Clinical and Radiographic Outcomes of Customized Titanium Mesh vs. Screw Tent-Pole Grafting: A Retrospective Study.

Abstract

<h4>Background</h4>Guided bone regeneration (GBR) is a predictable approach for managing severe alveolar ridge deficiencies prior to implant placement. Resorbable collagen membranes supported by tenting screws are widely used, although space maintenance in non-contained defects may be challenging. Customized CAD/CAM titanium meshes have been introduced to enhance graft stability and surgical workflow, but comparative clinical evidence remains limited.<h4>Objective</h4>To compare clinical, radiographic, procedural, and peri-implant outcomes of customized CAD/CAM titanium meshes versus resorbable collagen membranes supported by tenting screws for horizontal and/or vertical alveolar ridge augmentation.<h4>Materials and methods</h4>This retrospective study included 40 patients with severe alveolar ridge defects, allocated to two groups (n = 20 each). Both groups received particulate bone grafts stabilized either with tenting screws and a resorbable collagen membrane or with a patient-specific CAD/CAM titanium mesh. Cone-beam computed tomography (CBCT) scans at baseline and 6 months were used to assess vertical and horizontal bone gain. Intraoperative time, complications, pseudo-periosteum formation, implant survival, and peri-implant marginal bone levels at prosthetic loading and at 5-year follow-up were recorded.<h4>Results</h4>At 6 months, mean bone height reached 8.7-8.93 mm in the maxilla and 9.25-9.35 mm in the mandible, while mean ridge width ranged from 4.7 to 5.3 mm, with no significant intergroup differences (p > 0.05). Mean peri-implant marginal bone loss was limited and remained stable from prosthetic loading to the 5-year follow-up in both groups. Mean operative time was significantly shorter in the customized mesh group, 72.7 min (range: 60-85) for the Tent-pole group and 62.4 min (range: 60-65) for the Ti-mesh group. All 60 implants placed in 40 augmented sites survived, with no implant failures and no need for additional grafting procedures.<h4>Conclusions</h4>Both GBR techniques provided comparable bone regeneration and long-term peri-implant stability, while customized CAD/CAM titanium meshes were associated with reduced operative time.