Reduced Surgical Complications in Graft-Masked 3D Ti Mesh for Alveolar Augmentation: A Retrospective Comparative Study.

OBJECTIVE

To assess and compare the effectiveness of different bone grafting techniques, including unmasked meshes and graft-masked meshes approaches, for augmenting alveolar bone defects using 3D-printed titanium mesh (3D-TM).

MATERIALS AND

METHODS

This retrospective study included 34 patients (69 teeth with alveolar bone defects) who underwent guided bone regeneration (GBR) using 3D-printed titanium mesh (3D-TM). Patients were assigned to two groups: the unmasked meshes group (n = 17, 34 treatment sites) and the graft-masked meshes group (n = 17, 35 treatment sites). Cone beam computed tomography (CBCT) data of pre- and post-operative 3D-TM implantation were digitally reconstructed, with a minimum 6-month follow-up period. Clinical outcomes included titanium mesh exposure rates, pseudo-periosteum rates, and osteogenic efficiency metrics such as bone volume, vertical bone height/width, and bone contour. Bone volume was analyzed using samples t-tests, vertical bone height/width was analyzed using a generalized estimating equations (GEE) model, and bone contour was analyzed using the Mann-Whitney U test. Categorical outcomes were evaluated via Fisher's exact probability test.

RESULTS

Clinical complications analysis revealed distinct outcomes between the two groups. Titanium mesh exposure occurred in 7 cases overall, with no statistically significant difference between the unmasked meshes group (5/17, 29.4%) and the graft-masked meshes group (2/17, 11.8%) (Fisher's exact test, p = 0.398). In contrast, pseudo-periosteum demonstrated a significant discrepancy, observed in 14/17 cases (82.4%) in the unmasked meshes group compared to 4/17 cases (23.5%) in the graft-masked meshes group (Fisher's exact test, p = 0.002). Notably, no infections occurred in either group. Analysis of osteogenic efficacy revealed significant intergroup differences in bone volume ratio (Independent samples t-test, df = 32, p < 0.05), vertical bone height ratio, and width ratio (GEE, df = 1, p < 0.05), and bone contour accuracy at the minimum and 25% percentiles (Mann-Whitney U test, p < 0.05). No significant differences were observed at the 50%, 75% percentile, or maximum value.

CONCLUSION

The graft-masked meshes technique in 3D-TM guided bone regeneration surgery is a reliable and effective method for augmenting alveolar bone defects. This method effectively reduces procedure-related complications, including titanium mesh exposure and pseudo-periosteum, thereby improving osteogenic efficacy.