Tridimensional ridge augmentation with digital customized titanium mesh: radiological and histological evaluation. A case series.

OBJECTIVES

To evaluate the three-dimensional bone regeneration achieved with digitally customized titanium meshes in patients presenting Cawood and Howell Class V defects, 8 months after surgery.

METHODS

This retrospective clinical case series included 9 patients with severe alveolar ridge atrophy (Cawood and Howell Class V), who underwent guided bone regeneration using customized titanium meshes at 10 surgical sites (8 mandibular and 2 maxillary). Meshes were designed through a fully digital workflow based on cone-beam computed tomography (CBCT) data and manufactured using Direct Metal Laser Sintering (DMLS). This approach allowed accurate preoperative planning, optimal adaptation of the mesh, smooth and rounded margins, intrinsic stability, and reduced intraoperative time. Surgical procedures were performed with careful flap management to achieve tension-free primary closure. Clinical and histological outcomes were assessed at 8 months postoperatively.

RESULTS

No cases of mesh exposure, infection, or graft failure were observed. The mean vertical bone gain was 5.18 ± 1.82 mm, while the mean horizontal bone gain was 7.27 ± 1.74 mm. The mean regenerated bone volume was 1.25 ± 0.67 cm³. Histological analysis revealed vital, well-vascularized bone in direct contact with residual graft material.

CONCLUSIONS

Within the limitations of this retrospective case series, customized titanium meshes were associated with measurable three-dimensional bone gain in Cawood and Howell Class V defects. These preliminary findings support the feasibility of this patient-specific digital approach and warrant further investigation in larger prospective studies with appropriate control groups.

CLINICAL SIGNIFICANCE STATEMENT: Digitally customized titanium meshes manufactured through a fully digital workflow were associated with three-dimensional bone regeneration in severe alveolar ridge defects, with the formation of vital, well-vascularized bone observed histologically. Their accurate fit, intrinsic stability, and favorable clinical handling may facilitate the management of challenging clinical situations. These preliminary findings support further investigation of this patient-specific approach for implant rehabilitation in severely atrophic ridges.