Custom titanium mesh: what it is for and the principle of treatment

When is a mesh considered? Extensive bone defects

Most bone deficiencies are treated with a conventional bone graft and a flexible membrane. The mesh is intended for extensive defects, where bone is missing in both height and width across one or more teeth. These defects have recognisable causes: advanced periodontitis that destroyed bone around several roots before the teeth were lost; an old extraction never compensated, with the bone continuing to resorb over the years; trauma that removed part of the ridge; more rarely a large cyst or the removal of an implant that had lost its bone.

Patients often notice a sunken gum, a “hollow” ridge beneath the lip, or a removable denture that no longer fits well. It is the cone beam CT that measures the deficit in three dimensions and shows that an implant placed in the remaining bone would be too short, too narrow or poorly aligned beneath the future crown. At that point, Dr Hazout discusses the options with you: rebuild, or do without by choosing another prosthetic solution.

The role of the mesh: formwork for bone

In guided bone regeneration (GBR), graft material is placed against the bone and then protected so it can turn into bone. For a small defect, a flexible membrane is enough. For a large defect, especially in height, a membrane alone collapses under pressure from the gum. The rigid mesh maintains the space: it keeps the graft in the intended shape during healing.

The mesh does not make bone: the graft material and the patient’s own bone do. It stabilises and protects.

The object

Made to measure from your imaging

A conventional mesh is a standard sheet that the surgeon cuts and bends during the operation. A custom mesh is designed beforehand: from the cone beam CT (3D dental scan), the bone is reconstructed on the computer, the target volume is drawn, then the mesh that surrounds it. It is then made by metal 3D printing.

The expected advantages are a precise fit to the bone, fewer sharp edges and shorter operating time ^[1]. The manufacturing itself is explained in the article How is a titanium mesh 3D-printed?

Planning

The mesh is not designed for its own sake: it is designed for the implants. First, the future implants are placed in the software in the position the crowns require; then the bone volume that must surround them is built; the mesh follows that volume.

The grafting surgery and the stages of treatment

• Preparation: healthy gums, stable periodontitis, stopping smoking strongly advised.
• Grafting surgery: under local anaesthetic, in the practice’s operating room in Levallois-Perret, the gum is lifted, the mesh filled with graft material (often a mix of the patient’s bone and processed bovine bone) is screwed onto the ridge, covered with a membrane, and the gum is sutured without tension.
• Healing: bone forms beneath the mesh, while the gum covering it is monitored.
• Second surgery: the mesh is removed and the implants are placed in the rebuilt bone, often at the same appointment.
• Restoration: after osseointegration, the crowns are fitted.

Removing the mesh

The mesh is not meant to stay: once the bone has formed, it is removed during a second operation under local anaesthetic. The gum is lifted again, the screws are undone and the mesh is taken out. Beneath the mesh there is usually a thin layer of fibrous tissue, 1 to 2 mm thick, called the “pseudo-periosteum”, covering the regenerated bone ^[4]; it is removed or left in place depending on the situation, and the underlying bone can then be seen and measured.

When the volume obtained allows it, the implants are placed at the same appointment, following the position decided at the initial planning stage. Otherwise, a small additional graft is carried out at the same time. The practical arrangements, the course of treatment and aftercare instructions are explained at the practice, according to your situation.

Results and complications: what the publications say

A 2025 meta-analysis (22 studies, 608 patients) compared custom and conventional meshes: comparable vertical gain (5.1 mm vs 6.2 mm, difference not significant), and greater horizontal gain with custom meshes (6.4 mm vs 3.9 mm) ^[1]. Most studies are retrospective and small.

The main complication is exposure of the mesh: the gum opens and the metal becomes visible. It occurs in roughly one case in five with custom meshes (20.3% in the meta-analysis, versus 30.9% with conventional meshes, difference not significant) ^[1]. Published case series range from 21% ^[2] to 33% ^[3]. Exposure does not necessarily mean failure: in one series, 8 of the 11 exposed sites still integrated the graft ^[2]; but early exposure is associated with less bone formation ^[4].

In these series, survival of the implants placed afterwards was 100% at about one year of follow-up ^{[2, 3]}; this is still a short follow-up.

These figures come from the literature, not from a series at the practice: the animations on this page illustrate the technique as Dr Hazout performs it; they are not a record of results. Your own situation (extent of the defect, quality of the gum, smoking, general health) may place you above or below these averages; this is what is assessed at your consultation.

Alternatives

A mesh is only one of the options in bone regeneration: titanium-reinforced membrane, bone block or, in the lower jaw, short implants without grafting, whose five-year results are comparable to those of vertical augmentation with fewer complications ^[5]. The data and limitations of each are presented on the bone grafts page. The choice is discussed according to the size of the defect, the condition of your gums and your priorities.

Frequently asked questions