This is a journal club to start with for new omfs pgs . This is correctly criticized and cross-checked ppt. Also, it is a relevant topic in day to day preactise

1. JOURNAL CLUB PRESENTATION
PRESENTED BY
DR.AKHIL SANKAR
2ND YEAR MDS

2.  Evaluation of Alveolar Ridge Height Gained by Vertical Ridge Augmentation Using
Titanium Mesh and Novabone Putty in Posterior Mandible
 Malik R, Gupta A, Bansal P, Sharma R, Sharma S. Evaluation of Alveolar
Ridge Height Gained by Vertical Ridge Augmentation Using Titanium Mesh
and Novabone Putty in Posterior Mandible. J. Maxillofac. Oral Surg. 2019
pages32–39(2020)

3. INTRODUCTION:
Bone augmentation procedures in posterior edentulous mandible are often
necessary for placement of endosseous dental implants as, at times,
available bone height is limited due to ridge resorption and presence of
inferior alveolar nerve
different surgical techniques are currently being used to augment the
posterior mandible Such as vertical ridge augmentation (VBA),
horizontaridge augmentation , distraction osteogenesis, onlay bone
grafting, and vertical guided Regeneration, etc
most recent guided bone regeneration research has focused on
augmentation procedures using bone grafts and bone substitute materials
of allogeneic, xenogeneic and alloplastic origin.

4.  Titanium mesh seems to have some distinct advantages over other barrier membranes in VBA.
 bone can be regenerated beyond the skeletal envelope.
 The rigid structure of titanium mesh provides a secured space for new bone formation adding to
its advantages.
 Titanium mesh has a porous structure which allows better blood supply and also prevents bone
resorption during healing

5. AIM OF THE STUDY:
 to evaluate and report the clinical and radiographical outcomes of
ridge augmentation in edentulous posterior mandible using a
of titanium mesh with novabone putty.

6. Materials and Methods
Sample size:20 patients
INCLUSION CRITERIA
 aged between 15 and 65 years requiring vertical ridge augmentation
 Available alveolar ridge height between 6 and 9 mm
 patients with good medical condition

7. EXCLUSION CRITERIA
 Patients who had contraindications for local anesthesia or surgery
 habits of chronic smoking
 excessive alcohol consumption
 medically compromised status,
 immunocompromised status
 any underlying pathology at the augmentation site,
 Pregnant
 patient refusal to follow-u

8. SURGICAL PROCEDURE
 The patient was asked to rinse the mouth with 0.2% chlorhexidine solution prior to the procedure
 a crestal incision was made with a no.15 blade, connecting with an intrasulcular incision at the adjacent
teeth. Vertical incisions were made if indicated
 The lingual flap was reflected first to allow for measurement of the buccal flap thickness at the crest
followed by reflection of the buccal flap.

9.  Intramarrow penetration was performed, and tenting screws were placed with the aid of a driver. A
titanium mesh specimen was trimmed and stabilized to the lingual plate with fixation screws. Bone
graft novabone putty was added under the mesh and packed gently.
 The buccal flap and lingual flap were then released by periosteal scoring several millimeters from
the mucogingival junction to further facilitate flap advancement.
 Subsequently, the mesh was fixed to the buccal ridge. Flaps were approximated with non-
resorbable Ethicon 3–0 black braided silk sutures .
 Patients were given standard postoperative instructions and were prescribed antibiotics and
analgesics for 5 days.

11. • Postoperative follow-up was carried out after 1 week, 1 month, 3 months and 6
months
Evaluation
Evaluation was done by two methods:
 1. Clinical.
 2. Radiographical
Clinical Parameters: (By UNC-15 Probe)
 DD1,the depth of the bone defect, which was the distance from the deepest point of the defect to
the most coronal hole of the titanium mesh at the intraoral trial of the titanium mesh during its
placement.
 DD2, the depth from the top of the augmented bone to the titanium mesh by measuring the probe
through the corresponding hole of the titanium mesh at the second surgery for mesh removal.

12.  VHAB, the vertical height of the augmented bone calculated by subtracting DD2 from DD1.
 VHAB/DD1, the percentage of augmented bone height calculated by dividing VHAB by DD1.
 Clinical evaluation was done on follow-up of 1 week,
1 month, 3 months for:
1. Soft tissue dehiscence and titanium mesh exposure.
2. Graft extrusion.
3. Presence of any exudates.
4. Healing.

13.  Radiographical Evaluation
• Preoperative orthopantomogram (OPG): To access the available alveolar ridge height (RH1).
• Immediate postoperative OPG: To check for the placement of titanium mesh.
 OPG to check for an increase in alveolar ridge height at:
• 3 month;
• 6 months.
 Radiographic Parameters
• RH1, the total available alveolar ridge height prior To the procedure, measured from the
superior cortex of inferior alveolar canal to the superior border of edentulous alveolar ridge on an
OPG

14.  RH2, the total available alveolar ridge height, 3 months after the procedure, measured from the
superior cortex of inferior alveolar canal to the superior border of edentulous alveolar ridge on a
OPG.
 RH3, the total available alveolar ridge height, 6 months after the procedure, measured from the
superior cortex of inferior alveolar canal to the superior border of edentulous alveolar ridge on a
OPG.
 RVHAB, the vertical height of the augmented bone calculated by subtracting RH1 from RH3.
 RVHAB/RH1, the percentage of augmented bone height calculated by dividing RVHAB by RH1

15. RESULTS

17. DISCUSSION
All the sites showed bone regeneration equal or almost equal to the space created by the mesh;
however, the one site in which early mesh removal was necessary showed minimal (1 mm)
bone gain
This indicates that a dimensionally stable barrier, such as the titanium mesh enhances the
outcome of vertical bone augmentation.
maintaining enough space beneath the membrane is crucial for GBR. Membrane
collapse compromises the outcome of GBR techniques
the non resorbable membrane might provide better results since it stabilizes the blood clot and
bone substitute on the implant surface which is important in the early phase.

18.  4 out of 20 (20%) augmented sites showed mesh exposure due to soft tissue dehiscence.
 This is important because all membranes can become exposed during healing,
 A layer of pseudo-periosteum is constantly observed under the mesh.
 Literature has showed that though titanium mesh exposure was reported in 51.11%, the
success of bone grafting was not reduced, owing to the success rate of 97.72%
Titanium mesh has some distinct advantages as a barrier membrane.
 Its rigidity resists deformation by the overlying soft tissue.
 it is non-resorbable, it is present throughout the healing phase of the graft,
 it causes little soft tissue reaction even when it is exposed.

19. CONCLUSION
 This study shows usage of titanium mesh for the VBA is a reliable technique
 This technique may offer a predictable alternative and excellent results for the reconstruction of
ridge deficiencies for implant placement without undergoing major resorption.
 The possible clinical advantages of this technique include:
(1) applicability to severe vertical deficit
(2) decreased risk of injuries to neurovascular bundle and/or fractures

20. MERIT:
 Surgical Technique was given in detail.
 Clinical and Radiographic criterias were mentioned and evaluated separately
 Clinically relevant study
DEMERIT:
 Insufficient sample size
 Follow up period comparatively less

21.  Reconstruction of the Maxilla and Mandible With Particulate Bone
Graft and Titanium Mesh for Implant Placement
Louis J, Gutta R, Said-Al-Naief N, Bartolucci A A. J Oral Maxillofac Surg 66:235-245, 2008

22. AIM:
 To evaluate the magnitude of ridge augmentation with titanium mesh, overall graft success,
anatomic location of ridge defects and their relationship to mesh exposure.
Materials and Methods:
 This retrospective study
 44 patients , A total of 45 sites
 mandibular or maxillary reconstruction with autogenous particulate bone graft and titanium mesh
the purpose of implant placement.
 Autogenous bone graft was harvested from the iliac crest, tibia, and mandibular symphysis..
augmentation bone heights were measured and compared.
 At the time of second surgery for mesh removal implant placemrnt was done

23. Evaluation Criteria:
Clinical
infection,
graft loss,
dehiscence, and
loss of dental implants.
Radiological:
 by means of panoramic radiography.
 postoperative radiographs at immediate postoperative follow-up, 3 months, 6 months, 9
months, and yearly thereafter.
 Standardized structures such as dental implants or natural teeth were used as references

24. Results:
 The mean augmentation in partial maxillary defects was 11.33 * 1.56 mm, and in
complete maxillary augmentation, the height achieved was 14.3 * 1.39 mm.
 In the mandible, mean increase in height for partial defects was 14 1.42 mm and for
complete augmentation it was 13.71 1.14 mm.
 The mean augmentation for all sites was 13.7 mm
 In the maxillary group, 7 sites had exposure of the titanium mesh and 16 sites were
exposed in the mandible.
 The success of the bone grafting procedure was 97.72%
Conclusions:
 Porous titanium mesh is a reliable containment system used for reconstruction of the maxilla and the
mandible. This material tolerates exposure very well and gives predictable results.

25. Alveolar ridge augmentation with titanium mesh and a combination of autogenous bone and
anorganic bovine bone: a 2-year prospective study
Pieri F, Corinaldesi G, Fini M, Aldini NN, Giardino R, Marchetti C.. J
Periodontol. 2008;79(11):2093–2103.

26. AIM:
 The aim of this prospective study was to evaluate the clinical and radiographic parameters of implants
placed in augmented ridges using a 70:30 mixture of autogenous bone and BBM in association with
micro-mesh over a 2-year period
MATERIALS AND METHOD:
 Sixteen partially edentulous patients requiring bone augmentation were consecutively treated for 19
reconstructive procedures and delayed implant placement (44 implants) after 8 to 9 months of
submerged mesh healing.
 SURGICAL PROTOCOL:

27. INCLUSION CRITERIA EXCLUSION CRITERIA
• local infections;
• smoking >10 cigarettes per day;
• uncontrolled diabetes;
• history of radiation therapy in the head
or neck region;
• current antitumor chemotherapy;
• liver, blood, or kidney disease;
• immunosuppression;
• current corticosteroid use;
• pregnancy;
• poor oral hygiene and motivation.
• the presence of at least one edentulous
area required implants
• insufficient amount of residual bone
• patients gave written informed consent
prior

28.  The autogenous bone particles were mixed with anorganic bovine bone mineral (BBM)in a 70:30
mixture by weight
 Patients were seen 1, 3, and 6 months after surgery.CBCT scans were retaken before removing the
mesh, from 8 to 9 months after the reconstructive procedure,to plan for implant surgery.
 after reflecting bucco-labial and linguo-palatal full-thickness flaps,
 the titanium screws and mesh were removed, and using a surgical stent, 44 dental implants .
 All patients underwent cone-beam Ct at baseline and 8 to 9 months after reconstructive surgery.
Radiographic Analysis of Peri-Implant Bone Resorption
 Marginal bone resorption (MBR) was recorded by comparing periapical radiographs taken after 6
months of prosthetic loading and annually thereafter until the second year

29. RESULTS
CONCLUSION
 implants can be successfully placed in alveolar ridges augmented with a 70:30 combination
of autogenous bone and BBM and titanium mesh using a staged approach.

30.  CRITICAL APPRAISAL
Title of Article : complete and focuses on the research
does reflect Aim and Objective
does not give idea of study population
ABSTRACT : Informative and structured
comprehensive
It gives an idea of complete text
INTRODUCTION : Meaningful and built on existing literature
METHOD AND MATERIAL: Appropriate for the study
Described in detail for replication
RESULTS : Presented in a logical and comprehensive way
Charts and tables are included

31. Thank You