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Rebuilding bone: custom titanium mesh or titanium-reinforced PTFE membrane?

When bone is lacking to place an implant, it has to be rebuilt. Two devices hold the grafted volume in place during healing: the custom-made titanium mesh and the titanium-reinforced PTFE membrane. The choice depends on the shape and extent of the defect.

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Modélisation 3D d'une grille en titane au maxillaire

The principle: protecting the space where bone must regrow

A bone graft combines a filling material (the patient’s own bone, a bone substitute or a mixture of both) and a barrier that keeps this volume in place and prevents the gum from invading it during healing. This is guided bone regeneration. For large defects, the barrier must be rigid: it is then made of titanium, or reinforced with titanium.

The custom-made titanium mesh

Illustration : grille en titane personnalisée pour greffe osseuse
Custom-made titanium mesh and bone filling material (illustration).

From three-dimensional imaging (cone beam) and the implant project, a mesh is designed on computer to the exact shape of the bone volume to be rebuilt, then 3D-printed in medical-grade titanium. It arrives in the operating room ready to be placed and screwed.

  • Indications: extensive defects; loss of bone in height and in width at the same time; reconstructions spanning several teeth; situations where the final shape of the bone must match precisely the planned position of the implants.
  • Advantages: no bending or cutting during surgery, reproducible shape, stable maintenance of the volume, shorter operating time.
  • Constraints: prior manufacturing (time and cost), removal of the mesh during a second procedure, possible exposure through the gum, which requires monitoring.

The titanium-reinforced PTFE membrane

Dense PTFE (polytetrafluoroethylene) is a non-resorbable material, impermeable to bacteria. Reinforced with a thin titanium frame, it can be cut and shaped at the chair, then fixed with screws or pins to hold the graft.

  • Indications: defects of moderate size or simple shape, width augmentation, some limited height defects, sites of one or two teeth.
  • Advantages: immediate adaptation to the anatomy encountered, no manufacturing delay, lower cost, simple removal.
  • Constraints: manual shaping during surgery, less rigidity than a mesh for large volumes, removal required at a second stage, possible exposure.

How we decide

Planification 3D d'implants et de greffe
Three-dimensional planning of implants and graft.
  • The extent and shape of the defect: the larger and more complex the volume to rebuild, the more relevant the custom mesh; a moderate, regular defect is well treated with a reinforced membrane.
  • The precision expected: when the implant positions are planned to the millimetre, the mesh reproduces exactly the planned volume.
  • The number of procedures: both devices have to be removed; this second step is often combined with implant placement.
  • The gum: its thickness and quality determine the risk of exposure, common to both techniques; a gum graft may be proposed before or during the reconstruction.
  • Timing and budget: custom manufacturing takes time and costs more, to be weighed against the expected benefit.

The other techniques

In some situations other techniques remain preferable: block graft, sinus lift or a resorbable collagen membrane for small defects. The choice is made after the clinical examination and three-dimensional imaging, and it is explained to you before any decision.

At the practice

These reconstructions are performed in the practice’s operating room by Docteur Victor Hazout. Bone grafting with a custom titanium mesh is presented on a dedicated page of this site, and Docteur Hazout’s website implants-parodontie.com covers these techniques in more depth.

To go further on periodontics and implant surgery: Docteur Victor Hazout’s website.

Related care

Modélisation 3D d'une grille en titane au maxillaireDigital 3D bone graft Illustration : régénération parodontaleGuided tissue regeneration and lasers Implant dentaire dans l'os (animation)Implantology Intervention au bloc chirurgicalOral surgery

Further reading

Après deux implants et fines facettes en céramique (patient du cabinet, accord écrit)Missing tooth: bonded bridge, regular bridge or implant?A missing tooth is not always replaced the same way. Three fixed options exist; the choice depends first on the neighbouring teeth, on the available bone and on your situation. Empreinte optique : la praticienne montre à la patiente son modèle 3D sur l'écran du scanner intra-oralDigital impressions: the 3Shape TRIOS scanner in practiceAt the practice, impressions are taken with a 3Shape TRIOS intraoral scanner, without paste or trays. Here is how it works and what it brings to your care. Implant dentaire dans l'os (animation)Straumann and Dentsply Sirona implants: our choice explainedNot all implants are equal. The practice has chosen two long-established manufacturers, Straumann and Dentsply Sirona, for their clinical track record, the quality of their surfaces and the lasting availability of their components. Couronne sur implant transvissée (vis accessible par un puits) et couronne scellée (ciment entre pilier et couronne) (illustration)Implant crown: cemented or screw-retained, which one?Once the implant has integrated with the bone, the crown can be fixed in two ways: cemented onto an abutment, or screwed directly into the implant. At the practice, the screw-retained restoration is the rule; here is why.