New titanium mesh design method in customized bone regeneration of the jaws: preliminary study on a sample of 11 patients

Abstract

The aim of this study is 1) to present a new method of virtually-designed custom made scaffolds to be employed in customized bone regeneration (CBR) for segmental jaw atrophies and 2) to evaluate long-term clinical results in terms of bone regeneration success and implant rehabilitation success. A total of 11 patients with edentulousness and bone atrophy in a localized area of the mandible or the maxilla were recruited for the study. To fulfill the research inquiries, CT images of the pre-regeneration mandibular or maxillary arch of each patient were collected. A dedicated Mevislab 2.4 software was employed to virtually design custom bone regeneration meshes designed to fit the atrophic sector of each patient's mandible or maxilla. Subsequently, a second Meshmixer software was used to refine the margins of each of the designed meshes. All patients underwent oral surgery, during which a mixture of autologous and heterologous bone in a 1:1 proportion was grafted into the atrophic site, a custom-made mesh was placed, and a resorbable membrane was inserted. The mesh was removed after this procedure, and implant rehabilitation was performed. All patients underwent the bone regeneration procedure, with eight undergoing titanium mesh removal. A total of seven patients completed implant rehabilitation. Average horizontal bone augmentation was 3.525 ± 1.36 mm; average vertical bone augmentation was 4.45 ± 2.22 mm. Implant survival was 92.85%. During the healing phase, complications occurred in 9.09% of patients. The use of dedicated software, Mevislab 2.4 and Meshmixer, for titanium mesh design is an accurate, predictable, effective, and quick-to-use method. The learning curve for design is uncomplicated and rapid. Mesh exposure does not necessarily lead to bone graft failure; this complication can be treated by chlorhexidine aids.