Reconstruction of maxilla and mandible with titanium mesh for implants

Objective: To specifically evaluate the magnitude of ridge augmentation with a particular surgical technique, overall graft success, anatomic location of ridge defects and their relationship to exposure Materials and Methods: This is a retrospective study that evaluated 45 patients reconstructed with autogenous particulate bone graft and titanium mesh for the purposes of implant placement. Included were patients that had maxillary or mandibular atrophy and segmental defects due to trauma or tumor resection. Autogenous bone graft was harvested from iliac crest, tibia, and mandibular symphysis and mixed with particulate hydroxyapatite in a 75:25 ratio. Average augmentation bone heights were measured and compared. Statistical analysis was done with ANOVA and student's T-test. Results: Of these patients, 29 underwent mandibular reconstruction and 16 underwent maxillary reconstruction. In the mandible complete augmentation group, the mean increase in height is 13.71mm ± 1.14mm (P<0.0001). In the mandible partial defect augmentation group, mean increase in height is 14mm ± 1.42 (P<0.0001). Mean increase in height in anterior mandible defects is 13.47mm ± 1.48 (P<0.0001) and in posterior mandible, mean increase in height is 15.80mm ± 2.72 (P<0.0001). In maxillary complete augmentation group, mean increase in height is 14.3mm ± 1.33mm (P<0.0001) and mean increase in height in the anterior maxillary defects is 11.33mm ± 1.72 (P<0.0001). Total of 82 implants were placed in maxilla and 92 implants were placed in the mandible. In the maxillary group 7 sites had exposed the titanium mesh and 16 sites were exposed in the mandible. Conclusion: Porous titanium mesh is reliable method of containment system used for reconstruction of maxilla and mandible. This material tolerates exposure very well and gives predictable results. In spite of exposure of the material in 23 of 45 sites, generally in the form of small dehiscence, early removal was necessary in only 4 patients.