Assessment of Efficacy of Prebent Titanium Mesh versus Customized Poly-Ether-Ether-Ketone Mesh for Three-Dimensional Augmentation in Deficient Maxillary Ridge: A Randomized Clinical Trial

Assessment of Efficacy of Prebent Titanium Mesh versus Customized Poly-Ether-Ether-Ketone Mesh for Three-Dimensional Augmentation in Deficient Maxillary Ridge: A Randomized Clinical Trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of Efficacy of Prebent Titanium Mesh versus Customized Poly-Ether-Ether-Ketone Mesh for Three-Dimensional Augmentation in Deficient Maxillary Ridge: A Randomized Clinical Trial basma abd alkader alshikh, mohammed hassan eid, amr amin, mohamed elsholkamy This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8841053/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract 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 article has compared the effectiveness of these two modalities for bone augmentation. Materials and Methods 14 patients with 28 augmented sites in the maxillary ridges of horizontal bone deficiencies 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. Primary outcomes included horizontal and vertical bone gain, and volumetric analysis of gained bone and graft resorption as assessed by CBCT preoperatively, immediately post-operative, and at 6 months before implant placement. Results In this comparative three-dimensional volumetric CBCT analysis, 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). In contrast, the PEEK group demonstrated a significantly greater gained bone volume compared with the titanium mesh group (499.47 ± 80.46 mm³ vs. 370.82 ± 51.69 mm³; p = 0.004), along with a significantly 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 Prebent titanium and customized PEEK meshes proved effective for 3D maxillary ridge augmentation. The customized PEEK mesh allowed for a higher overall volume of bone, probably because of its preplanned design, but was associated with increased graft resorption, possibly due to reduced porosity. The decision on which material to use should consider the specific clinical scenario, weighing the advantages of a customized design against the cost and biological aspects. Trial registration: The study was registered at Clinical Trials.gov (NCT07040124) on 2025-06-25. Alveolar Ridge Augmentation Guided Bone Regeneration Titanium Mesh Bone Regeneration Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 24 Mar, 2026 Reviews received at journal 22 Mar, 2026 Reviews received at journal 14 Mar, 2026 Reviews received at journal 12 Mar, 2026 Reviewers agreed at journal 12 Mar, 2026 Reviewers agreed at journal 09 Mar, 2026 Reviewers agreed at journal 08 Mar, 2026 Reviewers invited by journal 06 Mar, 2026 Editor assigned by journal 06 Mar, 2026 Editor invited by journal 25 Feb, 2026 Submission checks completed at journal 25 Feb, 2026 First submitted to journal 25 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8841053","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":603871924,"identity":"097f5953-025a-4ca4-86df-e8363ed14d66","order_by":0,"name":"basma abd alkader alshikh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABC0lEQVRIiWNgGAWjYBACAwhlwWDAzMbG8KHCBshhbDxAhBYJsBbGGWfSQFoaiNTCwMbGzNt2GMzFq8Wc/fjTDT9qJOzN2dnSHs5sO2+3tv0w0JYam2hcWix7csxu9hyTSNzZzHbc4MO528nbziQCtRxLy23A5bADOWw3eNgkEgwOs7dJzii7nWx2AKiFseEwbi3nnz+7+eefhD1IizQP27lks/MPCWi5kWB2m7dNgnHDYbZj0jxtB+zMbhCwxXLGG7Pbsn0SiUAtaZIzziQnmN0A2pKAxy/m/OnPbr75ZmNvcP6YmcSHCjt7s/PpDx98qLHBqQUDJIJVJhCrHATsSVE8CkbBKBgFIwMAAO+nZ+cbH5OgAAAAAElFTkSuQmCC","orcid":"","institution":"Suez Canal University","correspondingAuthor":true,"prefix":"","firstName":"basma","middleName":"abd alkader","lastName":"alshikh","suffix":""},{"id":603871925,"identity":"cc703844-d224-4e7a-8a99-94dbf00186bb","order_by":1,"name":"mohammed hassan eid","email":"","orcid":"","institution":"Suez Canal University","correspondingAuthor":false,"prefix":"","firstName":"mohammed","middleName":"hassan","lastName":"eid","suffix":""},{"id":603871926,"identity":"c6ac6756-7164-4e1f-95d7-1f0383ebd742","order_by":2,"name":"amr amin","email":"","orcid":"","institution":"British University in Egypt","correspondingAuthor":false,"prefix":"","firstName":"amr","middleName":"","lastName":"amin","suffix":""},{"id":603871927,"identity":"cce67804-4299-4302-86b1-eb7e29df2d53","order_by":3,"name":"mohamed elsholkamy","email":"","orcid":"","institution":"Suez Canal University","correspondingAuthor":false,"prefix":"","firstName":"mohamed","middleName":"","lastName":"elsholkamy","suffix":""}],"badges":[],"createdAt":"2026-02-10 12:38:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8841053/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8841053/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104781442,"identity":"71c5651c-4a85-435d-879b-19e7461f226a","added_by":"auto","created_at":"2026-03-17 07:55:41","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":904205,"visible":true,"origin":"","legend":"","description":"","filename":"BasmafirstpaperfinalBMC.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8841053/v1_covered_a6ed2e1a-08d0-40ba-905d-5d52928dff3f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eAssessment of Efficacy of Prebent Titanium Mesh versus Customized Poly-Ether-Ether-Ketone Mesh for Three-Dimensional Augmentation in Deficient Maxillary Ridge: A Randomized Clinical Trial\u003c/p\u003e","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Alveolar Ridge Augmentation, Guided Bone Regeneration, Titanium Mesh, Bone Regeneration","lastPublishedDoi":"10.21203/rs.3.rs-8841053/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8841053/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eReconstruction 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 article has compared the effectiveness of these two modalities for bone augmentation.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e \u003cp\u003e14 patients with 28 augmented sites in the maxillary ridges of horizontal bone deficiencies were randomly assigned to two groups. The control group \u003cb\u003e(n\u0026thinsp;=\u0026thinsp;7)\u003c/b\u003e was augmented with a prebent titanium mesh, while the study group \u003cb\u003e(n\u0026thinsp;=\u0026thinsp;7)\u003c/b\u003e was augmented with a customized milled PEEK mesh. Both were grafted with a mixture of autogenous bone and xenograft. Primary outcomes included horizontal and vertical bone gain, and volumetric analysis of gained bone and graft resorption as assessed by CBCT preoperatively, immediately post-operative, and at 6 months before implant placement.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn this comparative three-dimensional volumetric CBCT analysis, no statistically significant differences were observed between the two groups regarding horizontal or vertical bone gain (Titanium: 3.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68 mm vs. PEEK: 2.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38 mm; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.065, and Titanium: 1.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10 mm vs. PEEK: 1.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25 mm; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.738, respectively). In contrast, the PEEK group demonstrated a significantly greater gained bone volume compared with the titanium mesh group (499.47\u0026thinsp;\u0026plusmn;\u0026thinsp;80.46 mm\u0026sup3; vs. 370.82\u0026thinsp;\u0026plusmn;\u0026thinsp;51.69 mm\u0026sup3;; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004), along with a significantly higher graft loss volume (174.83\u0026thinsp;\u0026plusmn;\u0026thinsp;40.78 mm\u0026sup3; vs. 127.73\u0026thinsp;\u0026plusmn;\u0026thinsp;35.55 mm\u0026sup3;; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.040). Clinical complications, including mesh exposure, were minimal and were successfully managed in both groups.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePrebent titanium and customized PEEK meshes proved effective for 3D maxillary ridge augmentation. The customized PEEK mesh allowed for a higher overall volume of bone, probably because of its preplanned design, but was associated with increased graft resorption, possibly due to reduced porosity. The decision on which material to use should consider the specific clinical scenario, weighing the advantages of a customized design against the cost and biological aspects.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e \u003cp\u003eThe study was registered at Clinical Trials.gov (NCT07040124) on 2025-06-25.\u003c/p\u003e","manuscriptTitle":"Assessment of Efficacy of Prebent Titanium Mesh versus Customized Poly-Ether-Ether-Ketone Mesh for Three-Dimensional Augmentation in Deficient Maxillary Ridge: A Randomized Clinical Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-12 12:45:01","doi":"10.21203/rs.3.rs-8841053/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-24T08:16:51+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-22T07:57:07+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-14T09:56:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-12T08:07:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"240504711059154248593744715109892630608","date":"2026-03-12T07:12:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"333378250217119543163139853036063462738","date":"2026-03-09T23:04:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"13477712412779385855460302661385061177","date":"2026-03-08T19:06:31+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-06T13:28:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-06T13:24:54+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-25T11:44:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-25T09:34:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2026-02-25T09:25:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"106ab619-a38e-45be-86da-c965215cb650","owner":[],"postedDate":"March 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-15T11:23:55+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-12 12:45:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8841053","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8841053","identity":"rs-8841053","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}