High porosity 3D printed titanium mesh allows better bone regeneration

Rui Ma, Qian Liu, Libo Zhou, Lingxiao Wang 

Full text link: https://pubmed.ncbi.nlm.nih.gov/36604677/

High porosity 3D printed titanium mesh allows better bone regeneration

1. Scientific Reference

• Study Title: High porosity 3D printed titanium mesh allows better bone regeneration
• Authors: Rui Ma, Qian Liu, Libo Zhou, Lingxiao Wang
• Journal: BMC Oral Health
• Year of Publication: 2023
• DOI: 10.1186/s12903-023-02717-5

2. Scientific Background

Bone augmentation remains one of the most challenging aspects of modern implant dentistry. Patients presenting with severe horizontal or vertical alveolar bone deficiencies frequently require reconstructive procedures before implant placement can be considered. Achieving adequate bone volume is essential for long-term implant stability and successful prosthetic rehabilitation.

Titanium meshes have become widely used in guided bone regeneration (GBR) because they provide structural support and maintain the regenerative space required for new bone formation. The emergence of digital workflows, CAD/CAM technologies, and additive manufacturing has enabled the production of patient-specific titanium meshes tailored to individual anatomical defects.

While previous investigations have explored the influence of titanium mesh material properties, thickness, and pore dimensions, the specific role of mesh porosity remains less clearly defined. Understanding how porosity affects bone regeneration could help optimize the design of customized titanium meshes used in implantology, oral surgery, and maxillofacial reconstruction. This study was conducted to address this question using a controlled preclinical model.

3. Study Objective

The primary objective of this study was to evaluate the impact of different porosity levels in three-dimensionally printed personalized titanium meshes on bone regeneration within surgically created alveolar bone defects.

The investigators sought to determine whether increasing mesh porosity could improve bone healing outcomes while maintaining the structural characteristics necessary for guided bone regeneration procedures.

4. Methodology

This was a preclinical animal study conducted using nine Beagle dogs.

Following extraction of the mandibular first through fourth premolars and a three-month healing period, standardized mandibular bone defects were surgically created. Three customized titanium meshes manufactured through 3D printing technology were evaluated:

• Low porosity (LP): 55%
• Medium porosity (MP): 62%
• High porosity (HP): 68%

Autogenous bone particles harvested during surgery were placed into the defects, followed by placement of the assigned titanium mesh and a collagen barrier membrane. Animals were sacrificed at 4, 8, and 12 weeks postoperatively.

Bone regeneration was assessed using micro-computed tomography (micro-CT) and histological analyses, including toluidine blue and basic fuchsin staining. Parameters such as trabecular thickness, trabecular number, trabecular separation, and bone volume fraction were evaluated.

5. Main Results

Both radiographic and histological assessments demonstrated superior bone regeneration in the high-porosity group.

Micro-CT analysis revealed that the HP meshes generated higher trabecular thickness (Tb.Th), trabecular number (Tb.N), and bone volume fraction (BV/TV) compared with the medium- and low-porosity groups. Conversely, trabecular separation (Tb.Sp), a parameter generally associated with lower bone density, was reduced in the HP group.

Histological findings supported these observations. At 8 and 12 weeks, the number of trabeculae was greater in the HP group than in the other experimental groups. At 12 weeks, the bone volume fraction was also significantly higher in the HP group. Histological sections demonstrated more extensive filling of the defect area with newly formed bone when mesh porosity reached 68%.

The reported differences between groups achieved statistical significance (p < 0.05).

6. Clinical Analysis

This study provides valuable insight into the design characteristics of customized titanium meshes used for guided bone regeneration and implant site development.

The findings suggest that porosity may play a biologically relevant role beyond its mechanical function. Increased porosity appears to facilitate a more favorable regenerative environment, potentially by improving the exchange of nutrients, cells, and biological mediators involved in osteogenesis. Within the experimental conditions investigated, higher porosity was consistently associated with enhanced bone formation.

From a clinical perspective, these observations are particularly relevant for complex bone reconstruction procedures where maintaining a stable regenerative space is essential. Customized titanium meshes are increasingly integrated into digital implant workflows, and understanding how architectural design influences biological performance may help improve future device development.

However, caution is warranted when interpreting the results. The study was conducted in an animal model and therefore cannot directly predict clinical outcomes in humans. In addition, only three specific porosity levels were evaluated. The results should not be interpreted as defining an optimal porosity threshold for all clinical situations. Further human clinical research will be required before definitive recommendations can be established.

7. Clinical Applications

The findings of this study may be relevant in several clinical scenarios involving bone reconstruction and implant rehabilitation, including:

• Guided bone regeneration procedures.
• Reconstruction of extensive alveolar ridge defects.
• Horizontal and vertical ridge augmentation.
• Implant treatment in patients with significant alveolar bone loss.
• Digitally planned CAD/CAM-guided reconstructive procedures.
• Use of customized titanium meshes manufactured through additive manufacturing technologies.
• Complex oral and maxillofacial reconstructive surgeries requiring predictable space maintenance.

The study may also contribute to future optimization of personalized biomaterials used in advanced implantology and bone regeneration protocols.

8. Level of Evidence, Limitations and Transparency

This investigation should be classified as a preclinical animal study.

As such, its level of evidence is lower than that of controlled clinical trials conducted in human subjects. While the study provides important biological and mechanistic information, its findings should not be considered definitive clinical evidence.

Several limitations should be acknowledged. The study involved a relatively small sample of nine animals and included a maximum observation period of twelve weeks. Furthermore, the results were obtained under controlled experimental conditions and have not yet been validated in human clinical studies.

Regarding transparency, one author was affiliated with Digital Mesh Beijing Technology Co., Ltd., a company involved in titanium mesh technology. Nevertheless, the publication states that the authors declared no competing interests.

9. Key Study Points

• Study Type: Preclinical animal study
• Level of Evidence: Preclinical
• Population: 9 Beagle dogs
• Number of Patients or Implants: Not specified in the provided data
• Follow-up Duration: 12 weeks
• Primary Outcome Evaluated: Effect of titanium mesh porosity on bone regeneration
• Main Finding: The 68% porosity mesh demonstrated the most favorable bone regeneration outcomes
• Scientific Conclusion: Higher porosity within the investigated range may enhance repair of large bone defects
• Potential Limitations: Animal model, limited sample size, short-term observation period, absence of human clinical validation

10. Scientific Impact

This study contributes to the growing body of research focused on optimizing the design of patient-specific titanium meshes for regenerative implant dentistry.

Rather than concentrating solely on material composition or mesh thickness, the investigators examined the influence of overall porosity on bone healing performance. The results provide experimental evidence suggesting that architectural characteristics can significantly affect regenerative outcomes.

The work also aligns with the broader evolution of digital dentistry, where individualized treatment planning, CAD/CAM design, and additive manufacturing are becoming increasingly integrated into implant rehabilitation workflows. By demonstrating a relationship between porosity and bone formation, this study offers useful information for future device development and biomaterial engineering.

Although clinical validation remains necessary, the findings help refine current understanding of how titanium mesh design may influence biological responses during guided bone regeneration procedures.

11. Editorial Conclusion

This preclinical investigation indicates that a highly porous 3D-printed customized titanium mesh may support more favorable bone regeneration than meshes with lower porosity when used to repair large alveolar bone defects. While these findings cannot yet be directly translated into clinical recommendations, they provide meaningful evidence that mesh architecture may influence regenerative performance. The study represents a valuable contribution to the ongoing development of digitally designed titanium meshes for advanced bone reconstruction and implant rehabilitation procedures.