TECHNICAL NOTE Direct metal laser sintering (DMLS) of a customized titanium mesh for prosthetically guided bone regeneration of atrophic maxillary arches L. Ciocca • M. Fantini • F. De Crescenzio • G. Corinaldesi • R. Scotti Received: 12 April 2011 / Accepted: 7 July 2011 / Published online: 21 July 2011 Ó International Federation for Medical and Biological Engineering 2011 Abstract This study describes a protocol for the direct manufacturing of a customized titanium mesh using CAD–CAM procedures and rapid prototyping to augment maxillary bone and minimize surgery when severe atro- phy or post-oncological deformities are present. Titanium mesh and particulate autogenous plus bovine deminera- lised bone were planned for patient rehabilitation. Bone augmentation planning was performed using the pre-op CT data set in relation to the prosthetic demands, mini- mizing the bone volume to augment at the minimum necessary for implants. The containment mesh design was used to prototype the 0.6 mm thickness customized tita- nium mesh, by direct metal laser sintering. The levels of regenerated bone were calculated using the post-op CT data set, through comparison with the pre-op CT data set. The mean vertical height difference of the crestal bone was 2.57 mm, while the mean buccal-palatal dimension of thickness difference was 3.41 mm. All planned implants were positioned after an 8 month healing period using two-step implant surgery, and finally restored with a partial fixed prosthesis. We present a viable and repro- ducible method to determine the correct bone augmenta- tion prior to implant placement and CAD–CAM to produce a customized direct laser-sintered titanium mesh that can be used for bone regeneration. Keywords Bone augmentation Á Titanium mesh Á Implant surgery Á CAD–CAM Á Rapid prototyping 1 Introduction Techniques to improve bone regeneration of segmental defects in the atrophic or dysmorphic (post-oncological) maxilla and mandible have been widely described since the 1990s [7, 10, 16]. Distraction osteogenesis, splitting osteotomy, lateral ridge augmentation [4], and guided bone regeneration [15] are the most commonly applied methods. One of the main disadvantages of these techniques is the lack of containment of the particulate graft, primarily due to the collapse of the soft tissue during function. During the post-op period, compression or displacement of the graft has been described [5]. Titanium meshes were introduced to limit or eliminate these problems and are used as a containment system for L. Ciocca (&) Section of Prosthodontics, Department of Oral Science, Alma Mater Studiorum, University of Bologna, via S. Vitale 59, 40125 Bologna, BO, Italy e-mail: leonardo.ciocca@unibo.it M. Fantini Á F. De Crescenzio Virtual Reality and Simulation Laboratory, Second Engineering Faculty, Alma Mater Studiorum, University of Bologna, via Fontanelle 40, Forlı `, FO, Italy e-mail: massimiliano.fantini@unibo.it F. De Crescenzio e-mail: francesca.decrescenzio@unibo.it G. Corinaldesi Section of Oral and Maxillofacial Surgery, Department of Oral Science, Alma Mater Studiorum, University of Bologna, via S. Vitale 59, 40125 Bologna, BO, Italy e-mail: giuseppe.corinaldesi@unibo.it R. Scotti Oral and Maxillo-Facial Rehabilitation, Section of Prosthodontics, Department of Oral Science, Alma Mater Studiorum, University of Bologna, via S. Vitale 59, 40125 Bologna, BO, Italy e-mail: roberto.scotti@unibo.it 123 Med Biol Eng Comput (2011) 49:1347–1352 DOI 10.1007/s11517-011-0813-4