Causes, prevention and treatment of titanium mesh exposure after 3D printing individualized titanium mesh supported guided bone regeneration

doi:10.12337/zgkqzzxzz.2025.02.003

Abstract

Abstract: 3D printing individualized titanium mesh serves as a space maintenance device, effectively creating and maintaining osteogenic space, reducing intraoperative time and the difficulty of surgery. It is a reliable bone augmentation solution for various types of alveolar ridge bone defects. However, during clinical application, postoperative titanium mesh exposure is the most common complication and requires clinicians' attention. This article elaborates on the causes, prevention, and treatment of postoperative titanium mesh exposure in guided bone regeneration supported by 3D-PITM, with the aim of providing clinical reference.

Key words: 3D printing individualized titanium mesh, Guided bone regeneration, Complications, Titanium mesh exposure

Su Yucheng, Ren Bin. Causes, prevention and treatment of titanium mesh exposure after 3D printing individualized titanium mesh supported guided bone regeneration[J]. Chinese Journal of Oral Implantology, 2025, 30(1): 5-12.

References

[1] Cordaro L, Terheyden H.口腔种植的牙槽嵴骨增量程序:分阶段方案[M].宿玉成, 译. 沈阳:辽宁科学技术出版社, 2016.
Cordaro L, Terheyden H.Ridge augmentation procedures in implant patients: a staged approach[M].Translated by Su YC.Shenyang:Liaoning Science and Technology Publishing House,2016.
[2] 郭雪琪, 陈韵欣, 杨岚, 等. 3D打印个性化钛网修复严重牙槽骨缺损的短期效果观察[J].中国口腔种植学杂志, 2021,26(6):368-375. DOI: 10.12337/zgkqzzxzz.2021.12.006.
Guo XQ, Chen YX, Yang L, et al.Short-term observation of 3D-printing individualized titanium mesh in restoration of severe alveolar bone defeats[J].Chin J Oral Implantol,2021,26(6):368-375. DOI: 10.12337/zgkqzzxzz.2021.12.006.
[3] Liu C, Li J, Zhang S, et al.Assessment of the application of a novel three-dimension printing individualized titanium mesh in alveolar bone augmentation: a retrospective study[J]. Clin Implant Dent Relat Res, 2024,26(6):1111-1125. DOI: 10.1111/cid.13372.
[4] 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. DOI: 10.1097/ID.0000000000000933.
[5] 周立波, 宿玉成, 李昕茹, 等. 比较个性化钛网与传统钛网在引导骨再生后暴露的系统综述[J].中国口腔种植学杂志, 2022,27(2):112-118. DOI: 10.12337/zgkqzzxzz.2022.04.011.
Zhou LB, Su YC, Li XR, et al.A systematic review comparing the exposure of customized titanium mesh and conventional titanium mesh after guided bone regeneration[J].Chin J Oral Implantol,2022,27(2):112-118. DOI: 10.12337/zgkqzzxzz.2022.04.011.
[6] 宿玉成. 钛网支撑的引导骨再生[M]. 沈阳: 辽宁科学技术出版社, 2024.
Su YC.Titanium mesh supported guided bone regeneration (TMs-GBR)[M].Shenyang:Liaoning Science and Technology Publishing House, 2024.
[7] Gao H, Li X, Wang C, et al.Mechanobiologically optimization of a 3D titanium-mesh implant for mandibular large defect: a simulated study[J]. Mater Sci Eng C Mater Biol Appl, 2019,104:109934. DOI: 10.1016/j.msec.2019.109934.
[8] 马蕊, 王志会, 刘洋, 等. 基于有限元模拟的引导骨再生个性化钛网受力分析[J].中国口腔种植学杂志, 2023, 28(3):198-203. DOI: 10.12337/zgkqzzxzz.2023.06.012.
Ma R, Wang ZH, Liu Y, et al.Force analysis of personalized titanium mesh for guided bone regeneration based on finite element method[J].Chin J Oral Implantol, 2023,28(3):198-203. DOI: 10.12337/zgkqzzxzz.2023.06.012.
[9] 季平. 3D打印个性化钛网用于复杂骨缺损增量治疗的研究进展[J].中国口腔种植学杂志,2022,27(6):334-339. DOI: 10.12337/zgkqzzxzz.2022.12.002.
Ji P.Research progress of 3D printing individualized titanium mesh for complex bone augmentation[J].Chin J Oral Implantol,2022,27(6):334-339. DOI: 10.12337/zgkqzzxzz.2022.12.002.
[10] Nan X, Wang C, Li L, 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. DOI: 10.1111/clr.14062.
[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. DOI: 10.1186/s40729-017-0097-z.
[12] 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. DOI: 10.1111/clr.13720.
[13] Lindfors LT, Tervonen EA, Sándor GK, et al.Guided bone regeneration using a titanium-reinforced ePTFE membrane and particulate autogenous bone: the effect of smoking and membrane exposure[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2010,109(6):825-830. DOI: 10.1016/j.tripleo.2009.12.035.
[14] 王婷婷, 王凤, 吴轶群. 3D打印数字化个性化钛网在牙槽嵴引导骨再生中的临床应用[J].中国口腔种植学杂志, 2022,27(4):208-216. DOI: 10.12337/zgkqzzxzz.2022.08.003.
Wang TT, Wang F, Wu YQ.Clinical application of three-dimensional printed digital customized titanium mesh in guided bone regeneration for alveolar bone reconstruction[J].Chin J Oral Implantol,2022,27(4):208-216. DOI: 10.12337/zgkqzzxzz.2022.08.003.
[15] Chao YC, Chang PC, Fu JH, et al.Surgical site assessment for soft tissue management in ridge augmentation procedures[J]. Int J Periodontics Restorative Dent, 2015,35(5):e75-e83. DOI: 10.11607/prd.2097.
[16] 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. DOI: 10.1563/aaid-joi-D-17-00125.
[17] Chen D, Zheng L, 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. DOI: 10.1111/cid.13205.
[18] 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. DOI: 10.1111/jerd.13012.
[19] 堀内克启. 口腔种植自体骨移植基础与要点[M]. 张健, 吴松涛, 译. 沈阳: 辽宁科学技术出版社, 2017.
Horiuchi K.Implant surgery high points of basic techniques and autogenous bone graft[M].Translated by Zhang J,Wu ST.Shenyang:Liaoning Science and Technology Publishing House,2017.
[20] De Stavola L, Tunkel J, Fincato A, et al.The vestibular shifted flap design for vertical bone augmentation in the maxilla: case report and technical notes[J]. Int J Periodontics Restorative Dent, 2021,41(3):367-373. DOI: 10.11607/prd.4471.
[21] 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. DOI: 10.1186/s40729-017-0097-z.
[22] Park JC, Kim CS, Choi SH, et al.Flap extension attained by vertical and periosteal-releasing incisions: a prospective cohort study[J]. Clin Oral Implants Res, 2012,23(8):993-998. DOI: 10.1111/j.1600-0501.2011.02244.x.
[23] Shay B, Mijiritsky E, Bronstein M, et al.Flapless decoronation: a minimally invasive approach[J]. Int J Environ Res Public Health, 2022,20(1):603. DOI: 10.3390/ijerph20010603.
[24] Zhao H, He Q, Huang Y, et al.3D-printed customised titanium mesh and bone ring technique for bone augmentation of combined bone defects in the aesthetic zone[J]. Int J Oral Implantol (Berl), 2024,17(2):203-220.
[25] Chappuis V, Martin W.美学区种植治疗:单颗牙种植的最新治疗方法与材料[M].宿玉成, 译.沈阳:辽宁科学技术出版社,2021.
Chappuis V, Martin W.Implant therapy in the esthetic zone: current treatment modalities and materials for single-tooth replacements[M].Translated by Su YC.Shenyang:Liaoning Science and Technology Publishing House,2016.
[26] Lobat Tayebi, Reza Masaeli, Kavosh Zandsalimi.3D printing in oral & maxillofacial surgery[M]. Switzerland: Springer Nature, 2021.
[27] Li S, Mi L, Bai L, et al.Application of 3D printed titanium mesh and digital guide plate in the repair of mandibular defects using double-layer folded fibula combined with simultaneous implantation[J]. Front Bioeng Biotechnol, 2024,12:1350227. DOI: 10.3389/fbioe.2024.1350227.
[28] Cucchi A, Sartori M, Aldini NN, et al.A proposal of pseudo-periosteum classification after GBR by means of titanium-reinforced d-PTFE membranes or titanium meshes plus cross-linked collagen membranes[J]. Int J Periodontics Restorative Dent, 2019,39(4):e157-e165. DOI: 10.11607/prd.e3598.
[29] Wang HL, Boyapati L."PASS" principles for predictable bone regeneration[J]. Implant Dent, 2006,15(1):8-17. DOI: 10.1097/01.id.0000204762.39826.0f.
[30] Hartmann A, Seiler M.Minimizing risk of customized titanium mesh exposures - a retrospective analysis[J]. BMC Oral Health, 2020,20(1):36. DOI: 10.1186/s12903-020-1023-y.
[31] 《中国口腔种植学杂志》编辑部. 钛网支撑的引导骨再生的专家共识[J].中国口腔种植学杂志,2024,29(2):95-100. DOI: 10.12337/zgkqzzxzz.2024.04.001.
Editorial Board of Chinese Journal of Oral Implantology. Expert consensus on titanium mesh supported guided bone regeneration[J].Chin J Oral Implantol,2024,29(2):95-100. DOI: 10.12337/zgkqzzxzz.2024.04.001.
[32] 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. DOI: 10.11607/prd.2447.
[33] Xie Y, Li S, Zhang T, et al.Titanium mesh for bone augmentation in oral implantology: current application and progress[J]. Int J Oral Sci, 2020,12(1):37. DOI: 10.1038/s41368-020-00107-z.
[34] 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. DOI: 10.1111/cid.13025.