Vertical Bone Reconstruction with CAD/CAM Titanium Mesh: A Prospective Clinical Trial.

The aim of the present study was to evaluate the use of customized CAD-CAM titanium mesh for the treatment of bone atrophy type V of Cawood and Howell as mean vertical and horizontal bone gain and complications rate. A prospective clinical trial aimed to evaluate the use of CAD-CAM titanium mesh for the treatment of bone atrophy type V of Cawood and Howell. All patients underwent a preoperative digital planning phase with CBCT, digital intraoral scan and extra-intraoral photos. The operative phases were divided into 4 stages: T1 recon-structive surgery T2 implant surgery T3 prosthetic phase T4 one year follow-up. Study variables were: the mean vertical and horizontal bone gain by CBCT superposition, peri-implant marginal bone loss by periapical radiographs, and complications by clinical examination. Twenty-five patients (9 males, 16 females; mean age: 60 ± 8.5 years) with 30 surgical sites were included. The bone defects involved spans of 3-6 missing teeth, with a mean mesiodistal length of 29.9 ± 8.53 mm and a mean augmentation volume of 2.03 ± 0.96 cm.³ Mean vertical and horizontal bone gains were 5.87 ± 1.6 mm and 5.64 ± 2.1 mm, respectively. Mean mesial and distal implant marginal bone losses were 0.61 ± 0.34 mm and 0.46 ± 0.32 mm, respectively. No intraoperative com-plications were observed. Healing complications included Class I membrane exposure in four patients (16%) and one case (4%) of Class III exposure with infection requiring mesh removal. Conclusions The use of CAD/CAM-customized titanium mesh in guided bone regeneration appears to be a predictable and effective technique for managing severe alveolar ridge atrophy. This approach allows for precise, patient-specific augmentation with favorable bone gain and a manageable com-plication profile, supporting its use as a valuable tool in advanced implant therapy.