Vertical Ridge Augmentation Using Xenogenic Material Supported by a Configured Titanium Mesh: Clinicohistopathologic and Histochemical Study

Purpose: The aim of this study was to evaluate the capability of a configured titanium mesh (CTM) to serve as a mechanical and biologic device for restoring a vertically defected/resorbed alveolar ridge. Materials and Methods: The study comprised 10 severely resorbed sites in 10 patients. Pre- and postoperative ridge measurements were taken with reference to the neighboring teeth and supporting screw head base of the CTM. Bovine bone mineral served as the augmentation filler material. The metal mesh was removed after 9 months. Subsequently, root-form, screw-type implants were placed. During the implant placement phase, cylindric bone samples were retrieved from the augmented area for histopathologic and histochemical examination. Results: Upon soft tissue reflection and before augmentation, defect height, as recorded by a periodontal probe along the main threads exposed on the support screw, was between 5 and 8 mm (average 6.4 mm; SD ± 1.17). At 9 months after augmentation, during the implant placement phase, the defect height was between 0 and 2 mm (average 1.2 mm; SD ± 0.63). Differences were statistically significant (P .001). Bone height gain was between 4 and 6 mm (average 5.2 mm, SD ± 0.79), which gave an average bone fill of 81.2% (SD ± 7.98). Polarizing microscopic examination of sections stained with Picrosirius red showed a gradual increase in new lamellar bone from coronal to apical cuts, reaching the highest area percentage in the deep apical zone. Discussion: At 9 months postaugmentation using the CTM surgical technique, the quality and quantity of the newly established hard tissue appeared to be different in the coronal versus apical areas of the restored alveolar ridge. Conclusion: Although at 9 months postoperatively, the augmented alveolar ridge had different bone content, clinicohistochemical results demonstrated that this surgical technique could be a successful and predictable procedure for rebuilding a resorbed/defected ridge to accommodate endosseous implants.