Introduction

For some patients, dental implants would not be an option without horizontal or vertical bone augmentation. Alveolar bone defects may be treated with various bone regeneration techniques including block bone graft, guided bone regeneration (GBR), ridge splitting, and distraction osteogenesis, as well as sinus floor augmentation procedures in the upper jaw.

Titanium meshes have been widely used for oral and maxillofacial defect reconstruction in terms of GBR technique. They are rigid enough to maintain the grafted space and to avoid soft tissue collapse. Onlay osseous graft protected by a titanium mesh demonstrated significantly less bone resorption compared with an onlay bone graft alone. Titanium mesh is also an alternative to a (resorbable) membrane for ridge augmentation.

With its advantages, such as biocompatibility, corrosion resistance, and thermal effects, a titanium mesh has been proven to be useful in these indications, and substantial bone augmentation can be achieved using the titanium construct in conjunction with bone grafting. The inherent rigidity of stiff titanium membranes maintains the space needed to allow bone growth. Studies have demonstrated that titanium mesh supports the grafted space and prevents soft tissue collapse. However, the clinical outcome of augmentation depends on the type of preoperative bone defect. In addition, titanium mesh has good mechanical strength, and it can be shaped readily and fixed with suture or pins with resulting potential space. Titanium fiber mesh has proven to act as a bone regeneration scaffold, even with a thin hydroxyapatite coating of the mesh.

The conventional already established GBR method, which is based on nonindividualized mesh constructs, shows significant disadvantages such as manual cutting, bending, and trimming to achieve the desired shape for implant placement. These steps are time intensive and prolong surgery. Furthermore, the outcome of the mesh frequently does not reflect the entire anatomic characteristics in a satisfactory level.

New bone reconstructive techniques based on guided bone regeneration for localized three-dimensional hard tissue augmentation are discussed. These techniques can result in significantly enhanced bone regeneration with minimal patient discomfort. The effectiveness of a customized, three-dimensional, preformed titanium mesh as a barrier membrane for peri-implant alveolar bone regeneration has proven to result in satisfactory bone regeneration. In general, the application of individual digital design and rapid prototyping in the reconstruction of bony defects seems promising.

This case report describes the three-dimensional reconstruction of a posterior mandible segment with the use of an individualized customized titanium lattice structure. After 24 months, clinical, radiologic, and histologic results are presented.