Assessment of two treatment protocols using prebent titanium mesh and customized PEEK mesh for predominantly horizontal maxillary ridge augmentation with volumetric evaluation: a randomized clinical trial

BACKGROUND: Reconstruction of the deficient maxillary ridge in three dimensions is crucial for the successful placement of implants. Prebent titanium meshes are an established modality for GBR, while patient-specific PEEK meshes have recently emerged with some possible advantages over the former. This study compared the effectiveness of two treatment protocols involving prebent titanium mesh and customized PEEK mesh, each combined with different graft compositions for bone augmentation. MATERIALS AND METHODS: 14 patients with 28 augmented sites in the maxillary ridges of primarily horizontal bone deficiencies, often associated with minor vertical components, were randomly assigned to two groups. The control group (n = 7) was augmented with a prebent titanium mesh, while the study group (n = 7) was augmented with a customized milled PEEK mesh. Both were grafted with a mixture of autogenous bone and xenograft. The primary outcome was horizontal bone gain. Secondary outcomes included vertical bone gain, gained bone volume, and graft resorption. These parameters were assessed by CBCT preoperatively, immediately postoperatively, and at 6 months before implant placement. RESULTS: In this comparative three-dimensional volumetric CBCT analysis of predominantly horizontal ridge augmentation, no statistically significant differences were observed between the two groups regarding horizontal or vertical bone gain (Titanium: 3.02 ± 0.68 mm vs. PEEK: 2.42 ± 0.38 mm; p = 0.065, and Titanium: 1.12 ± 0.10 mm vs. PEEK: 1.09 ± 0.25 mm; p = 0.738, respectively). Regarding secondary outcomes, the PEEK group, which received a graft composed of a higher percentage of autogenous bone (70:30 autograft: xenograft), showed a significantly higher amount of gained bone volume when compared to the titanium mesh group (who received a 60:40 graft mixture) (499.47 ± 80.46 mm³ vs. 370.82 ± 51.69 mm³; p = 0.004), as well as a higher graft loss volume (174.83 ± 40.78 mm³ vs. 127.73 ± 35.55 mm³; p = 0.040). Clinical complications, including mesh exposure, were minimal and were successfully managed in both groups. CONCLUSION: Both prebent titanium mesh and custom-made PEEK mesh materials were associated with successful three-dimensional maxillary ridge augmentation within the limitations of this study. Although differences in volumetric outcomes were noted, it should be emphasized that such differences may have been influenced by differences in graft composition. Therefore, the current study represents a comparison of two treatment protocols incorporating different mesh materials and graft compositions. TRIAL REGISTRATION: The study was prospectively registered at Clinical Trials.gov (NCT07040124) on June 25, 2025, before patient enrollment.