CUSTOMIZED TITANIUM MESH RECONSTRUCTION OF A SEVERELY ATROPHIC MANDIBLE WITH SUBSEQUENT IMPLANT-SUPPORTED REHABILITATION:A CASE REPORT

Background:Severe mandibular alveolar ridge atrophy represents a major challenge in implant dentistry, especially when associated with advanced periodontal destruction and extensive loss of supporting bone. In cases where residual bone volume is insufficient for prosthetically guided implant placement, guided bone regeneration (GBR) provides an effective approach for restoring the three-dimensional architecture of the alveolar ridge. Case Presentation:A systemically healthy female patient with Stage III generalized chronic periodontitis and severe mandibular alveolar bone loss was referred for implant-supported rehabilitation. Six non-restorable mandibular anterior teeth were extracted due to advanced periodontal destruction and poor long-term prognosis. Immediate ridge augmentation was performed following extraction and surgical debridement of the sites. The deficient mandibular ridge was reconstructed using a graft mixture consisting of 60% deproteinized bovine bone mineral (Bio-Oss®) and 40% autogenous bone. The graft material was stabilized with a patient-specific CAD/CAM titanium mesh designed according to preoperative cone-beam computed tomography (CBCT) evaluation and virtual planning. During the six-month healing period, the augmented ridge maintained its planned contour without wound dehiscence, infection, graft exposure, or titanium mesh exposure. CBCT evaluation demonstrated adequate bone regeneration for implant placement. After removal of the customized titanium mesh, eight BioHorizons implants were placed in prosthetically planned positions. Primary stability was achieved in all implants, with insertion torque values of approximately 35 Ncm. Following a three-month osseointegration period, a definitive implant-supported metal-ceramic fixed bridge was fabricated and delivered. Clinical and radiographic follow-up demonstrated stable peri-implant tissues and preservation of the regenerated bone volume. During the three-year follow-up period, no implant failures, periimplant infections, prosthetic complications, or graft-related complications were observed. Conclusion:This case demonstrates that customized CAD/CAM titanium mesh-assisted guided bone regeneration combined with a mixture of deproteinized bovine bone mineral and autogenous bone can provide predictable reconstruction of severely atrophic mandibular ridges. The technique allowed stable three-dimensional bone regeneration, successful implant placement, and long-term functional and esthetic rehabilitation.