Effect of pseudo-periosteum on hard and soft tissue regeneration following lateral bone augmentation using a titanium mesh: an experimental in vivo study

Purpose:The aims of this study were 1) to evaluate the 16-week bone augmentation outcomes using a titanium mesh (TM), including an 8-week transmucosal healing period following TM removal, and 2) to investigate the impact of pseudo-periosteum formation on regenerative outcomes.Methods: Atrophic alveolar ridge defects were induced in 6 canine mandibles, and 5 periimplant defects were created in each hemi-mandible.Bone augmentation was attempted using the following randomly allocated modalities: 1) Control: no treatment; 2) TM group: blood clot covered by TM; 3) TM + bone substitute (BS) group: synthetic BS covered by TM; 4) TM + collagen membrane (CM) group: blood clot covered by TM and CM; and 5) TM + BS + CM group: BS covered by TM and CM.TMs were removed after 8 weeks, followed by abutment connection and an additional 8-week healing period.After sacrifice, histomorphometric analyses of hard and soft tissues were conducted.Results: Regardless of early TM exposure (5/30), all implants achieved successful osseointegration and demonstrated comparable bone regeneration outcomes.No significant differences in horizontal or vertical bone gain were observed among the groups, whereas superiority of the TM + BS group over the control group showed a higher augmented bone percentage (P=0.021).The thickness of the pseudo-periosteum was not associated with hard or soft tissue regeneration outcomes.Conclusions: TM removal after 8 weeks did not significantly affect the histologic outcomes of lateral bone augmentation performed with simultaneous implant placement.The presence of a pseudo-periosteum did not adversely influence either hard or soft tissue regenerative outcomes.