical classification of complications in guided bone regeneration procedures by means of a nonresorbable membrane. Int J Periodontics Restorative Dent 2011;31(3):265–273.
Watzinger F, Luksch J, Millesi W, et al. Guided bone regeneration with titanium membranes: a clinical study. Br J Oral Maxillofac Surg 2000;38(4):312–315. DOI: 10.1054/bjom.1999.0228.
Lizio G, Corinaldesi G, Marchetti C. Alveolar ridge reconstruction with titanium mesh: a three-dimensional evaluation of factors affecting bone augmentation. Int J Oral Maxillofac Implants 2014;29(6):1354–1363. DOI: 10.11607/jomi.3417.