Efficacia delle griglie in titanio con osso particolato nella ricostruzione dei difetti alveolari tridimensionali dei mascellari

The thesis reports about the effectiveness of the titanium mesh technique with particulate graft in the reconstruction of three-dimensional alveolar defects for implant borne prosthetic rehabilitation. The first study evaluated the technique in terms of complications and implants and prosthetic results. 24 patients with varied morphological defects, treated with 34 titanium meshes and particulate bone and rehabilitated at least 8-9 months thereafter were included. Four of 34 meshes in three patients had to be removed before implant placement (11.76% total failure); 20 of 34 meshes were exposed due to soft tissue dehiscence (58.82% of complications): four (11.77%) prematurely (within 4-6 weeks) and 16 (47.05%) delayed (after 4-6 weeks), with no compromise in implant placement or prosthetic plan. After a mean follow-up of 20 (3-48) months of prosthetic loading, none of the 88 implants was lost during follow-up (100% implant survival) and 15 implants demonstrated increased bone loss, yielding a cumulative implant success rate of 82.9%. The second study was focused on the volumetric bone reconstruction obtained and its correlation with the extent and timing of mesh exposure and amount of reconstruction planned. 12 patients (mean age 49.1 years) with 15 alveolar defects, treated with Ti-mesh and particulate grafts were considered. For each site, computed tomography (CT) images were analyzed using software designed to measure 3D volumes: the bone volume lacking (LBV) was calculated by subtracting the reconstructed bone volume (RBV) at re-opening from the planned bone volume (PBV) to be created at the time of reconstruction. LBV was significantly positively correlated with the area of mesh exposed, with a 16.3% LBV for every cm2 of mesh exposed; there were positive correlations between LBV and early exposure and the PBV.