Comparison between CAD/CAM titanium mesh vs. conventional titanium mesh in bone regeneration: a systematic review and meta-analysis

Abstract

Background Vertical bone defects remain a challenge in implant dentistry. Titanium mesh (TM) is widely used in guided bone regeneration due to its ability to stabilize grafts, but it requires intraoperative adaptation, increasing surgical time and the risk of complications like mesh exposure. Customized titanium mesh (CTM), designed using CAD/CAM or 3D printing, offers a precise fit and may reduce surgical risks. This systematic review and metaanalysis aims to compare CTM and TM in terms of bone gain and complication rates in vertical ridge augmentation procedures. Materials and methods A systematic search was carried out in four electronic databases (PubMed, Cochrane Central, Web of Science, and Google Scholar) up to January 2025, with no time restrictions applied. Studies comparing customized titanium mesh (CTM) and conventional titanium mesh (TM) for vertical ridge augmentation were considered eligible if they included at least 10 patients and a minimum follow-up period of 6 months. The primary outcomes were vertical and horizontal bone gain, as well as membrane exposure. Meta-analyses and metaregressions were performed using R software. Results A total of 22 studies were included in the analysis (3 randomized controlled trials, 6 prospective studies, 12 retrospective studies, and 1 cohort study), comprising 608 patients and 1,318 implants. The mean vertical bone gain was 6.24 mm for the TM group and 5.14 mm for the CTM group, with no statistically significant difference between them (P=0.628). In contrast, CTM achieved significantly greater horizontal bone gain (6.38 mm vs. 3.85 mm; P=0.004). Membrane exposure occurred more frequently in the TM group (30.9%) than in the CTM group (20.3%), although the difference was not statistically significant (P=0.721). Other complications, such as infections, were also more common in the TM group but did not show statistical significance. Conclusion Within the limitations of the included studies, CTM appears to offer comparable bone gain to TM, with superior horizontal bone gain and a tendency to fewer complications. The results support the potential advantages of customized mesh in clinical practice. Further randomized trials with standardized protocols and long-term follow-up are recommended to confirm these findings.