Can Patient-Specific Titanium Meshes Achieve Predictable Bone Volume in Extensive Alveolar Defects?

Abstract

<h4>Background</h4>Reconstructing alveolar defects with titanium meshes is challenging and prone to complications. The introduction of patient-specific titanium meshes was expected to overcome these drawbacks.<h4>Purpose</h4>The aim of this study was to evaluate the association between planned and achieved augmentation volumes using patient-specific titanium meshes (Yxoss Customized Bone Regeneration ; ReOss, Filderstadt, Germany) and to identify factors associated with the clinically achieved augmentation volumes.<h4>Study design, setting, and sample</h4>A single-center, retrospective cohort study was performed in an outpatient clinic. Inclusion criteria were patients aged >18 who underwent jaw augmentation with custom titanium meshes and a complete follow-up (postoperative healing, implant placement, and loading) between 2018 and 2023. Exclusion criteria were objection or inability to submit informed consent, loss to follow-up, and incomplete documentation.<h4>Predictor variable</h4>The predictor was the planned augmentation volume (in mm³).<h4>Outcome variable</h4>The primary outcome variable was the achieved augmentation volume (in mm³) about 3 months after mesh placement, determined by cone beam computed tomography analysis using Slicer 3D software (Brigham and Women's Hospital, Boston, MA).<h4>Covariates</h4>The covariates were sex, wound healing disturbances, rigidity of mesh fixation (number of screws), and mesh exposure.<h4>Analyses</h4>Descriptive and inferential statistics were computed (P < .05).<h4>Results</h4>During the study interval, 82 patients were treated, and 53 (64%) were excluded due to incomplete radiological data or loss to follow-up. The sample was composed of 29 subjects with a mean age of 61.8 years (±12.75), in whom 33 augmentation procedures were performed. Eight (27.8%) subjects were male. The mean planned and achieved augmentation volumes were 1488.73 mm³ (±949.03 mm³) and 763.23 mm³ (±510.2 mm³), respectively (P < .001; Pearson correlation coefficient 0.73). A more rigid mesh fixation significantly increased the achieved bone volume (β = 0.34; P = .006). Wound healing disturbances occurred frequently (42%) but did not reduce the achieved bone volume. During the median follow-up period of 23 months (interquartile range: 14-31), none of the 60 implants placed in the augmented bone failed.<h4>Conclusion and relevance</h4>Despite a significant complication rate, adequate bone volume for implant placement can be attained with custom titanium meshes.