The vertical and horizontal regeneration of resorbed alveolar ridges remains a challenging surgical procedure, especially in the case of extensive bone atrophy. During the past years, different augmentation techniques have been proposed to restore an adequate bone volume. The aim of this study was to evaluate a technique for ridge augmentation in the maxilla and mandible using an individualized CAD-CAM-produced titanium mesh.

In our study, titanium mesh exposure occurred in 33% of the augmented sites. However, a premature removal of these exposed meshes was not necessary in any of these cases. In addition, exposure of the mesh did not affect the final outcome of the augmentation as implant insertion was possible in all cases in the desired position, indicating a success rate of 100% for the augmentation technique. The titanium mesh exposure is a common complication, with reported exposure rates between 0 and 80% in the international literature [11, 17]. Sumida et al. investigated custom-made titanium devices for bone augmentation compared to conventional titanium meshes in 26 patients [15]. Mucosal rupture occurred in a patient in the custom-made group (7.7%) and 3 in the conventional group (23.1%), indicating better results for the individualized mesh, however, neither statistically nor clinically significant. In a further clinical study investigating a conventional titanium mesh, exposure occurred in 6 of the 17 patients (35%) [22]. Two of them were early exposures (within 2 weeks) and 4 of them late exposures. Corinaldesi et al. showed an exposure rate of 14.8% [23]. These cases necessitated premature removal of the titanium mesh. In these exposed sites, reduction in mean bone regeneration was observed compared to mesh-retained sites in patients who received simultaneous augmentation and implant placement. A critical point discussed in the international literature is the time elapsed between augmentation procedure and exposure. An early exposure within the first weeks showed a negative impact on bone regeneration in contrast to a late exposure [12, 23,24,25]. To prevent such an exposure, an accurate soft tissue handling in terms of tension-free flaps over the mesh is mandatory.