Clinical Outcomes of Titanium Mesh for Alveolar Bone Augmentation: An Umbrella Review

Vertical bone defects remain a challenge in implant dentistry. Titanium mesh (TM) is widely used in guided bone regeneration due to its ability to stabilize grafts, but it requires intraoperative adaptation, increasing surgical time and the risk of complications like mesh exposure. Customized titanium mesh (CTM), designed using CAD/CAM or 3D printing, offers a precise fit and may reduce surgical risks. This systematic review and meta-analysis aims to compare CTM and TM in terms of bone gain and complication rates in vertical ridge augmentation procedures. A systematic search was carried out in four electronic databases (PubMed, Cochrane Central, Web of Science, and Google Scholar) up to January 2025, with no time restrictions applied. Studies comparing customized titanium mesh (CTM) and conventional titanium mesh (TM) for vertical ridge augmentation were considered eligible if they included at least 10 patients and a minimum follow-up period of 6 months. The primary outcomes were vertical and horizontal bone gain, as well as membrane exposure. Meta-analyses and meta-regressions were performed using R software. A total of 22 studies were included in the analysis (3 randomized controlled trials, 6 prospective studies, 12 retrospective studies, and 1 cohort study), comprising 608 patients and 1,318 implants. The mean vertical bone gain was 6.24mm for the TM group and 5.14mm for the CTM group, with no statistically significant difference between them (P = 0.628). In contrast, CTM achieved significantly greater horizontal bone gain (6.38mm vs. 3.85mm; P = 0.004). Membrane exposure occurred more frequently in the TM group (30.9%) than in the CTM group (20.3%), although the difference was not statistically significant (P = 0.721). Other complications, such as infections, were also more common in the TM group but did not show statistical significance. Within the limitations of the included studies, CTM appears to offer comparable bone gain to TM, with superior horizontal bone gain and a tendency to fewer complications. The results support the potential advantages of customized mesh in clinical practice. Further randomized trials with standardized protocols and long-term follow-up are recommended to confirm these findings.

To the best of the authors' knowledge, there is very limited clinical data on the outcomes of simultaneous guided bone regeneration (GBR) for horizontal and/or vertical bone gain for the reconstruction of severely atrophic edentulous maxilla. Therefore, the purpose of the clinical series presented herein was to clinically evaluate long-term horizontal and vertical bone gain, as well as implant survival rate after reconstruction of severely atrophic edentulous maxillary ridges. Sixteen patients (mean age: 64.6 ± 14.6 years of age) were consecutively treated for vertical and/or horizontal bone augmentation via GBR in combination with bilateral sinus augmentation utilizing a mixture of autologous and anorganic bovine bone. Implant survival, bone gain, intraoperative/postoperative complications and peri-implant bone loss were calculated up to the last follow-up exam. Overall, 122 dental implants were placed into augmented sites and have been followed from 12 to 180 months (mean: 76.5 months). Implant survival was 100% (satisfactory survival rate of 97.5%). Mean bone gain was 5.6 mm (max: 9 mm; min: 3 mm) While vertical bone gain was 5.1 ± 1.8 mm; horizontal bone gain was 7.0 ± 1.5 mm. No intraoperative/postoperative complications were noted. Mean peri-implant bone loss values were consistent within the standards for implant success (1.4 ± 1.0 mm). At patient-level, only one patient who had three implants presented with severe peri-implant bone loss. Complete reconstruction of an atrophied maxilla can be successfully achieved by means of guided bone regeneration for horizontal and/or vertical bone gain including bilateral sinus augmentation using a mixture of anorganic bovine bone and autologous bone.

The aim of the present study was to evaluate the use of customized CAD-CAM titanium mesh for the treatment of bone atrophy type V of Cawood and Howell as mean vertical and horizontal bone gain and complications rate. A prospective clinical trial aimed to evaluate the use of CAD-CAM titanium mesh for the treatment of bone atrophy type V of Cawood and Howell. All patients underwent a preoperative digital planning phase with CBCT, digital intraoral scan and extra-intraoral photos. The operative phases were divided into 4 stages: T1 recon-structive surgery T2 implant surgery T3 prosthetic phase T4 one year follow-up. Study variables were: the mean vertical and horizontal bone gain by CBCT superposition, peri-implant marginal bone loss by periapical radiographs, and complications by clinical examination. Twenty-five patients (9 males, 16 females; mean age: 60 ± 8.5 years) with 30 surgical sites were included. The bone defects involved spans of 3-6 missing teeth, with a mean mesiodistal length of 29.9 ± 8.53 mm and a mean augmentation volume of 2.03 ± 0.96 cm.³ Mean vertical and horizontal bone gains were 5.87 ± 1.6 mm and 5.64 ± 2.1 mm, respectively. Mean mesial and distal implant marginal bone losses were 0.61 ± 0.34 mm and 0.46 ± 0.32 mm, respectively. No intraoperative com-plications were observed. Healing complications included Class I membrane exposure in four patients (16%) and one case (4%) of Class III exposure with infection requiring mesh removal. Conclusions The use of CAD/CAM-customized titanium mesh in guided bone regeneration appears to be a predictable and effective technique for managing severe alveolar ridge atrophy. This approach allows for precise, patient-specific augmentation with favorable bone gain and a manageable com-plication profile, supporting its use as a valuable tool in advanced implant therapy.

BackgroundAlveolar ridge augmentations are challenging procedures in dental implantology, especially in esthetic zone. 3D alveolar defects can be treated by guided bone regeneration (GBR), distraction osteogenesis, or bone blocks. This study introduces a new technique for 3D-alveolar ridge augmentation by using L-shape autogenous symphyseal bone block.PurposeThis study aimed to assess both horizontal and vertical alveolar bone augmentation for severe atrophied anterior maxilla and mandible, using an L- shape autogenous bone block harvested from the symphysis.Patients and methodelven partially edentulous patients who needed horizontal and vertical bone augmentation in the anterior maxilla or mandible before implant placement were selected for this study. For each patient, an autogenous bone block was harvested from the symphysis, trimmed to L-shape, and used to augment the anterior maxilla or mandible horizontally and vertically. Horizontal and vertical bone gain was measured by CBCT immediate postoperative and at 6months postoperatively.ResultsIn this study, 14 L-shape bone blocks were grafted in 11 patients. The patients were 4males and 7females, with a mean age of 24.63years. Healing was uneventful for all patients with no sensory disturbance. The Mean of horizontal bone gain was 4.17 ± 0.77 mm immediate postoperative, and was 3.52 ± 0.75 after 6months. While, the mean of vertical bone gain was 6.51 ± 1.01 mm immediate postoperative, and was 4.74 ± 1.03after 6months. The mean of horizontal and vertical bone loss was 0.74 ± 0.24 mm and 1.62 ± 0.19 mm after 6 months, respectively.ConclusionUsing L- shape autogenous bone block harvested from the symphysis for alveolar ridge augmentation is a safe, predictable and effective method for 3D ridge augmentation.

We performed this clinical study in order to evaluate the reliability of the Guided Bone Regeneration (GBR) surgical technique through the use of customized CAD CAM titanium meshes (Yxoss CBR® Reoss) in order to show an alternative method of bone augmentation. Materials and methods: Nine patients presenting 10 bone defects were referred to solve oral dysfunction due to edentulous atrophic ridges. Guided bone regeneration was performed with titanium meshes combined with autogenous bone grafting and heterologous bovine bone mineral grafting, and exclusively a “poncho technique” soft tissue approach for all the cases. After a mean 9 months of graft healing (range 6–12 months), titanium meshes were removed, and implant surgery was subsequently performed. The results we obtained were positive in terms of volumetric increases in height, length and thickness of the atrophic ridges without biological complications detectable before implant surgery. Results: Out of nine, one site met titanium mesh exposure: however, in all 10 sites a three-dimensional volumetric bone implementation was obtained. The statistical results were estimated by uploading and superimposing cbct scans before and after CBR surgery for each patient, so it was possible evaluate the maximum linear vertical and horizontal bone gain through dedicated Cad Cam software (Exocad GmbH®). The average horizontal gain was 6.37 ± 2.17 mm (range 2.78–9.12 mm) and vertical gain was 5.95 ± 2.06 mm (range 2.68–9.02 mm). A total of 18 implants were placed into the grafted sites with a 100% survival rate (clearly they are relative percentages to be compared to the short time elapsed). Conclusions: The results we obtained in this study suggest that this CBR procedure (Yxoss® by Reoss) is reliable and safe for bone regeneration to allow implant-prosthetic restoration in horizontal, vertical and combined bone defects. The soft tissue management is diriment: all the cases were managed with a “poncho” flap approach to decrease exposure complication.

To present the results of guided bone regeneration (GBR) of atrophic edentulous ridges with customized CAD/CAM titanium meshes. Forty-one patients, presenting with 53 atrophic sites, were enrolled between 2018 and 2019. GBR was obtained with titanium meshes filled with autogenous bone chips and bovine bone mineral (BBM). After a mean of 7months (range: 5-12months), meshes were removed and 106 implants placed. After a mean of 3.5months (range: 2-5months), implants were uncovered and prosthetic restorations started. The outcomes were vertical and horizontal bone augmentation changes, biological complications and implant survival. Out of 53 sites, 11 underwent mesh exposure: eight of them were followed by uneventful integration of the graft, while three by partial bone loss. The mean vertical and horizontal bone gain after reconstruction was 4.78±1.88mm (range 1.00-8.90mm) and 6.35±2.10mm (range 2.14-11.48mm), respectively. At the time of implant placement, mean changes of initial bone gain were -0.39±0.64mm (range -3.1 to+0.80mm) and -0.49±0.83mm (range -3.7 to +0.4mm), in the vertical and horizontal dimensions, respectively. Reduction of bone volume was significantly higher (p<.001 for both dimensions) in the exposed sites. The mean follow-up of implants after loading was 10.6±6.5months (range: 2-26months). The survival rate of implants was 100%. Customized titanium meshes can represent a reliable tool for GBR of severely atrophic sites, with simplification of the surgical phases.

Titanium-reinforced polytetrafluoroethylene (Ti-PTFE) and titanium mesh (Ti-mesh) are used to augment atrophic alveolar ridges to facilitate the placement of dental implants. This study aimed to evaluate and compare the average vertical and horizontal bone gain and outcomes between Ti-PTFE and Ti-mesh techniques. To assess outcomes, retrospective chart review and superimposition of preoperative and postoperative cone beam computerized tomography scans were used. The vertical component of the augmented site (L1) was assessed along a vertical bisecting line. Horizontal width was measured in buccolingual dimension at 3-mm intervals (W1-6) along the L1. Paired t tests were used to compare bone measurements at each location, and analysis of covariance models were used to compare the grafting methods. Successes were compared with chi-squared tests. Forty-eight ridge augmentation cases with 70 sites were included: 25 Ti-PTFE with 35 sites and 23 Ti-mesh with 35 sites. The average gain in length (L1) was statistically significant for Ti-PTFE, 0.75 mm, and nonstatistically significant for Ti-mesh, 0.61 mm. The average increase in width for Ti-PTFE was 2.05 mm, whereas for Ti-mesh, it was 2.42 mm. After adjusting for preoperative bone levels, Ti-PTFE had significantly greater gains at W1 than Ti-mesh. Seventy-six percent of the cases were considered successes with 74% for Ti-PTFE and 77% for Ti-mesh with no statistically significant difference. Both ridge augmentation techniques resulted in reliable horizontal bone gains, whereas a wide range of outcomes was observed for vertical bone gains.

BackgroundThe use of guided bone regeneration (GBR) for vertical and horizontal bone gain is a predictable approach to correct the bone defects before implant installation; however, the use of different protocols is associated with different clinical results. It is suggested that platelet-rich fibrin (PRF) could improve the outcomes of regenerative procedures. Thus, this study aimed to describe the bone gain associated with GBR procedures combining membranes, bone grafts, and PRF for vertical and horizontal bone augmentation.Materials and methodsEighteen patients who needed vertical or horizontal bone regeneration before installing dental implants were included in the study. The horizontal bone defects were treated with a GBR protocol that includes the use of a mixture of particulate autogenous and xenogenous grafts in the proportion of 1:1, injectable form of PRF (i-PRF) to agglutinate the graft, an absorbable collagen membrane covering the regenerated region, and leukocyte PRF (L-PRF) membrane covering the GBR membrane. The vertical bone defects were treated with the same grafted mixture protected by a titanium-reinforced non-resorbable high-density polytetrafluoroethylene (d-PTFE-Ti) membrane and covered by L-PRF. The bone gain was measured using a cone-beam computed tomography at baseline and after a period of 7.5 (± 1.0) months.ResultsAll patients underwent surgery to install implants after this regenerative protocol. The GBR produces an increase in bone thickness (p < 0.001) and height (p < 0.005) after treatment, with a bone gain of 5.9 ± 2.4 for horizontal defects and 5.6 ± 2.6 for vertical defects. In horizontal defects, the gain was higher in the maxilla than in mandible (p = 0.014) and in anterior than the posterior region (p = 0.033). No differences related to GBR location were observed in vertical defects (p > 0.05).ConclusionGBR associated with a mixture of particulate autogenous and xenogenous grafts and i-PRF is effective for vertical and horizontal bone augmentation in maxillary and mandibular regions, permitting sufficient bone gain to future implant placement.Trial registrationREBEC, RBR-3CSG3J. Date of registration—19 July 2019, retrospectively registered. http://www.ensaiosclinicos.gov.br/rg/RBR-3csg3j/

Fresh frozen bone allografts (FFB) have become an alternative for bone augmentation in the past decades, especially because of the absence of recent reports of disease transmission or immunologic reactions when it is used. The aim of this prospective controlled study is to evaluate volumetric changes of newly created bone following reconstruction of the atrophic posterior mandible. Twenty consecutive patients presenting for reconstruction of posterior mandibular alveolar bone ridge width ≤6.0 mm and/or height ≤6.0 who met all inclusion and exclusion criteria were included. FFB blocks were used. The main outcome variable investigated was bone volume dynamics. Vertical, horizontal, and 3-dimensional bone gain data were measured from computerized tomography scans. The main predictor variable was time evaluated at 3 points: immediately after surgery (T1), at implant placement (T2), and 1 year after functional loading (T3). Secondary outcome parameters evaluated were implant survival, histologic findings, and microtomographic morphometry. The study included 28 hemi-mandibles, 50 FFB bone blocks, and 15 female and 5 male patients (mean age, 51.8 years). Block and implant survival rates were 100% and 96%, respectively, after 31.75 months of follow-up. Vertical and horizontal bone gain at T2 was 5.15 and 6.42 mm, respectively. Volumetric resorption was 31% at T2, followed by an additional 10% reduction at T3. Histologic evaluation showed newly formed vital bone in intimate contact with the remaining FFB. Microtomography revealed 31.8% newly formed bone, 14.5% remaining grafted bone, and 53.7% connective tissue and bone marrow. Thus, FFB blocks may lead to new bone formation and consolidation, with satisfactory volumetric bone maintenance, allowing implant-supported rehabilitation with high success rates.

The aim of the present split-mouth prospective study was to evaluate clinically and histologically the bone regeneration obtained following preprosthetic vertical bone augmentation performed with titanium-reinforced dense polytetrafluoroethylene membrane (d-PM) compared to titanium mesh (TM). Healthy adult patients presenting with bilateral partial edentulism in the posterior mandible requiring vertical ridge augmentation for implant placement purposes were consecutively included. One side of the mandible was randomly assigned to the use of d-PM, the other to TM. The graft consisted in a mixture of autogenous bone harvested nearby the surgical site and deproteinized bovine bone mineral particles in a 1:1 ratio. On each side during bone augmentation surgery, a 2-mm diameter mini-implant was inserted for clinical and histological analyses. After a healing period of 8 months, the second surgical phase was carried out to remove the nonresorbable barriers, to evaluate clinically the vertical bone gain, and to collect a bone biopsy that included the mini-implant. During the same surgical session, dental implants were inserted in a prosthetically guided position. A total of five patients were enrolled. Eight out of 10 sites healed uneventfully. In the remaining two sites, premature exposure of the TM was observed. Mean vertical bone gain of 4.2 and 1.5 mm was achieved in d-PM and TM groups, respectively (p = 0.06). A mean mineralized tissue of 48.28 and 35.54% was observed in d-PM and TM groups, respectively (p = 0.51). The vertical bone gain, although not significantly, was higher in the d-PM group. Similar histological outcomes were noticed if exposure did not occur. In case of wound dehiscence, major resorption was observed. Both d-PM and TM can be used to augment atrophic localized ridges vertically. The outcome of bone regeneration seems to be impaired by exposure of the device. How to cite this article: Maiorana C, Fontana F, Rasia dal Polo M, et al. Dense Polytetrafluoroethylene Membrane versus Titanium Mesh in Vertical Ridge Augmentation: Clinical and Histological Results of a Split-mouth Prospective Study. J Contemp Dent Pract 2021;22(5):465-472.

Background: Guided bone regeneration (GBR) is a reliable technique used in vertical and horizontal bone defects. The posterior mandibular region is an area limited by anatomic constraints. The use of resorbable membranes with a cortical component could compensate for the lack of rigidity of resorbable membranes without the complications of non-resorbable membranes. The aim of this study was to evaluate the mean bone gains of a xenogeneic cortical membrane in horizontal and vertical bone defects in comparison with other membranes in the literature. Methods: A porcine cortical membrane was used to perform 7 GBR in the posterior mandibular region of five patients. Preoperative (T0) and six months postoperative (T1) cone beam computed tomography were superimposed to measure the horizontal and vertical bone gain. Implants were positioned at all sites, six months after GBR. Complications and bone resorption around the implants were also documented. Results: The mean horizontal and vertical bone gains were 3.83 ± 1.41 mm and 4.17 ± 1.86 mm, respectively. The analysis of repeatability was 0.997. As many as 40% of patients experienced pain refractory to analgesics. No exposure or infectious phenomenon was observed. Conclusions: This xenogeneic cortical membrane seemed to provide interesting results in the regeneration of horizontal and vertical bone defects. Comparative and prospective studies are necessary to validate the effectiveness of this membrane.

Background: Vertical alveolar ridge augmentation (ARA) > 3 mm is associated with increased surgical complexity and higher complication rates. Despite the availability of various ARA techniques and graft materials, robust comparative clinical data remain limited. This retrospective multicenter study aimed to evaluate and compare surgical and patient-relevant outcomes across seven established vertical ARA techniques. Methods: This retrospective multicenter study included 70 cases of vertical ARA > 3 mm using seven different techniques (10 cases each): an iliac crest graft (ICG), intraoral autogenous bone block (IBB), allogeneic bone block (ABB), CAD/CAM ABB, CAD/CAM titanium mesh (CAD/CAM TM), magnesium scaffold (MS), and the allogeneic shell technique (ST). The outcome parameters included harvesting and insertion time, bone gain (vertical and horizontal, after a minimum of one year), graft resorption (after one year), donor site morbidity, dehiscence rate, need for material removal, and biological and general financial costs. Results: Harvesting time significantly varied among the different ARA techniques (p = 0.0025), with the longest mean durations in ICGs (51.6 ± 5.8 min) and IBBs (36.5 ± 10.8 min), and no harvesting was required for the other techniques. Insertion times also significantly differed between the different ARA techniques (p < 0.0001) and were longest in IBBs (50.1 ± 7.5 min) and the ST (47.3 ± 13.9 min). ICGs achieved the highest vertical and horizontal bone gain (5.6 ± 0.4 mm), while ABBs and CAD/CAM ABBs showed the lowest (~3.0 mm). Resorption rates significantly differed between the different ARA techniques (p < 0.0001) and were highest for ICGs (25.9 ± 3.9%) and lowest for MSs (5.1 ± 1.5%). Donor site morbidity was 100% in ICGs and 50% in IBBs, with no morbidity in the other groups. Dehiscence rates were 10% in most techniques but 30% in CAD/CAM TMs. Removals were required in all techniques except MSs. Biological and financial costs were high for ICGs and CAD/CAM ABBs and low for MSs. Conclusions: Vertical ARA techniques significantly differ regarding harvesting and insertion time, bone gain, graft resorption, donor site morbidity, dehiscence rates, removals, and costs. While ICGs achieved the highest bone volume, less invasive techniques, such as CAD/CAM-based or resorbable scaffolds, reduced biological costs and complication risks. Technique selection should be individualized based on defects, patients, and reconstructive goals.

Vertical Ridge Gain with Various Bone Augmentation Techniques: A Systematic Review and Meta-Analysis.

BackgroundOne of the most recent innovations in bone augmentation surgery is represented by computer-aided-design/computer-aided-manufacturing (CAD/CAM) customized titanium meshes, which can be used to restore vertical bone defects before implant-prosthetic rehabilitations. The aim of this study was to evaluate the effectiveness/reliability of this technique in a consecutive series of cases.MethodsTen patients in need of bone augmentation before implant therapy were treated using CAD/CAM customized titanium meshes. A digital workflow was adopted to design virtual meshes on 3D bone models. Then, Direct Metal Laser Sintering (DMLS) technology was used to produce the titanium meshes, and vertical ridge augmentation was performed according to an established surgical protocol. Surgical complications, healing complications, vertical bone gain (VBG), planned bone volume (PBV), lacking bone volume (LBV), regenerated bone volume (RBV), average regeneration rate (RR) and implant success rate were evaluated.ResultsAll augmented sites were successfully restored with definitive implant-supported fixed partial dentures. Measurements showed an average VBG of 4.5 ± 1.8 mm at surgical re-entry. Surgical and healing complications occurred in 30% and 10% of cases, respectively. Mean values of PBV, LBV, and RBV were 984, 92, and 892 mm3, respectively. The average RR achieved was 89%. All 26 implants were successfully in function after 1 year of follow-up.ConclusionsThe results of this study suggest that the bone augmentation by means of DMLS custom-made titanium meshes can be considered a reliable and effective technique in restoring vertical bone defects.

Background: bone augmentation by means of manually shaped titanium mesh is an established procedure to regenerate atrophic alveolar ridges and recreate a proper contour of the peri-implant bone anatomy. Conversely, current literature on the use of preformed titanium meshes instead of traditional grids remains lacking. Therefore, the aim of the present prospective study was to evaluate the use of preformed titanium mesh to support bone regeneration simultaneously to implant placement at dehiscence-type defects from clinical, radiological, and patient-related outcomes. Methods: 8 implants showing buccal dehiscence defects were treated with preformed titanium mesh directly fixed to flat abutments screwed to the implant. Intrasurgical clinical measurements and radiographic evaluations by means of cone-beam computed tomography scans were performed to assess the horizontal bone gain after 8 months from the augmentation surgery. Biological and patient-centered outcomes were also evaluated.; Results: clinically, a mean horizontal bone gain of 4.95 ± 0.96 mm, and a mean horizontal thickness of the buccal plate of 3.25 ± 0.46 mm were found. A mean horizontal bone gain of 5.06 ± 0.88 mm associated with a mean horizontal thickness of the buccal plate of 3.45 ± 0.68 mm were observed radiographically. From a macroscopic aspect, the remodeled graft appeared well integrated with the host bone. Well vascularized newly formed bone-like tissue was observed in intimate contact with the implants. Conclusions: preformed titanium mesh may be effective in supporting simultaneous horizontal bone regeneration at dehiscence-type peri-implant defects. Titanium mesh exposure still remain an issue in this type of surgery.