Abstract Background: Reconstruction of deficient alveolar ridges in the anterior maxilla remains a major challenge in implant dentistry because of the functional and esthetic demands associated with this region. Following tooth loss, rapid and progressive bone resorption often results in insufficient bone volume for ideal implant placement. Guided bone regeneration (GBR) using titanium mesh has been widely applied to address such defects; however, clinical evidence regarding ultra-thin titanium mesh remains limited. Furthermore, the potential synergistic effect of combining ultra-thin titanium mesh with biologically active grafts such as sticky bone has not been sufficiently explored. Therefore, this study aimed to evaluate the clinical and radiographic outcomes of ultra-thin titanium mesh combined with sticky bone during simultaneous implant placement in the anterior maxilla. Methods: Eight patients presenting with horizontal or combined alveolar ridge deficiencies in the anterior maxilla were enrolled in this prospective clinical study. All patients underwent simultaneous implant placement and GBR using xenograft mixed with advanced platelet-rich fibrin (A-PRF) to form sticky bone. Ultra-thin titanium mesh was used for graft stabilization and space maintenance, followed by coverage with a collagen membrane. Clinical parameters, including implant stability and soft tissue conditions, were recorded. Radiographic assessment using Cone-beam computed tomography (CBCT) was performed preoperatively and after 6 months to evaluate changes in bone width, height and bone density. Results: All implants achieved successful osseointegration, with a 100% survival rate and no signs of mobility or infection at the 6-month follow-up. A statistically significant increase in bone density was observed, rising from 656.5 ± 52.8 HU preoperatively to 923.2 ± 126.5 HU at 6 months (p < 0.001), representing a mean increase of 40.7 ± 15.8%. Similarly, horizontal bone width increased significantly from 3.08 ± 0.3 mm preoperatively to 6.88 ± 0.5 mm at 6 months (p < 0.001), with a mean gain of 3.8 mm, while no significant difference was observed between immediate postoperative and 6-month measurements (p = 0.49). Bone height showed a slight, non-significant reduction from 14.8 ± 0.9 mm preoperatively to 13.9 ± 2.9 mm at 6 months (p = 0.408), with no significant percentage reduction over time (p = 0.404). Soft tissue parameters remained stable, with no statistically significant changes in gingival thickness (p = 0.444) or keratinized tissue width measured using digital scanning (2.05 ± 0.70 mm vs. 1.90 ± 0.73 mm; p = 0.685) and periodontal probe (p = 0.374). Mesh exposure occurred in 3 out of 8 cases (37.5%) but was successfully managed without compromising implant survival or final clinical outcomes, and postoperative pain scores showed a statistically significant reduction over time (p < 0.001). Conclusions: The combined use of ultra-thin titanium mesh and sticky bone demonstrated favorable clinical and radiographic outcomes for guided bone regeneration in the anterior maxilla with simultaneous implant placement. This approach provided predictable horizontal ridge augmentation, satisfactory implant stability, and acceptable soft tissue healing. Further studies of larger sample sizes and longer follow-up periods are recommended to confirm the long-term predictability of this technique.
MOLLA et al. (Tue,) studied this question.