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Reduced Surgical Complications in Graft-Masked 3D Ti Mesh for Alveolar Augmentation: A Retrospective Comparative
Hui Gao1, Dan Chen2, Chao Wang1,2
1The Affiliated Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering Education, Chongqing Municipal Health Commission Key Laboratory of Oral Biomedical, Chongqing, China.
Objective:
To assess and compare the effectiveness of different bone grafting techniques, including unmasked meshes and graft-masked meshes approaches, for augmenting alveolar bone defects using 3D-printed titanium mesh (3D-TM).
Materials And Methods:
This retrospective study included 34 patients (69 teeth with alveolar bone defects) who underwent guided bone regeneration (GBR) using 3D-printed titanium mesh (3D-TM). Patients were assigned to two groups: the unmasked meshes group (n = 17, 34 treatment sites) and the graft-masked meshes group (n = 17, 35 treatment sites). Cone beam computed tomography (CBCT) data of pre- and post-operative 3D-TM implantation were digitally reconstructed, with a minimum 6-month follow-up period. Clinical outcomes included titanium mesh exposure rates, pseudo-periosteum rates, and osteogenic efficiency metrics such as bone volume, vertical bone height/width, and bone contour. Bone volume was analyzed using samples t-tests, vertical bone height/width was analyzed using a generalized estimating equations (GEE) model, and bone contour was analyzed using the Mann-Whitney U test. Categorical outcomes were evaluated via Fisher's exact probability test.
Results:
Clinical complications analysis revealed distinct outcomes between the two groups. Titanium mesh exposure occurred in 7 cases overall, with no statistically significant difference between the unmasked meshes group (5/17, 29.4%) and the graft-masked meshes group (2/17, 11.8%) (Fisher's exact test, p = 0.398). In contrast, pseudo-periosteum demonstrated a significant discrepancy, observed in 14/17 cases (82.4%) in the unmasked meshes group compared to 4/17 cases (23.5%) in the graft-masked meshes group (Fisher's exact test, p = 0.002). Notably, no infections occurred in either group. Analysis of osteogenic efficacy revealed significant intergroup differences in bone volume ratio (Independent samples t-test, df = 32, p < 0.05), vertical bone height ratio, and width ratio (GEE, df = 1, p < 0.05), and bone contour accuracy at the minimum and 25% percentiles (Mann-Whitney U test, p < 0.05). No significant differences were observed at the 50%, 75% percentile, or maximum value.
Conclusion:
The graft-masked meshes technique in 3D-TM guided bone regeneration surgery is a reliable and effective method for augmenting alveolar bone defects. This method effectively reduces procedure-related complications, including titanium mesh exposure and pseudo-periosteum, thereby improving osteogenic efficacy.
