Analysis of the clinical efficacy of 3D-printed individualized titanium mesh in the treatment of complex alveolar bone defects

doi:10.19439/j.sjos.2025.04.009

Abstract

Abstract: PURPOSE: To analyze the clinical efficacy of 3D-printing individualized titanium mesh (3D-PITM) technology in the treatment of complex alveolar bone defects. METHODS: A total of 22 patients with complex alveolar bone defects were selected for treatment with 3D-PITM. Mimics 21.0 software was used to reconstruct the CBCT data before surgery, immediately after surgery, and 6 months after surgery. Alveolar bone width and bone height increase were measured and postoperative complications were recorded. Buccal keratinized gingival width was measured before and after bone grafting, and the correlation between the change of keratinized gingival width and the amount of bone grafting immediately after surgery was analyzed. RESULTS: Six months post-grafting, there was significant increase in horizontal bone gain (4.21±1.03) mm and vertical bone gain (4.24±1.12) mm (P<0.001). One patient experienced postoperative infection, with no other complications reported. Six months after grafting, the width of the keratinized gingiva on the buccal side was significantly reduced by (1.19±0.20) mm compared to pre-graft measurements (P<0.001). The reduction in keratinized gingival width was positively correlated with the immediate postoperative bone volume (r=0.80, P<0.001). CONCLUSIONS: 3D-PITM can effectively complete complex bone augmentation with low incidence of complications, but there is a reduction in the buccal keratinized gingivitis after bone augmentation, and the reduction is positively correlated with the amount of bone grafting immediately after surgery.

Key words: Alveolar bone defects, 3D printing individualized titanium mesh, Guided bone regeneration, Keratinized gingiva

CLC Number:

R782.13

Shui Yuhao, Zhang Yingying, He Xiuquan, Li Yushan, Liu Kun. Analysis of the clinical efficacy of 3D-printed individualized titanium mesh in the treatment of complex alveolar bone defects[J]. Shanghai Journal of Stomatology, 2025, 34(4): 392-397.

References

[1] Chiapasco M, Casentini P.Horizontal bone-augmentation procedures in implant dentistry: prosthetically guided regeneration[J]. Periodontol 2000, 2018, 77(1): 213-240.
[2] Kofina V, Monfaredzadeh M, Rawal SY, et al.Patient-reported outcomes following guided bone regeneration: Correlation with clinical parameters[J]. J Dent, 2023, 136: 104605.
[3] Aprile P, Letourneur D, Simon-yarza T. Membranes for guided bone regeneration: a road from bench to bedside[J]. Advanced healthcare materials, 2020, 9(19): e2000707.
[4] Wadde K, Kri M, Venkatakrishnan L, et al.Vertical ridge augmentation using distraction osteogenesis versus autogenous bone grafting: a systematic review and meta-analysis[J]. J Maxillofac Oral Surg, 2023, 22(3): 672-679.
[5] Urban IA, Monje A, Lozada JL, et al.Long-term evaluation of peri-implant bone level after reconstruction of severely atrophic edentulous maxilla via vertical and horizontal guided bone regeneration in combination with sinus augmentation: a case series with 1 to 15 years of loading[J]. Clin Implant Dent Relat Res, 2017, 19(1): 46-55.
[6] Ghanaati S, Al-maawi S, Conrad T, et al. Biomaterial-based bone regeneration and soft tissue management of the individualized 3D-titanium mesh: an alternative concept to autologous transplantation and flap mobilization[J]. J Craniomaxillofac Surg, 2019, 47(10): 1633-1644.
[7] Cucchi A, Giavatto MA, Giannatiempo J, et al.Custom-made titanium mesh for maxillary bone augmentation with immediate implants and delayed loading[J]. J Oral Implantol, 2019, 45(1): 59-64.
[8] Ciocca L, Ragazzini S, Fantini M, et al.Work flow for the prosthetic rehabilitation of atrophic patients with a minimal-intervention CAD/CAM approach[J]. J Prosthet Dent, 2015, 114(1): 22-26.
[9] Gu C, Xu L, Shi A, et al.Titanium mesh exposure in guided bone regeneration procedures: a systematic review and meta-analysis[J]. Int J Oral Maxillofac Implants, 2022, 37(1): e29-e40.
[10] Sumida T, Otawa N, Kamata YU, et al.Custom-made titanium devices as membranes for bone augmentation in implant treatment: clinical application and the comparison with conventional titanium mesh[J]. J Craniomaxillofac Surg, 2015, 43(10): 2183-2188.
[11] Li L, Wang C, Li X, et al.Research on the dimensional accuracy of customized bone augmentation combined with 3D-printing individualized titanium mesh: a retrospective case series study[J]. Clin Implant Dent Relat Research, 2021, 23(1): 5-18.
[12] Lee SH, Moon JH, Jeong CM, et al.The Mechanical properties and biometrical effect of 3D preformed titanium membrane for guided bone regeneration on alveolar bone defect[J]. BioMed Res Int, 2017: 7102123.
[13] Cucchi A, Vignudelli E, Franceschi D, et al.Vertical and horizontal ridge augmentation using customized CAD/CAM titanium mesh with versus without resorbable membranes. a randomized clinical trial[J]. Clin Oral Implants Res, 2021, 32(12): 1411-1424.
[14] Nickenig HJ, Riekert M, Zirk M, et al.3D-based buccal augmentation for ideal prosthetic implant alignment-an optimized method and report on 7 cases with pronounced buccal concavities[J]. Clin Oral Investig, 2022, 26(5): 3999-4010.
[15] Chiapasco M, Casentini P, Tommasato G, et al.Customized CAD/CAM titanium meshes for the guided bone regeneration of severe alveolar ridge defects: preliminary results of a retrospective clinical study in humans[J]. Clin Oral Implants Res, 2021, 32(4): 498-510.
[16] Lizio G, Pellegrino G, Corinaldesi G, et al.Guided bone regeneration using titanium mesh to augment 3-dimensional alveolar defects prior to implant placement. a pilot study[J]. Clin Oral Implants Res, 2022, 33(6): 607-621.
[17] Cucchi A, Bianchi A, Calamai P, et al.Clinical and volumetric outcomes after vertical ridge augmentation using computer-aided-design/computer-aided manufacturing (CAD/CAM) customized titanium meshes: a pilot study[J]. BMC Oral Health, 2020, 20(1): 219.
[18] Tallarico M, Park CJ, Lumbau AI, et al.Customized 3D-printed titanium mesh developed to regenerate a complex bone defect in the aesthetic zone: a case report approached with a fully digital workflow[J]. Materials (Basel), 2020, 13(17): 3874.
[19] Lizio G, Mazzone N, Corinaldesi G, et al.Reconstruction of extended and morphologically varied alveolar ridge defects with the titanium mesh technique: clinical and dental implants outcomes[J]. Int J Periodontics Restorative Dent, 2016, 36(5): 689-697.
[20] De Santis D, Gelpi F, Verlato G, et al.Digital customized titanium mesh for bone regeneration of vertical, horizontal and combined defects: a case series[J]. Medicina (Kaunas), 2021, 57(1): 60-74.
[21] Louis PJ, Gutta R, Said-Al-naief N, et al. Reconstruction of the maxilla and mandible with particulate bone graft and titanium mesh for implant placement[J]. J Oral Maxillofac Surg, 2008, 66(2): 235-245.
[22] Zhou L, Su Y, Wang J, et al.Effect of exposure rates with customized versus conventional titanium mesh on guided bone regeneration: systematic review and meta-analysis[J]. J Oral Implantol, 2022, 48(4): 339-346.
[23] Hartmann A, Seiler M.Minimizing risk of customized titanium mesh exposures -a retrospective analysis[J]. BMC Oral Health, 2020, 20(1):36.
[24] Wang X, Wang G, Zhao X, et al.Short-term evaluation of guided bone reconstruction with titanium mesh membranes and CGF membranes in immediate implantation of anterior maxillary tooth[J]. BioMed Res Int, 2021: 4754078.
[25] Wang Q, Tang Z, Han J, et al.The width of keratinized mucosa around dental implants and its influencing factors[J]. Clin Implant Dent Relat Res, 2020, 22(3): 359-365.
[26] Gamborena I, Avila-ortiz G. Peri-implant marginal mucosa defects: classification and clinical management[J]. J Periodontol, 2021, 92(7): 947-957.
[27] Sanz M, Schwarz F, Herrera D, et al.Importance of keratinized mucosa around dental implants: consensus report of group 1 of the DGI/SEPA/Osteology Workshop[J]. Clin Oral Implants Res, 2022, 33(Suppl 23): 47-55.