Tridimensional Ridge Augmentation with Digital Customized Titanium Mesh: Radiological and Histological Evaluation. A Case Series.

OBJECTIVES: To evaluate the three-dimensional bone regeneration achieved with digitally customized titanium meshes in patients presenting Cawood and Howell Class V defects, 8 months after surgery. METHODS: This retrospective clinical case series included 9 patients with severe alveolar ridge atrophy (Cawood and Howell Class V), who underwent guided bone regeneration using customized titanium meshes at 10 surgical sites (8 mandibular and 2 maxillary). Meshes were designed through a fully digital workflow based on cone-beam computed tomography (CBCT) data and manufactured using Direct Metal Laser Sintering (DMLS). This approach allowed accurate preoperative planning, optimal adaptation of the mesh, smooth and rounded margins, intrinsic stability, and reduced intraoperative time. Surgical procedures were performed with careful flap management to achieve tension-free primary closure. Clinical and histological outcomes were assessed at 8 months postoperatively. RESULTS: No cases of mesh exposure, infection, or graft failure were observed. The mean vertical bone gain was 5.18 ± 1.82 mm, while the mean horizontal bone gain was 7.27 ± 1.74 mm. The mean regenerated bone volume was 1.25 ± 0.67 cm³. Histological analysis revealed vital, well-vascularized bone in direct contact with residual graft material. CONCLUSIONS: Within the limitations of this retrospective case series, customized titanium meshes were associated with measurable three-dimensional bone gain in Cawood and Howell Class V defects. These preliminary findings support the feasibility of this patient-specific digital approach and warrant further investigation in larger prospective studies with appropriate control groups.