When to Remove Titanium Mesh?

Three months post 1st GBR, a larger flap is raised to reveal a seemingly large bony defect around the exposed threads (Fig.1).  After thorough debridement, the threads are treated by Clindamycin soaking, Chlorhexidine, Hydrogen Peroxide and EDTA rubbing.  Autogenous bone is harvested from the tuberosity.  The tooth #2 with mobility II is extracted.  The autogenous bone graft is placed over the exposed thread, supplemented by Osteogen in syringe.  The graft is fixed by a Titanium mesh.  An abutment is placed to keep perio dressing in place.  Post op, the patient is doing well.  The perio dressing is dislodged 2 weeks postop.

When he returns 1 month postop, the Titanium mesh is exposed asymptomatically (Fig.2).  The implant threads appear not to be exposed.  When to remove the mesh?  A: abutment, which is removed before discharge of the patient.  G: granulation tissue; *: possible the rough (R) surface of the implant (S: smooth surface).

Three months post 2nd bone graft, the gingiva inside the Titanium mesh (used to be granulation tissue 1 month postop (Fig.2)) turns (Fig.3 I) as mature as the outside portion (O).   When the mesh is removed, there is no thread exposure.  The inner and outer portions of the gingiva are sutured later (Fig.4).  The implant is restored immediately.  It appears that Titanium mesh exposure is not a severe complication.  If asymptomatic, leave the gingiva to heal by itself.  Use small size of the mesh and release of soft tissue as much as possible may reduce the chance of mesh exposure.

The patient returns asymptomatic for follow up 1 year post cementation.  In fact the buccal threads are exposed without infection (Fig.5 <).  There remains bone loss around the most coronal threads (Fig.6 *).  Water pik is recommended.

To prevent thread exposure complication, the implant should have at least 1-2 mm buccal clearance (gap (Fig.7 double arrows)).  Place a relatively smaller implant (~6 mm) as palatal as possible.  Pack bone graft in the remaining gap solidly (covering implant threads buccally and interproximally, Fig.8 (green circles)).

Return to Upper Molar Immediate Implant, Instrument

Xin Wei, DDS, PhD, MS 1st edition 04/11/2015, last revision 06/26/2016