Journal of Periodontology; Copyright 2016 DOI: 10.1902/jop.2016.150432 1 The Titanium Mesh Technique in the Rehabilitation of Totally Edentulous Atrophic Maxilla. A Retrospective Case Series Gerardo Pellegrino * , Giuseppe Lizio * , Giuseppe Corinaldesi * , Claudio Marchetti * * Department of Biomedicine and Neuromotor Sciences, Dental Clinic, Alma Mater Studiorum-University of Bologna, Bologna, Italy. Background. This study evaluates the implant-borne prosthetic rehabilitation of 10 totally edentulous atrophic maxillae after bone reconstruction with a titanium mesh technique and a particulate bone graft. Methods. In total, 10 atrophic maxillae were reconstructed with 19 titanium meshes and particulate autologous-heterologous bone and rehabilitated at least 5 months thereafter with the placement of 67 implants that were connected to the prostheses after an additional 4 months. The cases were retrospectively evaluated in terms of complications rate, particularly on the exposure amount of the mesh, and implant survival and success rates at the end of follow-up. Results. In seven cases, the meshes were exposed, two prematurely (within 4–6 weeks) and five later (after 4–6 weeks). Only two of the later exposures extended > 1 cm 2 . Nevertheless, the reconstructions achieved allowed implant placement and prosthetic rehabilitation in all cases. Two implants were lost before loading. After a mean follow-up of 39.3 (20–56) months since prosthetic loading, all 65 implants were functional (100% implant survival), but 15 implants demonstrated a peri-implant mean bone resorption of 2,96 mm increased bone loss yielding a cumulative implant success rate of 76.9%. No prosthetic problem was observed. Conclusions. The use of titanium mesh with particulate bone can be considered a valid option in the reconstruction of the atrophic maxilla to allow its implant-borne prosthetic rehabilitation. A high level of dehiscence did not compromise the final outcome. KEY WORDS: edentulous maxilla, atrophy, surgical mesh, dental implants. The treatment of Cawood and Howell’s class IV–VI 1 totally edentulous atrophic maxillae for fixed dental rehabilitation is still debated in dentistry 2 considering the several proposed therapeutic approaches avoiding 3-5 or employing grafting procedures 2, 6-8 with a no clear anatomical indication. 9-12 The grafting procedures entail long-term treatment timing with correlate discomforts for the patient, but usually avoid prosthetic compromises to compensate for inter-arch occlusal discrepancies . 13,14 These approaches can be mainly distinguished in autologous bone block grafting and guided bone regeneration (GBR) with particulate graft. Autogenous block grafts must be oversized to be modeled and fitted properly in a deficit with a particular shape, and this indicates the need for a large amount of bone. 15,16 The block graft is prone to a high rate of resorption, especially in the vertical dimension. 15,17- 19 Furthermore, the weak medullary bio-structure of the atrophic maxilla does not often allow the rigid fixation of a block graft. Particulate grafts can be readily adapted to the recipient site and are more rapidly incorporated, with major colonization by osteogenic elements, 20 but they must be associated with a device that ensures a space-making effect and adequate graft containment. Titanium (Ti) mesh has been demonstrated to be an alternative to membranes. 20-24 This reconstructive approach can lead to an adequate quality and quantity of bone, even in the vertical dimension, 25-27 for implant placement. It allows the use of mixtures of autologous and heterologous bone 25, 28 and of heterologous bone alone , 29 reducing donor-site morbidity issues. It has been reported in the literature that the Ti-mesh technique has an implant success rate > 90%, but only two studies evaluated these parameter in different jaw portions. 25,26