Vertical Ridge Augmentation With a Honeycomb Structure Titanium Membrane: A Technical Note for a 3-Dimensional Curvature Bending Method
Guided bone regeneration is the most commonly used technique for vertical ridge augmentation (VRA), and it is popular because it is less invasive and highly formative. Since the augmented site is exposed to external pressure, it is preferable to support the membrane using a framework to maintain the shape of the VRA. Recently, a titanium framework–reinforced ultrafine titanium membrane was developed by laser processing technology. The technique allows microperforations to be made (φ20 μm) into a titanium membrane, which is expected to prevent fibrous tissue ingrowth from outside the membrane. In addition, significant bone regeneration was confirmed on ridge defects in previous animal studies. However, the membrane tends to crumple during the bending process, because it is very thin (20 nμm); thus, the bending procedures are technically sensitive. Since this titanium honeycomb membrane was first approved for clinical use in Japan, no international clinical reports have been published. The purpose of this case report is to describe a technical note for a 3-dimensional curvature bending method in VRA using the newly developed honeycomb structure titanium membrane.
Figure 1. Buccal intraoral views with frontal direction (a) and left oblique direction (b). Figure 2. Preoperative cone beam computerized tomography images: the axial (a) and 3-dimensionally reconstructed (b) images show that buccal alveolar bone is resorbed. The position and size of the virtual implants were determined based on ideal crown configuration fabricated by radiopaque resin in the radiographic template. The sagittal images in implant site No. 8 (c), the midpoint between No. 8 and No. 9 (d), and No. 9 (e) show that a part of buccal surface of the implants seems to be exposed.
Figure 3. Intraoral images with buccal (a) and occlusal (b) views immediately after implant placements. Figure 4. Titanium frame–reinforced titanium honeycomb membrane: photos with the front side of the membrane (a: mucosal side) and back side of the membrane (b: bone side). Stereomicroscope images of the front side of the membrane (c, d).
Three-dimensional curvature bending method using a honeycomb-structured Ti membrane. The procedures are shown in an artificial model (a–i). This artificial model was not created from this patient; it is a demonstration pattern model.
Figure 6. A titanium membrane tray fabricated by a 3-dimensional curvature bending method (a, b). Figure 7. Guided bone regeneration with a Ti honeycomb membrane: the membrane was attached to the palate with 2 bone pins and to the buccal with 2 bone pins (a). A 3-dimensionally bent membrane is transitionally compatible with the alveolar bone of adjacent teeth. The occlusal (b) and buccal (c) views show the positional relationship between the ideal crown configuration and augment site.
Figure 8. Cone beam computerized tomography (CBCT) images at 6 months after guided bone regeneration. Significant radiographical bone gain is observed in the CBCT images with axial (a) and coronal (b) views, respectively. The axial image shows that the thickness of the regenerated tissue at the platform level is more than 4 mm (a). The sagittal images in implant site No. 8 (c), the midpoint between Nos. 8 and 9 (d), and No. 9 (e) show 2–3 mm vertical and 3–4 mm horizontal bone gain. These images show the newly created ridge, which can support the esthetic buccal implant papillae. Figure 9. Intraoral images with buccal (a), left side (b), and occlusal (c, d) views 6 months after guided bone regeneration: 3-dimensionally bent honeycomb Ti membrane achieved significant bone gain without collapse.
Figure 10. Subepithelial connective tissue graft 6 months after guided bone regeneration: the intraoperative image (a) shows that 2 connective tissue bands were sutured with the labial and palatal flaps. Postoperative image shows that connective tissue bands were partially covered by mucoperiosteal flaps because the buccal flap was repositioned apically (b). Figure 11. Intraoral images 6 weeks after connective tissue graft (a) and 4 months after placement of the implant-supported provisional crown (b). Figure 12. Intraoral (a, b) and radiographic (c) images 1 year after placement of the screw-retained all-ceramic crown.
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