Guided Bone Regeneration and Mesh

A 62-year-old man has had periodic episodes of periodontal abscess of the tooth #27 (Fig.1,2).  The tooth should be extracted, but the patient wants to have a break from implants (1,2,3).  When the acute infection is under control (Fig.3), the buccal flap is raised to expose granulation tissue (Fig.4 *) and bony defect (Fig. 5*).  It is easy to graft between the lateral and canine, but the graft buccal to the canine may migrate when collagen membrane and the flap are placed.  To overcome this issue, a Titanium mesh is placed following application of Emdogain (Fig.6).  Allograft mixed with synthetic bone is placed underneath the mesh securely (Fig.7 G).  More graft will be added coronal to the mesh (Fig.8) before placement of collagen membrane (Fig.9 M).  The latter should reduce the chance of mesh exposure.  Perio dressing is used to cover the surgical field.  Fig.10,11 show the dressing (D) 9 days postop and dislodgement of the lingual portion (arrow).  The patient is pain and swelling free (Fig.10 *).

Three-month follow up shows that there is no sign of infection (Fig.12,13), although he feels that the tooth is not strong.  Occlusal equilibrium is provided.

The patient remains asymptomatic with the tooth #27 8 months postop.  The bone appears to have regenerated (Fig.14).  The tooth feels better after occlusal adjustment.  The patient is not in hurry to have the mesh removed.  He wants to have #18 implant placed first.

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Xin Wei, DDS, PhD, MS 1st edition 07/17/2014, last revision 03/08/2015