A severe bone defect augmentation with bone graft & titanium mesh

Very nice concept of 3D reconstruction. Did you utilize any bioactive modifiers? Did you add tissue or do you plan to later in treatment? Why Ti-Mesh over standard Membranes which are kinder to early wound dehiscence? Why autogenous bone from Chin and not all Allograft or Xenograft? Please put re-entry of case on site when completed. Nicely performed and my compliments.
Dr. Salama

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Thanks for your scientific questions dr salama:1.i dident use any biomodifiers 2. i think before surgery i should increase kt to better flap management during surgery. i will do it in implant placement stage 3. to answer to third question i am not sure, but i think Ti mesh better than membrane can tolerate wound dehisence( better plaque control and less inflammation ) i wait for your answer to this question. 4. i used mixed autogen bone with allograft (50%_50%) to have better osteoblastic activity on whole of the defect. 5. ok i will put next stages photos here
thank you again
Ali

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please dr Salama answered me why bette membrane from ti mesh???please can u tell me ?best regards

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Without thick gingiva TiMesh has high exposure rate as high as 51% in literature. This may cause loss of some of the bone graft and gingival recession. Perhaps, Ti reinforced Gortex or CurV from Zimmer or Sonic Weld from KLS Martin may be kinder to outer flap.
Dr. Salama

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I think the results will be great because the exposure rate is highly dependent on flap management and ali is a skillful surgeon. To lower the risk membranes are the superior choice as Dr. Salama points out. For several reasons I would prefer Linea oblique as source of bone grafts. Sometimes the best source is right next to the defect. Please post the re-entry pictures. Did you perforate the cortical bone prior to augmentation? I like the nice form of your case presentation.

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thank you dear hanna. yes i always perforate cortical bone to release bone marrow growth factor. Titanium mesh has a low cost and in this case was my choice because of patient economy consideration.

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Great job Ali.
I usually do the same but most of the time i only use a low turn over rate bone graft such as FDBA or xenografts and it works.most of the time i prefer not to harvest autogenous bone from another area.in this part i am agree with Dr Salama.

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hi dear omid.im happy to see you here. autografts are the only well documented materials with osseoinductive potential. mixture autogen with other grafts can be enhance bone surface area for better augmentation(20 years of GBR in implant dentistry _ daniel buser 2009)
best regard
ali

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Before the Hard Tissue Management I would have increased the width of keratinized gingiva with a free gingival graft prior any GBR procedure lacking of keratinized tissue, especially with Ti Mesh and especially on the anterior area. High risk of early and delayed exposure. At this point I recommend to graft the area with a FGG prior to the implant placement. Good Luck

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