Clinical Outcomes of Titanium Mesh for Alveolar Bone Augmentation: An Umbrella Review.

OBJECTIVES: To critically evaluate the evidence derived from systematic reviews for titanium mesh as a bone augmentation method for alveolar ridge deficiencies. MATERIALS AND METHODS: Five databases were searched for systematic reviews describing any interventions to increase the dimensions of the alveolar ridge using titanium mesh. Included reviews had to report on the primary outcome of vertical and/or horizontal bone gain after augmentation with titanium mesh. The methodological quality of the systematic reviews was assessed with the AMSTAR 2 tool, and the certainty of evidence was evaluated with GRADE. RESULTS: Eight systematic reviews were identified, including two with meta-analysis. Of the 51 index studies included in the reviews, 20 were RCTs. The weighted mean reported vertical bone gain was 4.05 mm, and horizontal gain was 3.96 mm. However, overlap of primary studies across included reviews limits the precision of these estimates. When stratified by review quality, the single high-quality review showed lower vertical and horizontal bone gain compared to the weighted mean. The average mesh exposure rate was 25%, although bone regeneration was usually still sufficient for implant placement. CONCLUSIONS: Titanium mesh can be effective for bone regeneration but carries a notable risk of site exposure. When choosing the technique for bone augmentation, clinicians should balance achieving optimal bone regeneration with minimal complications to enhance patient care and surgical outcomes.