Individualized 3D-Printed Titanium Mesh-Assisted Alveolar Reconstruction and Implant Rehabilitation Following MRONJ Resection: A Case Report

Medication-related osteonecrosis of the jaw is a severe complication of antiresorptive therapy that often necessitates complex reconstructive surgery. This report describes a case of implant supported rehabilitation using a customized 3D-printed titanium mesh for an extensive mandibular defect resulting from medication-related osteonecrosis of the jaw. A 58-year-old woman with stage-3 medication-related osteonecrosis of the jaw after zoledronate therapy underwent segmental mandibulectomy and reconstruction with a free iliac crest graft. Nine months later, a customized titanium mesh was placed to protect the planned 9.5–11mm augmentation. Cone beam computed tomography confirmed mineralized regeneration within the mesh. The mesh was removed after achieving 9.5mm vertical and 11 mm horizontal alveolar augmentation, and four implants were placed with high primary stability (insertion torque ≥ 40 N cm). At 6 months, resonance frequency analysis values ranged from 75 to 84, allowing delivery of a splinted fixed prosthesis. At 12 months of loading, the peri-implant tissues remained normal with stable radiographic bone levels and satisfactory function. Combining customized 3D-printed titanium mesh with guided implant placement supports stable bone regeneration and prosthetic rehabilitation in patients with medication-related osteonecrosis of the jaw. However, outcomes depend on medication history, therapy timing, and unresolved drug-related factors, underscoring the need for a multidisciplinary approach with individualized treatment and proactive complication care.