Individualized 3D-Printed Titanium Mesh-Assisted Alveolar Reconstruction and Implant Rehabilitation Following MRONJ Resection: A Case Report.

Medication-related osteonecrosis of the jaw is a severe complication of antiresorptive therapy that often necessitates complex reconstructive surgery. This report describes a case of implant-supported rehabilitation using a customized 3D-printed titanium mesh for an extensive mandibular defect resulting from medication-related osteonecrosis of the jaw. A 58-year-old woman with stage-3 medication-related osteonecrosis of the jaw after zoledronate therapy underwent segmental mandibulectomy and reconstruction with a free iliac crest graft. Nine months later, a customized titanium mesh was placed to protect the planned 9.5-11 mm augmentation. Cone beam computed tomography confirmed mineralized regeneration within the mesh. The mesh was removed after achieving 9.5 mm vertical and 11 mm horizontal alveolar augmentation, and 4 implants were placed with high primary stability (insertion torque ≥ 40 N cm). At 6 months, resonance frequency analysis values ranged from 75 to 84, allowing delivery of a splinted fixed prosthesis. At 12 months of loading, the peri-implant tissues remained normal with stable radiographic bone levels and satisfactory function. Combining customized 3D-printed titanium mesh with guided implant placement supports stable bone regeneration and prosthetic rehabilitation in patients with medication-related osteonecrosis of the jaw. However, outcomes depend on medication history, therapy timing, and unresolved drug-related factors, underscoring the need for a multidisciplinary approach with individualized treatment and proactive complication care.