Preformed titanium mesh for posterior maxillary reconstruction with regenerative strategies: Two cases

Posterior maxillary reconstruction often requires simultaneous management of ridge deficiency, sinus pneumatization, and localized periodontal defects within the same surgical field. This report describes an indirect preformed titanium mesh workflow that supports individualized posterior maxillary reconstruction through defect-specific sinus elevation and periodontal regenerative strategies.

In two patients, titanium mesh was adapted extraorally on a patient-specific 3D-printed model before surgery to improve graft contour control and reduce intraoperative mesh adjustment. The first case combined simultaneous lateral sinus elevation with vertical ridge augmentation and adjacent enamel matrix derivative-assisted periodontal regeneration. The second case followed a staged approach consisting of vertical ridge reconstruction with membrane-based guided tissue regeneration, followed by transcrestal sinus elevation and implant placement at reentry.

Reentry demonstrated favorable hard tissue regeneration, permitting stable implant placement and successful prosthetic rehabilitation in both cases.

An indirect preformed titanium mesh workflow may facilitate individualized posterior maxillary reconstruction by providing predictable space maintenance while allowing sinus elevation and periodontal regenerative strategies to be tailored according to defect characteristics.

An indirect preformed titanium mesh workflow reduces intraoperative mesh adjustment while maintaining predictable space for bone regeneration. Selection of lateral or transcrestal sinus elevation should be based on the anticipated residual bone height after vertical ridge reconstruction. When periodontal defects are present adjacent to the reconstruction site, regenerative therapy should be tailored to defect morphology and integrated into the surgical plan.

Rebuilding bone in the back part of the upper jaw for dental implant placement can be challenging because many patients have lost a large amount of bone, the nearby sinus has expanded, and the teeth next to the missing area may also have damaged supporting tissues. This report describes a digital workflow that uses a patient-specific 3D-printed model to shape a titanium mesh before surgery. Preparing the mesh in advance reduces the need for adjustments during the operation and helps maintain the space needed for new bone to grow. The same workflow was adapted to each patient's condition. Depending on the amount of available bone, sinus elevation was performed either during the initial surgery or later at the time of implant placement. Depending on the type of periodontal defect, the most appropriate regenerative treatment was performed during the initial surgery. In both patients, sufficient new bone was regenerated for successful dental implant placement. These cases demonstrate how a single digital workflow can support individualized treatment planning while simplifying surgery and promoting predictable posterior maxillary reconstruction.