Objectives: A titanium mesh or other permeable membranes were often used to obtain bone augmentation, while in the present experiment occlusive titanium membranes were tried out to profit from the osteoconductive properties of titanium surfaces. Methods: In 9 rabbits, two preformed titanium caps (Ø 12, height 6 mm) were placed subperiostally on the skull, one anteriorly and one posteriorly. At 3, 6 and 12 months respectively, 3 rabbits were sacrificed to allow histometry. In a series of 10 consecutive patients with highly resorbed maxillae, a customized stiff occlusive titanium membrane was moulded on top of a modified model derived from a high precision CT-scan. This membrane was installed subperiostally under local anesthesia. Results: On top of the rabbit skull a tissue augmentation of up to 6 mm was observed after 12 months, while the original thickness of skull bone was 1.5-2.5 mm. The bone, which kept an immature outlook (3-14% of the original volume occupied by trabeculae), grew systematically along the inner titanium surface. In 6 out of the10 patients in whom the membranes remained unexposed, an increase of the jaw-bone height of up to 16 mm could be observed after 12 to 18 months. Biopsies confirmed the osteoid nature of the tissue which allowed the insertion of 33 Brånemark system® implants, wherefrom 30 remained osseointegrated. The marginal bone level remained stable even up to 5 years after implant placement. Conclusion: Both animal and clinical data prove that guided bone neogenesis under a subperiosteally placed occlusive titanium membrane can reach large volumes.

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