The Outcomes of Vertical Alveolar Bone Augmentation by Guided Bone Regeneration with Titanium Mesh: A Systematic Review.

AIM

This study aimed to systematically review the published studies on vertical alveolar bone augmentation (VABA) by guided bone regeneration (GBR) with titanium mesh (TM).

BACKGROUND

Guided bone regeneration is a procedure that can be used for VABA of the alveolar ridge. Titanium mesh is used as a barrier due to its ability to maintain a space that the newly formed bone will occupy.

MATERIALS AND METHODS

A computerized literature search was conducted on the databases PubMed, SCOPUS, Science Direct, and Cochrane Library to review the published article on VABA by TM from 2011 to 2021.

REVIEW RESULTS

Eight out of 574 retrieved articles were included in the qualitative analysis, three randomized clinical trials, two prospective clinical trials, and three retrospective trials. They were assessed for risk of bias using the critical appraisal skills program checklist. Titanium mesh was utilized as a barrier in three different ways, adapted directly on the alveolar bone, bent preoperatively on three-dimensional (3D) models, and 3D-printed. Two randomized clinical trials (RCTs) reported 20.8% bone gain, while the other studies reported the means ranging from 2.56 to 4.78 mm. All studies reported TM exposure that ranged from 7.69 to 66.66%. Exposure during the four postoperative weeks led to inadequate bone regeneration. However, late exposure had no effect or caused only slight bone resorption. Early TM removal was performed in two studies, one case per each, ranging from 2.4 to 11.1%. Infection was presented in three studies, one case per each, and the percentages were 5, 11.1, and 25%.

CONCLUSION

All types of TM had exposure, which was the most common complication, but early removal was indicated only in a few cases. Titanium mesh showed reliability and efficacy as a barrier for VABA by GBR.

CLINICAL SIGNIFICANCE

By this procedure, bone height can be restored, however, meticulous follow-up is recommended for the detection and management of TM exposures.