Titanium is widely used in surgical operations due to its high stiffness, low density, corrosion resistance, and good biocompatibility. Titanium mesh, as its application product, has unique characteristics as a GBR barrier membrane for bone augmentation.
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Titanium mesh has good mechanical properties, its high strength and stiffness enable space support for osteogenesis, its stability is necessary to maintain bone graft volume during wound healing, and the elasticity can reduce the oppression of oral mucosa.11 Due to its good plasticity, titanium mesh can adapt to various bone defects through bending and shaping. These features enable GBR with titanium mesh to show a high stable osteogenesis effect, and achieve coinstantaneous bone augmentation in horizontal and vertical directions.5
For different titanium mesh, the thickness and porosity are the key factors affecting its mechanical properties. Study suggested that the thickness of titanium mesh may affect the total amount of new bone formation, while the pore size may affect the proportion of bone tissue and soft tissue formation under titanium mesh.12 The thickness of titanium mesh is directly proportional to its mechanical properties, which commonly used ranges from 0.1 to 0.6 mm currently. Usually, the titanium mesh at 0.2 mm can be suitable for most instances.13 Under this thickness, titanium mesh can provide sufficient stiffness to maintain space and protect grafts, while offer appropriate flexibility that reduces the risk of tissue rupture. With the increase of reconstruction area of alveolar ridge, thicker titanium mesh should be used in GBR to maintain bone regeneration space. As for thick titanium mesh, there are often some sharp edges in the process of bending titanium mesh due to the decrease of plasticity, which is closely related to the mucosal rupture titanium mesh exposure, many researches focus on finding a more suitable thickness of titanium mesh. A study showed that 100–200 μm is the ideal thickness of titanium mesh to reconstruct a large number of bone defects.14 Consistent with the result, Rakhmatia et al. compared the bone augmentation effect with titanium mesh at 20, 50, and 100 μm in mouse model and concluded that compared with thinner Ti-mesh, the use of titanium mesh at 100 μm can achieve more extensive bone regeneration effect.12 Owing to the thinner titanium mesh is rarely used in clinic currently, when it comes to thinner titanium mesh’s clinical application, a balance between the strength for spatial stability and malleability for adapting adjacent bone contours must be found.
In terms of pore size, it also affects the performance of titanium mesh during bone augmentation. The pore of the titanium mesh is thought to play an essential role in establishing blood supply and facilitating metabolic processes of the grafts at the defect site.15 Celletti et al. demonstrated that without pores on titanium mesh, exposure of the mesh would occur in 3 weeks after surgery.16 However, the relationship between the pore size of titanium mesh and bone formation is still controversial. For the existence of pores on titanium mesh, it is difficult to achieve selective cell isolation, and soft tissue often grow under titanium mesh. Therefore, many studies have attempt to investigate the relationship between the pore size and the amount of soft tissue growth. A study suggested that compared to the titanium mesh with small diameter (0.6 mm), the titanium mesh with large diameter (1.2 mm) promoted more bone regeneration and prevented soft tissue growth more effectively.15 This phenomenon may be related to the increased distribution of blood supply, and diffusion of nutrients and oxygen leaded by the large aperture. On the contrary, a study showed that the use of titanium mesh with large diameter (>2 mm) may lead to more soft tissue growth upon the surface of new bone than the use of titanium mesh with small diameter.17 A similar result for GBR with polyester meshes in different pore size may explain this contradictory phenomenon: the larger the pore size of the barrier membrane, the more connective tissue grows between the membrane and the regenerated bone, and the more rapid bone regenerate, while the pore size does not make much difference to the amount of bone formation after the osteogenesis stabilized.3
Titanium mesh has good biocompatibility and can be compatible with tissues. The biocompatibility of materials can be divided into corrosion resistance and cytotoxicity. Due to its low electrical conductivity, titanium is prone to perform electrochemical oxidation to form a passive and inert oxide layer.18 This oxide layer can be retained under the pH of human body, leading to high and persistent corrosion resistance in titanium.19 Hence, little amount of metal particles can be released from titanium mesh, while the titanium particles has no significant effect on human cells’ relative growth rate.20 Study observed that after alveolar ridge reconstruction conducted by titanium mesh, a thin layer of 1–2 mm thick, soft tissue can often be found upon the regenerated bone surface, called “pseudo-periosteum”.21 The formation of this soft tissue layer may be related to the insufficient cell exclusion ability of titanium due to its pores. The role of pseudo-periosteum may be related to bone graft protection, graft infection prevention, and absorption. Currently, it is often be removed with titanium mesh in subsequent operation.22
According to the currently reported literature, GBR with titanium mesh has strong osteogenesis predictability, and both horizontal and vertical bone augmentation can be obtained in the process with delayed or simultaneous implantation. In the delayed implantation strategy of bone augmentation, most researchers have gained an average bone augmentation of 4–5 mm in bone width and 5–7 mm in bone height.10,23,24,25,26 While in the strategy of simultaneous implantation with bone augmentation, although there are few researches about three-dimensional bone increment, the realization of ~3–4 mm average bone gain in width and height seems feasible.27,28 However, a meta-analysis about the horizontal or vertical bone augmentation effect of titanium mesh could not be performed for the heterogeneity of the data.13
Compared to other methods, bone resorption due to infection is rare in the application of titanium mesh.29,30,31 As a small amount of peri-implant bone resorption usually occurs after implant loading,32,33 GBR with titanium mesh will also experience small amount of bone resorption. Zhang et al. showed that for a single anterior tooth defect, during the 41-month follow-up period after implant placement, the labial bone plate experienced an average of −0.81 ± 1.00 mm vertical absorption, which bone upon the implant absorbed at mean of 0.13 ± 1.19 mm in horizontal dimension.28 And the study conducted by Poli et al. showed that for a large range of GBR with titanium, the mesial and distal bone resorption were at an average of 1.743 ± 0.567 and 1.913 ± 0.71 mm, respectively, during the 88-month follow-up period after implantation.34 Therefore, the possibility of bone resorption also needed to be considered when performing bone augmentation with titanium mesh.
Nowadays, the barrier membranes commonly used in clinical can be divided into absorbable and nonabsorbable membranes according to their absorbability. The main absorbable membrane is collagen membrane, and the main nonabsorbable membranes are ePTFE, titanium-reinforced PTFE, and titanium mesh.35 Among the barrier membranes mentioned above, titanium mesh is the only one entirely made of metal. It exploit the advantages of titanium in mechanical and biological properties to the full, performing excellent in space maintenance and bone reconstruction.13 In comparison, though some enhanced absorbable collagen membranes can provide spatial protection to the bone graft material at the initial placement, they will gradually degrade with the absorption of the membrane, making them unable to achieve the same spatial maintenance ability as titanium mesh.7 Konstantinidis et al. compared the effect of collagen membrane and titanium mesh in the vertical bone augmentation, and found that the collagen membrane group gained 2.77 ± 1.97 mm bone height, and the titanium mesh group gained 4.56 ± 1.74 mm bone height (p < 0.05),36 which can be considered that titanium mesh has certain advantages in bone augmentation effect. Although Cucchi et al. proved that there is no significant difference (p < 0.05) between titanium mesh and titanium-reinforced PTFE in vertical bone augmentation and complication rates.27 Researches showed that different from absorbable membranes or other nonabsorbable barrier membranes like ePTFE, it is rare to observe consequent infection of bone regeneration failure in bone-augmented sites after exposure of titanium mesh.37,38 This may be related to the dense and surface structure of titanium that is less susceptible to be adhered by bacteria, and the protective effect of pseudo-periosteum formed under titanium mesh.37,39 Due to the presences of pores, titanium mesh may lead to spontaneously heal of mucosa upon bone reconstruction area after exposure, which means unlike ePTFE or titanium-reinforced PTFE, it may not need to remove titanium mesh immediately as there is no infection after mesh exposure.40
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However, titanium mesh also has shortcomings. Unlike absorbable membranes, titanium mesh cannot be resorbed by the body, which means the titanium mesh and fixation screws need to be removal through second-stage surgery, causing trauma to the patients. Besides, different form other absorbable and nonabsorbable barrier membranes, due to its stiffness, titanium mesh needs to be shaped during surgery to adapt profile of alveolar ridge. This process is technically sensitive, time-consuming, and laborious. And the sharp edges will inevitably form during bending, which may stimulate the mucosa, leading to mucosal rupture and exposure of titanium mesh.41
In the Shipbuilding industry, ships have many filters and strainers. Titanium Mesh is used as a water filter which stops the solid impurities from the sea entering the water system. Titanium Mesh also has a strong resistance to acids and alkalis, making it ideal for filtering in chemical engineering as the material does not corrode. In the security industry Titanium Mesh has proven its strength and durability, with its high corrosion resistance the mesh can be used as fencing outdoors without the worry of rust or defect.
Mechanical Properties: Grade 1 Titanium is lightweight and has a high formability value giving the mesh very high tensile strength and low density which is very beneficial for bends and shaping.
Low initial cost: It’s natural corrosion resistance, means it needs no corrosion allowance. Therefore it can be specified in thinner cross-sections, using less metal per unit of area.
Excellent Weldabilty: Our Titanium Mesh is Grade 1 commercially pure, It’s the most softest and ductile grades of Titanium, perfect for welding.
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