Customized three-dimensional-printed titanium mesh for alveolar bone augmentation: Retrospective consecutive case series.

Abstract

Background: This retrospective case series evaluated linear and volumetric bone changes in alveolar bone defects treated with guided bone regeneration (GBR) using a next-generation customized three-dimensional (3D)-printed titanium mesh.

Methods: Medical history, surgical details, and cone beam computed tomography (CBCT) data were collected from patients undergoing GBR with the customized 3D-printed titanium mesh. CBCT subtraction analysis was performed using 3D digital models, created via spatial registration and semi-automatic segmentation. Outcomes included complication rates, linear bone measurements, volumetric hard tissue gain, graft volume stability, and augmentation efficacy.

Results: Nine cases were included: five combined large defects, two vertical large defects, and two combined medium defects. Two cases showed no complications, while seven had mesh exposure. Two cases experienced complete early mesh exposure (22.2%), resulting in total graft loss and premature removal. The mean linear vertical bone gain at the defect's middle plane was 5.7 ± 2.3 mm for large defects, 2.7 ± 0.5 mm for medium defects, and 4.8 ± 2.4 mm for both. The overall volumetric gain was 0.49 ± 0.20 cm³, with graft volume stability at 87.9 ± 19.5% and augmentation efficacy of 0.037 ± 0.012 cm³/mm.

Conclusions: Customized 3D-printed titanium mesh is a feasible and effective option for augmenting defective edentulous ridges, providing predictable outcomes in linear and volumetric gains. Mesh exposure is the most common complication.

Key points: Novelty and Contribution of These Cases This case series provides important insights into GBR using customized 3D-printed titanium meshes. These devices aim to overcome several limitations commonly associated with traditional non-resorbable membranes and conventional titanium meshes. The inclusion of comprehensive, CBCT-based linear and volumetric measurements of hard tissue gain adds valuable quantitative data to the field, supporting the clinical utility of customized titanium meshes in alveolar ridge augmentation. Key Factors for Successful Case Management Successful outcomes in these cases were associated with several critical factors: Thorough preoperative planning Precise execution of the surgical technique Effective management of potential postoperative mesh exposure Primary Limitations to Treatment Success The main limitations that impacted treatment outcomes included: Compromised systemic health or medical history Improper adaptation or seating of the mesh Premature and complete mesh exposure during the healing period PLAIN LANGUAGE SUMMARY: This study looked at a new way to rebuild lost bone in the jaw using a custom-made, three-dimensional (3D)-printed titanium mesh. Nine patients with different types of bone defects were treated, and detailed scans were taken before and after surgery to measure bone growth. Most patients experienced some improvement, with an average increase in bone height of about 5 mm in larger defects. On average, the bone volume increased by roughly half a cubic centimeter, and most of the grafted bone remained stable over time. However, the most common problem was the mesh becoming exposed, which in two cases led to the loss of the graft. Successful results depended on careful planning, precise surgery, and managing any mesh exposure that occurred afterward. Factors that made treatment harder included patients' health issues and difficulties fitting the mesh properly. Overall, this work shows that customized 3D-printed titanium meshes are a promising tool for rebuilding the jawbone in patients with missing or damaged bone. The detailed measurements from this study provide helpful information for surgeons and support the use of these meshes to achieve predictable bone regeneration.