3D-printed customised titanium mesh and bone ring technique for bone augmentation of combined bone defects in the aesthetic zone

Purpose: Complex bone defects with a horizontal and vertical combined deficiency pose a clinical challenge in implant dentistry. This study reports the case of a young female patient who presented with a perforating bone defect in the aesthetic zone. Materials and methods: Based on prosthetically guided bone regeneration, virtual 3D bone augmentation was planned. A 3D printed customised titanium mesh and the autogenous bone ring technique were then utilised simultaneously to achieve a customised bone contour. After 6 months, the titanium mesh was removed and connective tissue grafting was performed. Finally, implants were placed and the provisional and definitive prostheses were delivered following a digital approach. Vertical and horizontal bone gain, new bone density, pseudo-periosteum type and marginal bone loss were measured. Planned bone volume, regenerated bone volume and regeneration rate were analysed. Results: Staged tooth shortening led to a coronal increase in keratinised mucosa. The customised titanium mesh and bone ring technique yielded 14.27 mm vertical bone gain and 12.9 mm horizontal bone gain in the perforating area. When the titanium mesh was removed, the reopening surgery showed a Type 1 pseudo-periosteum (none or < 1 mm), and CBCT scans revealed a new bone density of similar to 550 HU. With a planned bone volume of 1063.55 mm(3), the regenerated bone volume was 969.29 mm(3), indicating a regeneration rate of 91.14%. The 1-year follow-up after definitive restoration revealed no complications except for 0.55 to 0.60 mm marginal bone loss. Conclusion: Combined application of customised titanium mesh and an autogenous bone ring block shows promising potential to achieve prosthetically guided bone regeneration for complex bone defects in the aesthetic zone.