Bone graft and 3D-printed titanium mesh for jaw bone repair

Abstract

<h4>Purpose</h4>After tooth loss, alveolar bone resorption is irreversible and often results in insufficient bone volume to consider implant placement. In recent years, Guided Bone Regeneration (GBR) with 3D-printed individualized titanium meshes has been increasingly employed in oral surgery, either as an alternative to or in combination with resorbable membranes, to achieve predictable bone regeneration prior to implant placement. Various mesh designs, mostly macro-porous and micro-porous structures, along with different surgical techniques, have been proposed. Although the approach has demonstrated consistent clinical reliability, complications such as mesh exposure and/or limited bone gain still occur. This study aims to evaluate the reliability of a GBR technique based on the use of micro-perforated grade-2 titanium meshes held by two vestibular screws and pure autologous bone, both in terms of clinical outcomes and bone gain.<h4>Materials and methods</h4>A retrospective study including sixteen patients implanted with this GBR technique in the same dental center was conducted. The meshes were digitally designed and manufactured using Direct Metal Laser Sintering in grade-2 titanium. All patients underwent a two-step bone regeneration procedure, including a first surgery for mesh placement, followed by a healing period of at least four months before the implant placement, with a secondary slight GBR being done. For each implanted titanium mesh, both the planned and the real bone augmentations were measured by three different operators using pre and post-surgical CBCT and planification data. A statistical linear mixed model was applied to the data (102 measurements) to assess any significant difference between the planned augmentation and the real clinical augmentation.<h4>Results</h4>All meshes were successfully implanted with no complications or exposition. After 122 to 160 days, all patients showed enough bone volume to ensure safe implant placement. No significant difference was observed between the planned bone augmentation and the clinical outcomes, indicating that the targeted augmentation was successfully achieved.<h4>Conclusions</h4>These results suggest a high level of short-term clinical reliability and predictability of the guided bone regeneration using 3D-printed individualized micro-perforated grade-2 titanium meshes in combination with pure autologous bone.