Titanium Mesh Technique for Simulataneously horizontal and vertical ridge Augmentation

congratulation for your nice result omid. A question; is there any different between mesh designs an diameters, for example in my case mesh has a smaller hole than your mesh or mesh that dr misch used in her presentation has a different design?

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Tnx Ali
Well when talking about prevention of soft tissue the micro meshes acts better,and soft tisshue retraction at recently is much easier,also according to a literature by Gutta 2009 it has been shown macro meshes can have better new bone formation than micro meshes.i usually use a layer of alloderm or similar products on titanium mesh,not only increasing soft tissue thickness if it's needed,but also especially in cases of larger pore sizes the invasion of soft tissue I going to be reduced.

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good job.did you used resorbable memberane on top ti mesh?did you faced to ti mesh or memberane exposure?if yes what did you do? thanks again dr neamat.kol

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Tnx Neemat
Well in this case I didn't,but most of the time I use a layer of alloderm or collagen on top of the mesh.no exposure happened in this case,but I have had some cases with exposure,all I did was just instructing my patient to rinse the area with chlorhexidine and most of the time the wound margins closed by secondary intention healing.the point which is really important is tension free closure of the flap and tissue thickness according the amount of the augmentation.

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thanks alot dear dr omid moghaddas for your excellent comment.

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Dear Omid,

Excellent technique with a great result !

I have a couple of questions for you.

1-What type of bone graft do you use?

2-You said you've had exposures, where you just instructed the patients on Chlorhexidine rinse and the wound closed. Do you mean early or late exposures?

Thank you.

Cheers,

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Dear Nawwaf
I used FDBA in this case.no exposure in this case,but in few of my other cases,it happened at the incision line,about 3to4 weeks after surgery with about 1-2mm opening,I instruct my patient to rinse the area ,and healing happened without any intervention.

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dr omid moghaddas:
why FDBA?

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The reason is FDBA is a slow turn over rate bone graft,in these cases I need a bone graft which resorbs slowly cause I need it as a scaffold to be there for bone formation and maturation which take place in about six months,also you can use xenografts cause they have slow turn over rates too.

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Are you believe to use biomodifier such as BMP2 in this case?

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I think it was not necessary to use them in this case.i have used a mesh which protect my graft and stabilize it,also a graft material which acts as scaffold,but in cases which I want to have enhanced soft tissue healing I think it would be logical to use modifiers,I have used PRGF in some of my cases,And the conclusion I got was better soft tissue healing and less exposure of mesh or non restorable membranes.

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EXCUSE ME DR MOGHADDAS ,IF WE USE BIO ACTIVE-MODIFIER,RISK MEMBERANE EXPOSURE IS MORE,AM I RIGHT?

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no ,it will be lower,we have also articles in this field by Torres 2010,by Misch 2012 and more.

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Hi nice performance thanks
My question is about the adjacent teeth.did you use any regenerative material such as emdogain on adjacent root surface to promote the PDL regeneration or not?you know in these cases the main problem is regarding to the neighboring teeth bone crest which potentially determines the level of our enhancing attachment and somehow limits the amount of bone volume vertically.
Best regards

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No i didnt. but root planning of adjacent teeth is important.
usually we can gain the bone vertically to the level of inter proximal bone of adjacent teeth,and in this case it happened.the point to remember is that its not predictable to try to gain bone in a higher level than interproximal bone even with use of emdogain or similar materials.

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