Part 2- GBR with preformed titanium meshes

126 Rating(s).


Posted on By Cristian Rotaru In Bone Grafting

Hi,

This is an update of the case posted a while back--In the upper right corner.
Next apointment is in Jan for FGG and provisionals.




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12 Comments

Impressive. Do you have any cases where the ti-mesh has perforated the flap? If so how did you manage? How is the bone beneath the mesh? Can you describe for us. Thanks again. Great skills. Dr. Salama


Reply

Hi, Dr S!
As i said in another post on this forum, i have aound 60+ now of this meshes used untill now and i didnt experienced any early or late exposure YET. I have only one case where the overlying mucosa bacame so thin that i could see the membrane through it and i managed this by inserting a CTG at the time of mesh removal.


Thank you !


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Beautiful result Cristian. Can these membranes be used with the implant cover screws or do they have their own cover screws?


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Hi, Naheed.

The membranes have their own screws that you need to buy, the flat abutment and the cover screw and a specific key for them.

http://megagen.ro/wp-content/uploads/2014/12/igen-gbr-membrane.pdf

If you are to use them for implants that needs to sit subcrestal, i suggest you take also the flat abutments and screw for this membranes, because the flat abutments make the membrane to sit above the implant shoulder with 1 mm and thus the augmented bone is above implant shoulder and the implant will be subcrestal.
BUT, If you are to use them for bone level implants, you can use the provided implant screws. I used them with other system that needs to be seated at bone level or above and i used the implant screw to fix the membrane, but first look at the length of the thread of the screw and check to have enough threads to be well engaged into the implants when fixing the membranes. I have used one system with the threaded part of the screw short and i couldnt engage very good the implant with the mesh between them and this gave me a hard time intraop

Thank you for your comment , hope this helps :)


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Thank you for such a detailed response. I will look into it.


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Christian. I tried these meshes when they were first introduced and observed similar early healing results. Soft tissue between the graft and Ti BUT also apparently well vascularized graft independent of Ti " protected" regions. IMO these meshes are "flimsy" and allow micomotion. Today I perform this similar type of augmentation with the same FLAP MANANGEMENT AND SUTURES but WITHOUT the Ti MESH. Using ONLY taller healing COLLARS for TENTING. I have found slightly less bone present during early healing but no difference within a year. Have you tried this approach without the mesh? BTW your work is impeccable and pleasure to view! Best regards. Chuck


Reply

Hi, dr Scwimmer .

Thank you for your comment and information.

I agree with you, these membranes are quite flimsy and unstable if not secured properly. I found this the hard way with a not so great result because of the apical part of the membranes not being secured to the bone with micromovement during healing probably.
I now try to secure them by bending them more before placing so that the apical part of the mesh seats firmly on the bone and also use periosteal flap to further tighten the mebrane against bone. I leave this suture for 1 month.
If that doesnt work , i use also an apical screw though the membrane to the bone and secure it this way.

Can you be more specific about your approach nowadays ? Sounds very interesting and i am willing to try it. If i undersatood well, you are using collars for tenting and you cover the bone with what ? What type of bone graft do you use, i presume DFDBA.

Thank you again.

Kind regards !


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Hi christian, what a great result. Its really a treat to watch.

Have you ever tried other bone graft materials (for example synthetic or bovine or combination etc.) for horizontal augmentation under Ti Mesh. Whats your opinion on that. Regards, Ashok.


Reply

Hi, Ashok !

Thank you very much for your compliment !

I have used these membranes only with autogenous or a mix of autogenous and cortical or corticocancellous allograft . I never used them with xeno or synthetic.
Currently we have a problem in the country with allografts and when my stock will end, i will be using autogenous and xeno probably, but untill now i never did use xeno or synthetic.

Not such a big fan of xeno or synthetic as i never liked the quality of the bone when re-entering, i am more of a autogenous type of guy :)

Thanks.

Best wishes !


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Thanks Christian. Regarding DFDBA Iam also facing the same situation in my country hence I asked you that questions. I have few doubts to be clarified in this technique. ashok_v2000@yahoo.com ,can you write an e- mail so that I can ask you more questions, lol.Regards .Dr.Ashok


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Christian,

Beautiful work !!. I have learned that without skill and knowledge of surgical principles, no technique or magical product will work. Your skills in managing this case are outstanding,, Bravo!!.
On a side note, I have to say that I am in agreement with chuck. My experience with these membrane has lead me to the fact that micro motion is a big problem, and they often need additional means of stabilization. When securing them only coronally, I have often ended with bone/tissue that is soft. Personally, I still use these meshes for small buccal defects while additionally securing them periosteal sutures or a tacked collagen membranes. In larger defects like the one you show I feel more comfortable using small pieces of traditional mesh that I can tack down.

Thank you for sharing this beautiful case and result :)

Ehab


Reply

Hi, Ehab !

Thank you for your comment and for the nice words !

I would welcome your experience to comment this case and i wish i could have your input on every cases that i share here, as you are one great clinician.

As i said in my bellow comment, i too agree with the fact that these meshes are a bit tricky to use and to get good results if they arent stabylized well enough.
Untill now, fixing it with an additional apical screw, using periostal sutures and preforming them more before placing, have returned good results at uncovery. Leaving them with just the coronal provided screw fixation is not predictable. By adding an apical srew you now have a 2 point stable fixation and i dont feel the need for using a traditional mesh.

i wish you all te best !


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