See the new J Perio. Good article on Ti Mesh

During my implant fellowship program, I had a chance to work with titanium mesh one time and I like it alot. Pt had a missing tooth site #12 for many years and the buccal bone defect was severed. I did two bone graft for that site and both failed. The first time I used DFDBA particulates and membrane. With post op appointments, I can tell that I did not gain the ideal alveolar thickness as I wanted. The second time I used iliac block with Lorenz screws and DFDBA particulates with membrane. Some how the block graft did not take. I ended up removing the block graft, and corticated the site for another graft. The 3rd time, my perio faculty and I ended up deciding on the titanium mesh membrane. I went back and used DFDBA particulate bone and fixated the titanium mesh with Lorenz screws. Four months later, we got awesome result, both width and height. When the pt was ready for implant placement, I already gradutated from the program. Thus, I have NO hesitation of using the Ti mesh again but always base on case selection.
ps. I have photophraphs for the procedure but don't know how to down loan them for you to see. :(

I have used titanium mesh several times.

Ace surgical sells it in two different thicknesses, as well as bioplate from impladent. I like it as thin as possible. It can be bent to conform to the shape that you want.

The first time I used it gave me some of the very best grafting results I had ever obtained. Since that time I have used it under various circumstances with success and failures.

Problems and recommendations with titanium mesh:

1. You must cut the mesh to fit the site. That leaves sharp edges which can cause exposure. The problem with the titanium mesh, is that if you leave sharp edges the mateial gets exposed.

The edges of the titanium mesh are sharp, and causes gingival irritation, which can lead to infection, exposure and failure of your graft.

Recommendation: Use orthodontic instruments to make the sharp areas curve towards bone instead of the soft tissues. Place a barrier over the mesh (my preference is collagen soaked in prp). Lastly tack the mesh occlusally and apicallty so that it will not move.

2. Exposure. My only advice is that if it does get exposed, to remove it asap and cover the grafted area with collagen or alloderm.

3. Removal of the mesh. Some times it works so well that bone grows through, not just under the mesh. Also, it can become imbedded in soft tissue.

Recommendation: Just allow more time for removal.

When placing ti mesh, always extend the flap at least one tooth mesial and distal to the graft site. Score the flap to obtain primary closure.

Give titanium mesh a try. It is versatile. Often the hardest part is the fixation step. Placing screws or tacks in every area of the mouth can be a challenge.

Hope that helps you all.

Brooke

I have not used the Macropore mesh, but I have used Vicryl Mesh with results that I was happy with. I too would be interested in hearing people's experience with the resorbable screws.

I have seen some great results with Titanium mesh, but I have also seen some catastrophic failures. The problem with Ti Mesh is sharpness. Usually, somewhere on the mesh, there will be sharp spots after trimming, bending, tacking, etc. When I used to do Ti Mesh, I would cover with a membrane in an effort to "cover" the sharp spots.

My bottom line in GBR is predictable results with as few complications as possible. Dealing with one failure can erase the satisfaction of ten successful cases. I like to minimize my failures, so I don't do Ti mesh anymore. Like I said, I got many good results from it, but the few failures I had caused me so much grief that I don't do it anymore. Over time, experience has shown me other techniques that produce similar, if not better, results with more predictability and less risk.

Just my 2 cents.

I myself have had problems with ti-mesh. Difficult to work with. Always exposes. What results have others had and any tips to make life easier?

I agree with the above comments. I feel the same about thin versus thick tissue. A clinician needs to make sure there is no sharp areas and there is good closure

Dr Pratt,
Indeed Ti Mesh can be difficult when exposed due to flap tension.The key is the soft tissue and the soft tissue manipulation.Thin soft tissue will create a nightmare therfore sometimes you will need to pregraft with conn tissue or dermis to increase volume and thickness prior to your augmentation procedure.Second- flap relese and when you think it is released enough,release some more...
The mesh I like to use is osteomesh by Osteogenics and i fixate it with mini screws.

Ziv when do you decide to augment the tissue before ti-mesh? How do you sell the patient on the idea of two surgeries when you can use regenaform to accomplish the goal without t-mesh.
I quess my real question is when do you decide to use ti-mesh vs regenaform?
Thanks Barry

Dear Ziv,
I think Barry wanted to know what kind of defects need ti-mesh with regenaform vs using regenaform without ti mesh?
What defects do you feel can be restored with regenaform with a membrane versus what defects do you need to break out the mesh?
TY
Tina

As for limits- one can say the sky is the limit yet to my experience horizontal aug is highly predictable using Regenaform with a membrane either with tent screws or Ti reinforced dense PTFE.
As for vertical- these are the ones I prefer using the Ti mesh with Regenaform.
As for bleeding- try to decorticate at the beginning and not just before placing the graft.The bleeding will be much less over time.

Anyone using Ti-mesh with infuse?

Dear Varghese
Thanks again for the compliments.As you know I love teaching and getting these feedbacks gives me more energy to carry on.
Regarding your question on stabilization of the mesh let me give you two tips:
1)make a small hole in the mesh before placing it and the graft so you will not suffer and sweat...of course undersize the hole to fit with your fixating screw.
2)If you decide to use tacks- I prefer the autotec from Biohorizon yet sometimes in lower mandible and dense bone you will have difficulty in tacking.
Keep on your good work and looking forward to see you again in our future courses.Dates can be found in www.handsoncourse.com

Steve- I usually use the Mesh by Osteogenics which has snall pores .In that type of a mesh you can tack through yet you can't screw without making a hole initially.
Large meshes such as the one from Ace you can screw without any preparation.

What Mesh system are people using and Why?

KLS has a nice jaw recon kit with screws. It does have a hefty cost but well worth it.

What are others using for ti Mesh?