Introduction
Having sufficient available bone is the most important requirement for implant clinicians. GBR (Guided Bone Regeneration), Block Bone Graft, Ridge Splitting, Distraction Osteogenesis, etc. are the various types of bone regeneration procedure for making sufficient available bone. Especially, the GBR is the most well-known procedure among others. In order to achieve most successful outcome from GBR procedure, the following four biological principles should be satisfied : Primary Wound Closure; Angiogenesis; Space Maintenance; Stability of Blood Clot. (Hom Lay Wang, Implant Dent 2006). Among these four elements, Space Maintenance has been obtained through utilizing the Titanium mesh (Ti-mesh).
Dental clinicians did not prefer the GBR procedure in the past because of its inconvenience, such as difficulty of shaping the form of Ti- mesh and inconvenience of screwing each implant one at a time. However, in recent years, the Ti-mesh, such as the CTi-membrane, has been in the spotlight for clinicians since it is much easier to manipulate. Additionally, although the autogenous bone has a higher bone regeneration ability than other bone graft materials, it was difficult for clinicians to collect autogenous bone since it required high level skills in the past. The ACM (Autobone Chip Maker) Tool (Neo-biotech’s product) solved this inconvenience of collecting autogenous bone. Therefore, I am introducing the clinical cases of the GBR procedure using the CTi-membrane and the ACM, which makes the GBR procedure much easier and more predictive than before.
CASE1
C.C : “I want to restore my left lower molars with dental implants.”
Age : 56yrs
Sex : F
PMH/PDH : N.S.
Tx.: Old Bridge removal (#34~38), #38 Ext.
and Re-restoration on #34,35
Implantation on #36,37 with GBR using
CTi-membrane and collagen membrane
1st surgery stage
2nd surgery stage
Final Restoration
CASE2
C.C : “I want to restore my lower missing teeth with dental implants.”
Age : 58yrs
Sex : M
PMH/PDH : N.S.
Tx. : Old Crown removal (#32,33, 44,45) & Re-restoration, #43 Extraction
Implantation on #34,36, 43, 46,47
with GBR using CTi-membrane and collagen membrane
1st surgery stage
2nd surgery stage
Final Restoration
CASE 3
C.C : “I want to restore my right lower molars with dental implants.”
Age : 38yrs
Sex : F
PMH/PDH : N.S.
Tx.: #44~46 Old Bridge Removal & Re-restoration on #44,45
Implantation on #46,47 with GBR using CTi-membrane
1st surgery stage
2nd surgery stage
Final Restoration
Conclusions
Ti-mesh is a very good material as a means to secure the Space Maintenance among the four elements of biological principles for predictive bone regeneration. Nevertheless, many clinicians were reluctant to use it because of the inconvenience of its manipulation. However, as we have seen in the cases above, Neobiotech’s CTi-membrane dramatically enhanced the convenience of the Ti-mesh surgery through its various designs designated for the variety of bone defect types and very handy way of installation and removal. Still, the Ti-mesh’s weakness of having a low cell barrier property can be minimized by using additional absorbent shielding film. In addition, it is observable that there is no big influence on bone regeneration if clinicians apply sufficient amount of bone graft materials when possibility of infiltration of soft issue, in the case of small bone defect, is considered during the surgery. And, it is confirmed that the autogenous bone retrieval device, such as ACM, can be used to easily retrieve autogenous bone to obtain high quality regenerated bone.