In a retrospective study, the clinical outcome of an individualized CAD-CAM-produced TM (Yxoss CBR®, Filderstadt, Germany) inserted by experienced surgeons in the Department of Oral and Maxillofacial Surgery of the University Medical Centre Mainz, Germany, between December 2014 and January 2017, was analyzed. Therefore, all patients with this CAD-CAM mesh augmentation and reentry operation for implant insertion in this time period were included in this study. There were no patients excluded from this study. The retrospective data analysis was conducted in accordance with the Helsinki Declaration of 1975, as revised in 2008, and all patients signed an informed consent. After consulting the local ethic committee, the decision was that due to the retrospective character of this study with no additional data acquisition, no ethical approval was needed according to the hospital laws of the appropriate state (Landeskrankenhausgesetz Rhineland Palatinate, Germany).

With the Customized Bone Regeneration (CBR®) technology, the manufacturing of custom-molded protective TM is achieved. Using the DICOM data of the CBCT scan of the defect region, an individualized mesh was produced using the CAD-CAM technology by ReOss Ltd. (Filderstadt, Germany). The meshes were produced using three-dimensional printing. Surgeries were performed under local or anesthesia or in general anesthesia. Depending on the defect configuration, a mid-crestal or a modified poncho incision was performed. For the modified poncho, the incision was made in the vestibulum parallel to the alveolar ridge by a tunneling preparation (Fig. 1). This poncho technique was preferred in pronounced vertical defects. After incision, preparation of a mucoperiosteal flap, debridement of scar tissue, and exposure of the defect were conducted. Then, a passive tension-free fit of the TM was verified. Autologous bone was harvested with bone scraper from the intraoral regions, such as the tuber maxillae, the symphysis, the mandibular body, and the retromolar pad region (Safescraper®, Zimmer Biomet, Germany) or from the iliac crest. The TM was loaded with an equal mixture of deproteinized bovine bone mineral (Bio-Oss®, Geistlich Biomaterials, Switzerland) and autologous bone or autologous bone alone and fitted to the defect. The rationale of mixing autogenous bone with DBBM is to combine the scaffold properties of the xenograft with the osteogenic and osteoinductive properties of the autograft [18,19,20]. To fix the TM in place, two bone screws were used. TM were covered in situ with nothing, a resorbable collagen membrane (Bio-Gide®, Geistlich Biomaterials, Switzerland) alone, or a resorbable collagen membrane, followed by platelet-rich fibrin (PRF) membranes (Choukroun A-PRF™) in a double-layer technique. The PRF membranes were produced according to the manufacturer’s protocol. All patients underwent an oral antibiotic therapy with amoxicillin 1000 mg (1 to 0–1) for 5 days starting at the operation day. Reentry with explantation of the TM and simultaneous implantation were performed after a 6-month healing period. Figures 2, 3, 4, 5, 6, 7, and 8 present a clinical case.