Titanium Mesh Exposure: A Case Report of Retrieved Underlying Soft Tissue and a Review of Literature

In this study, we aimed to report histopathological evaluation of the underlying tissues in a case of premature Titanium mesh exposure and assess the rate of Titanium mesh (Ti-mesh) exposure in the literature and its effect on treatment outcomes when used as a barrier membrane in jaw-bone reconstruction.

We reviewed articles that used Ti-mesh with/without grafting materials to reconstruct atrophic ridges both vertically and/or horizontally. Considering our inclusion criteria, 51studies were included. All relevant RCTs,retrospective studies (cohortsandcase-controls)and case-series were included but case-reports and review articles were excluded. Data regarding premature exposure rate, removal rate, associated bone loss, and implant survival rate were extracted. Later, a report of an early Ti-mesh exposure in anterior maxillary horizontal augmentation with autogenous bone graft and deproteinized bovine bone mineral in a 50-year-old female is presented with a histological study of the underlying soft tissue at the time of mesh removal.

A total of 51 studies were included in the review. Among the 41 studies reporting exposure, 18 reported removal of membranes, of which 3caused significant bone loss. In the obtained biopsy from the reported case, a connective tissue infiltrated with sporadic inflammatory cells covered with keratinized stratified squamous epitheliumwas observed.

Our results indicate the loss of outcomes(both bone loss and implant failure) may not be associated with Ti-mesh exposure, which could, along with the rate of exposure, help the clinician assess the relative risk of its application.