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

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.