Clinical and histological evaluation of three-dimensional printing individualized titanium mesh for alveolar bone defect repair

doi:10.7518/hxkq.2025.2024481

Abstract

Abstract:

Objective To evaluate the osteogenic efficacy of three-dimensional printing individualized titanium mesh (3D-PITM) as a scaffold material in guided bone regeneration (GBR). Methods 1) Patients undergoing GBR for alveolar bone defects were enrolled as study subjects, and postoperative healing complications were recorded. 2) Postoperative cone beam computed tomography (CBCT) scans acquired at least 6 months post-surgery were used to calculate the percentage of actual bone formation volume. 3) Alveolar bone specimens were collected during the first-stage implant surgery for histomorphometric analysis. This analysis quantitatively measured the proportions of newly formed bone and newly formed unmineralized bone within the specimens. Specimens were categorized into three groups based on healing complications (good healing group, wound dehiscence group, 3D-PITM exposure group) to compare differences in the proportions of newly formed bone and newly formed unmineralized bone. Results 1) Twelve patients were included. Guided bone regeneration failed in one patient, and 3D-PITM exposure occurred in three patients (exposure rate: 25%). 2) The mean percentage of actual bone formation volume in the 11 successful guided bone regeneration cases was 95.23%±28.85%. 3) Histomorphometric analysis revealed that newly formed bone constituted 40.35% of the alveolar bone specimens, with newly formed unmineralized bone accounting for 13.84% of the newly formed bone. Intergroup comparisons showed no statistically significant differences (P>0.05) in the proportions of newly formed bone or newly formed unmineralized bone between the good healing group and the wound dehiscence group or the 3D-PITM exposure group. Conclusion 3D-PITM enables effective bone augmentation. Radiographic assessment demonstrated favorable bone formation volume, while histological analysis confirmed substantial formation of newly formed mineralized bone within the surgical site.

Key words: three-dimensional printing individualized titanium mesh, guided bone regeneration, histology, histomorphometry, titanium mesh exposure

CLC Number:

R782

Zhao Pengyu, Chen Gang, Cheng Yi, Wang Chao, Chen Dan, Huang Haitao. Clinical and histological evaluation of three-dimensional printing individualized titanium mesh for alveolar bone defect repair[J]. West China Journal of Stomatology, 2025, 43(4): 592-602.

Figures/Tables 11

Fig 1

Fig 2

Tab 1

Tab 2

Fig 3

Tab 3

Tab 4

Fig 4

Fig 5

Tab 5

Tab 6

References 57

[1]	Alotaibi FF, Rocchietta I, Buti J, et al. Comparative evidence of different surgical techniques for the management of vertical alveolar ridge defects in terms of complications and efficacy: a systematic review and network meta-analysis[J]. J Clin Periodontol, 2023, 50(11): 1487-1519.
[2]	Li SH, Zhao YX, Tian TR, et al. A minimally invasive method for titanium mesh fixation with resorbable sutures in guided bone regeneration: a retrospective study[J]. Clin Implant Dent Relat Res, 2023, 25(1): 87-98.
[3]	Yang W, Chen D, Wang C, et al. The effect of bone defect size on the 3D accuracy of alveolar bone augmentation performed with additively manufactured patient-specific titanium mesh[J]. BMC Oral Health, 2022, 22(1): 557.
[4]	Wang HL, Boyapati L. “PASS” principles for predicta-ble bone regeneration[J]. Implant Dent, 2006, 15(1): 8-17.
[5]	Xie Y, Li SH, Zhang TX, et al. Titanium mesh for bone augmentation in oral implantology: current application and progress[J]. Int J Oral Sci, 2020, 12(1): 37.
[6]	Cunha G, Carvalho PHA, Quirino LC, et al. Titanium mesh exposure after bone grafting: treatment approaches-a systematic review[J]. Craniomaxillofac Trauma Reconstr, 2022, 15(4): 397-405.
[7]	Briguglio F, Falcomatà D, Marconcini S, et al. The use of titanium mesh in guided bone regeneration: a systematic review[J]. Int J Dent, 2019, 2019: 9065423.
[8]	Ciocca L, Fantini M, De Crescenzio F, et al. Direct metal laser sintering (DMLS) of a customized titanium mesh for prosthetically guided bone regeneration of atrophic maxillary arches[J]. Med Biol Eng Comput, 2011, 49(11): 1347-1352.
[9]	Sumida T, Otawa N, Kamata YU, et al. Custom-made titanium devices as membranes for bone augmentation in implant treatment: clinical application and the comparison with conventional titanium mesh[J]. J Craniomaxillofac Surg, 2015, 43(10): 2183-2188.
[10]	Chiapasco M, Casentini P. Horizontal bone-augmentation procedures in implant dentistry: prosthetically guided regeneration[J]. Periodontol 2000, 2018, 77(1): 213-240.
[11]	Sagheb K, Schiegnitz E, Moergel M, et al. Clinical outcome of alveolar ridge augmentation with individualized CAD-CAM-produced titanium mesh[J]. Int J Implant Dent, 2017, 3(1): 36.
[12]	Cucchi A, Vignudelli E, Franceschi D, et al. Vertical and horizontal ridge augmentation using customized CAD/CAM titanium mesh with versus without resorbable membranes. A randomized clinical trial[J]. Clin Oral Implants Res, 2021, 32(12): 1411-1424.
[13]	Chiapasco M, Casentini P, Tommasato G, et al. Customized CAD/CAM titanium meshes for the guided bone regeneration of severe alveolar ridge defects: preliminary results of a retrospective clinical study in humans[J]. Clin Oral Implants Res, 2021, 32(4): 498-510.
[14]	Chrcanovic BR, Albrektsson T, Wennerberg A. Bone quality and quantity and dental implant failure: a systematic review and meta-analysis[J]. Int J Prosthodont, 2017, 30(3): 219-237.
[15]	Nicolielo LFP, van Dessel J, Jacobs R, et al. Relationship between trabecular bone architecture and early dental implant failure in the posterior region of the mandible[J]. Clin Oral Implants Res, 2020, 31(2): 153-161.
[16]	Li SH, Zhang TX, Zhou M, et al. A novel digital and visualized guided bone regeneration procedure and digital precise bone augmentation: a case series[J]. Clin Implant Dent Relat Res, 2021, 23(1): 19-30.
[17]	Pillai S, Upadhyay A, Khayambashi P, et al. Dental 3D-printing: transferring art from the laboratories to the clinics[J]. Polymers (Basel), 2021, 13(1): E157.
[18]	Fontana F, Maschera E, Rocchietta I, et al. Clinical classification of complications in guided bone regeneration procedures by means of a nonresorbable membrane[J]. Int J Periodontics Restorative Dent, 2011, 31(3): 265-273.
[19]	Simion M, Pistilli R, Vignudelli E, et al. Semi-occlusive CAD/CAM titanium mesh for guided bone regeneration: preliminary clinical and histological results[J]. Int J Oral Implantol (Berl), 2023, 16(4): 327-336.
[20]	Li L, Wang C, Li X, et al. Research on the dimensional accuracy of customized bone augmentation combined with 3D-printing individualized titanium mesh: a retrospective case series study[J]. Clin Implant Dent Relat Res, 2021, 23(1): 5-18.
[21]	Zhang G, Miao X, Lin H, et al. A tooth-supported titanium mesh bending and positioning module for alveolar bone augmentation and improving accuracy[J]. J Esthet Restor Dent, 2023, 35(4): 586-595.
[22]	Chen D, Zheng LL, Wang C, et al. Evaluation of surgical placement accuracy of customized CAD/CAM titanium mesh using screws-position-guided template: a retrospective comparative study[J]. Clin Implant Dent Relat Res, 2023, 25(3): 519-531.
[23]	许来俊, 袁鹤, 叶青, 等. 负载纳米羟磷灰石的结冷胶修复大鼠下颌骨缺损的效果评价[J]. 上海口腔医学, 2022, 31(5): 449-453.
	Xu LJ, Yuan H, Ye Q, et al. Repair of mandibular defects with. hydrogel loaded with nano-hydroxyapatite in rats[J]. Shanghai J Stomatol, 2022, 31(5): 449-453.
[24]	杜文瑜, 杨静文, 姜婷. 甲磺酸去铁胺促进大鼠颅骨临界骨缺损血管化骨再生的早期连续观察[J]. 北京大学学报(医学版), 2021, 53(6): 1171-1177.
	Du WY, Yang JW, Jiang T. Early constant observation of the. effect of deferoxamine mesylate on improvement of vascularized bone regeneration in SD rat skull critical size defect model[J]. J Peking Uni (Health Sci), 2021, 53(6): 1171-1177.
[25]	Cucchi A, Sartori M, Parrilli A, et al. Histological and histomorphometric analysis of bone tissue after guided bone regeneration with non-resorbable membranes vs resorbable membranes and titanium mesh[J]. Clin Implant Dent Relat Res, 2019, 21(4): 693-701.
[26]	Cucchi A, Bettini S, Fiorino A, et al. Histological and histomorphometric analysis of bone tissue using customized titanium meshes with or without resorbable membranes: a randomized clinical trial[J]. Clin Oral Implants Res, 2024, 35(1): 114-130.
[27]	MacBeth N, Trullenque-Eriksson A, Donos N, et al. Hard and soft tissue changes following alveolar ridge preservation: a systematic review[J]. Clin Oral Implants Res, 2017, 28(8): 982-1004.
[28]	Dellavia C, Canciani E, Pellegrini G, et al. Histological assessment of mandibular bone tissue after guided bone regeneration with customized computer-aided design/computer-assisted manufacture titanium mesh in humans: a cohort study[J]. Clin Implant Dent Relat Res, 2021, 23(4): 600-611.
[29]	Aludden H, Mordenfeld A, Dahlin C, et al. Histological and histomorphometrical outcome after lateral guided bone regeneration augmentation of the mandible with different ratios of deproteinized bovine bone mineral and autogenous bone. A preclinical in vivo study[J]. Clin Oral Implants Res, 2020, 31(10): 1025-1036.
[30]	Gallo P, Díaz-Báez D, Perdomo S, et al. Comparative analysis of two biomaterials mixed with autogenous bone graft for vertical ridge augmentation: a histomorphometric study in humans[J]. Clin Implant Dent Relat Res, 2022, 24(5): 709-719.
[31]	Corinaldesi G, Pieri F, Marchetti C, et al. Histologic and histomorphometric evaluation of alveolar ridge augmentation using bone grafts and titanium micromesh in humans[J]. J Periodontol, 2007, 78(8): 1477-1484.
[32]	Zazou N, Diab N, Bahaa S, et al. Clinical comparison of different flap advancement techniques to periosteal releasing incision in guided bone regeneration: a randomized controlled trial[J]. Clin Implant Dent Relat Res, 2021, 23(1): 107-116.
[33]	Bertran Faus A, Cordero Bayo J, Velasco-Ortega E, et al. Customized titanium mesh for guided bone regeneration with autologous bone and xenograft[J]. Materials (Basel), 2022, 15(18): 6271.
[34]	Galindo-Moreno P, Moreno-Riestra I, Avila G, et al. Effect of anorganic bovine bone to autogenous cortical bone ratio upon bone remodeling patterns following maxillary sinus augmentation[J]. Clin Oral Implants Res, 2011, 22(8): 857-864.
[35]	Leblebicioglu B, Tatakis DN. Complications following alveolar ridge augmentation procedures[J]. Periodontol 2000, 2023, 93(1): 221-235.
[36]	Poli PP, Beretta M, Maiorana C, et al. Therapeutic strategies in the management of nonresorbable membrane and titanium mesh exposures following alveolar bone augmentation: a systematic scoping review[J]. Int J Oral Maxillofac Implants, 2022, 37(2): 250-269.
[37]	Lim G, Lin GH, Monje A, et al. Wound healing complications following guided bone regeneration for ridge augmentation: a systematic review and meta-analysis[J]. Int J Oral Maxillofac Implants, 2018, 33(1): 41-50.
[38]	Lizio G, Mazzone N, Corinaldesi G, et al. Reconstruction of extended and morphologically varied alveolar ridge defects with the titanium mesh technique: clinical and dental implants outcomes[J]. Int J Periodontics Restorative Dent, 2016, 36(5): 689-697.
[39]	Ciocca L, Lizio G, Baldissara P, et al. Prosthetically CAD-CAM-guided bone augmentation of atrophic jaws using customized titanium mesh: preliminary results of an open prospective study[J]. J Oral Implantol, 2018, 44(2): 131-137.
[40]	Zhou L, Su Y, Wang J, et al. Effect of exposure rates with customized versus conventional titanium mesh on guided bone regeneration: systematic review and meta-analysis[J]. J Oral Implantol, 2022, 48(4): 339-346.
[41]	Cucchi A, Vignudelli E, Napolitano A, et al. Evaluation of complication rates and vertical bone gain after guided bone regeneration with non-resorbable membranes versus titanium meshes and resorbable membranes. A randomized clinical trial[J]. Clin Implant Dent Relat Res, 2017, 19(5): 821-832.
[42]	Nan X, Wang C, Li LZ, et al. Application of three-dimensional printing individualized titanium mesh in alveolar bone defects with different Terheyden classifications: a retrospective case series study[J]. Clin Oral Implants Res, 2023, 34(6): 639-650.
[43]	Machtei EE. The effect of membrane exposure on the outcome of regenerative procedures in humans: a meta-analysis[J]. J Periodontol, 2001, 72(4): 512-516.
[44]	Atef M, Tarek A, Shaheen M, et al. Horizontal ridge augmentation using native collagen membrane vs titanium mesh in atrophic maxillary ridges: randomized clinical trial[J]. Clin Implant Dent Relat Res, 2020, 22(2): 156-166.
[45]	Hofferber CE, Beck JC, Liacouras PC, et al. Volumetric changes in edentulous alveolar ridge sites utilizing guided bone regeneration and a custom titanium ridge augmentation matrix (CTRAM): a case series study[J]. Int J Implant Dent, 2020, 6(1): 83.
[46]	Hartmann A, Seiler M. Minimizing risk of customized titanium mesh exposures-a retrospective analysis[J]. BMC Oral Health, 2020, 20(1): 36.
[47]	Rakhmatia YD, Ayukawa Y, Furuhashi A, et al. Microcomputed tomographic and histomorphometric analyses of novel titanium mesh membranes for guided bone regeneration: a study in rat calvarial defects[J]. Int J Oral Maxillofac Implants, 2014, 29(4): 826-835.
[48]	Lee WZ, Ong MMA, Yeo ABK. Gingival profiles in a select Asian cohort: a pilot study[J]. J Invest Clin Dent, 2018, 9(1). DOI:10.1111/jicd.12269 .
[49]	Hartmann A, Hildebrandt H, Schmohl JU, et al. Evaluation of risk parameters in bone regeneration using a customized titanium mesh: results of a clinical study[J]. Implant Dent, 2019, 28(6): 543-550.
[50]	Frost NA, Mealey BL, Jones AA, et al. Periodontal biotype: gingival thickness as it relates to probe visibility and buccal plate thickness[J]. J Periodontol, 2015, 86(10): 1141-1149.
[51]	Wang CX, Rong QG, Zhu N, et al. Finite element analysis of stress in oral mucosa and titanium mesh interface[J]. BMC Oral Health, 2023, 23(1): 25.
[52]	Lin GH, Chan HL, Wang HL. The significance of keratinized mucosa on implant health: a systematic review[J]. J Periodontol, 2013, 84(12): 1755-1767.
[53]	Miyamoto I, Funaki K, Yamauchi K, et al. Alveolar ridge reconstruction with titanium mesh and autogenous particulate bone graft: computed tomography-based evaluations of augmented bone quality and quantity[J]. Clin Implant Dent Relat Res, 2012, 14(2): 304-311.
[54]	Bahaa S, Diab N, Zazou N, et al. Evaluation of bone gain in horizontal ridge augmentation using titanium mesh in combination with different flap advancement techniques: a randomized clinical trial[J]. Int J Oral Ma-xillofac Surg, 2023, 52(3): 379-387.
[55]	Torres J, Tamimi F, Alkhraisat MH, et al. Platelet-rich plasma may prevent titanium-mesh exposure in alveolar ridge augmentation with anorganic bovine bone[J]. J Clin Periodontol, 2010, 37(10): 943-951.
[56]	Kaner D, Zhao H, Arnold W, et al. Pre-augmentation soft tissue expansion improves scaffold-based vertical bone regeneration-a randomized study in dogs[J]. Clin Oral Implants Res, 2017, 28(6): 640-647.
[57]	Kablan F, Laster Z. The use of free fat tissue transfer from the buccal fat pad to obtain and maintain primary closure and to improve soft tissue thickness at bone-augmented sites: technique presentation and report of case series[J]. Int J Oral Maxillofac Implants, 2014, 29(2): e220-e231.

病例编号	性别	年龄/岁	缺牙位点	种植位点	Terheyden分型	愈合期/月
1	男	48	12	12	3/4型	8
2	女	52	35、36、37	35	3/4型	9
2	女	52	35、36、37	37	3/4型	9
3	男	52	21、22	21	3/4型	9
3	男	52	21、22	22	3/4型	9
4	女	50	21、22	21	3/4型	8
4	女	50	21、22	22	3/4型	8
5	男	38	21、22、23、24	22	3/4型	7
				23	3/4型
				24	2/4型
6	女	40	24、25、26、27	24	3/4型	11
				26	3/4型
				27	3/4型
7	女	49	36、37	36	3/4型	10
7	女	49	36、37	37	3/4型	10
8	女	28	11、12、21、22	12	3/4型	11
8	女	28	11、12、21、22	22	3/4型	11
9	男	37	11	11	3/4型	10
10	女	50	11、12	11	4/4型	10
10	女	50	11、12	12	3/4型	10
11	女	57	11、21	11	3/4型	10
11	女	57	11、21	21	3/4型	10
12	男	53	31、32、41、42	32	2/4型	9
12	男	53	31、32、41、42	42	2/4型	9

病例编号	愈合并发症		备注
病例编号	创口裂开	3D-PITM暴露	备注
1	术后2周创口裂开可吸收胶原膜暴露	-	术后4周内创口二次愈合
2	-	-	-
3	-	-	-
4	-	-	-
5	-	-	-
6	术后2周创口裂开可吸收胶原膜暴露	-	术后4周内创口二次愈合
7	-	-	-
8	-	-	-
9	术后2周创口裂开可吸收胶原膜暴露	术后3周暴露（早期暴露）	GBR手术失败
10	-	术后4月暴露（晚期暴露）	-
11	术后10天创口裂开可吸收胶原膜暴露	术后4周暴露（早期暴露）	-
12	-	-	-

病例编号	计划骨增量体积/mm³	实际骨增量体积/mm³	实际成骨体积百分比/%
1	175	289	165.14
2	573	321	56.02
3	401	380	94.76
4	107	95	88.79
5	583	526	90.22
6	757	696	91.94
7	1025	800	78.05
8	810	754	93.09
9	434	失败	-
10	1463	833	56.94
11	472	542	114.83
12	491	578	117.72

标本编号	新生未矿化骨面积/mm²	新生骨总面积/mm²	视野内组织总面积/mm²	新生骨占比/%	新生未矿化骨占比/%
1	0.28	1.75	2.75	63.75	15.76
2	0.01	0.3	2.97	10.14	3.68
3	0.06	2.07	5.76	35.93	2.90
4	0.14	0.67	3.45	19.40	20.53
5	0.4	1.08	4.33	24.97	36.86
6	0.2	5.78	11.3	51.14	3.42
7	0.04	3.46	7.14	48.51	1.02
8	0.35	1.11	2.49	44.76	31.01
9	0.1	0.23	3.89	6.03	40.68
10	0.78	2.84	3.22	88.17	27.34
11	0.23	1.59	7.3	21.71	14.48
12	0.03	0.24	2.16	11.17	13.19
13	0.05	0.72	2.95	24.51	7.09
14	0.86	4.83	6.9	69.97	17.85
15	0.2	1.68	2.09	80.52	12.18
16	0.03	1.09	7.25	15.06	2.46
17	0.1	2.07	2.57	80.58	4.87
18	1.91	3.24	3.8	85.33	59.05

骨组织类型	组别	n	中位数	四分位间距	W值	P值
新生骨占比	创口愈合良好	16	42.2%	21.13%~72.61%	21.0	0.549
新生骨占比	创口裂开	2	29.9%	22.49%~37.34%	21.0	0.549
新生未矿化骨占比	创口愈合良好	16	13.8%	4.57%~22.23%	18.0	0.837
新生未矿化骨占比	创口裂开	2	16.7%	9.60%~23.87%	18.0	0.837