logo 19 • CAMLOG Partner Magazine • December 2018 22 The average vertical augmentation height for customized titanium meshes was given in the literature with a mean of 6.5 ± 1.7 mm [7]. A systematic review [24] indicates a mean of 3.7 ± 1.4 mm with regard to prefabricated meshes. The present case with a vertical augmentation of approx. 9 mm therefore clearly represents a limit as to what is surgically possible. From a conservative point of view, the pronounced vertical defect would have required a two-stage procedure. In the present case, the implant was inserted using an “adjusting screw“ and a “modified tentpole technique“ [25], which had a stabilizing effect on the augmentation. The limiting factor in such a pronounced augmentation is primarily the soft tissue management [7]. The development of dehiscences is the most common complication in the use of titanium meshes. In this case, the necessary gain in soft tissue was achieved by pure periosteal slitting and tunneling into the vestibule. If necessary, a free connective tissue graft could have been used simultaneously with the first intervention. The creation of a fixed gingival area around the implant was decisive. Subsequent peri-implant hygiene and thus long-term prognosis of the implant-prosthetic restoration were therefore to be improved. In general, vertical augmentation is liable to lead to complications [26]. In this case, the insertion of an additional occlusal collagen membrane inhibited competitive wound healing and thus the ingrowth of soft tissue cells. This may have contributed to sufficient revascularization of the augmentation material and to the longterm success. The bone level also proved to be stable after a 2-year follow-up and the peri-implant conditions were free of irritation. Further research on the topic of customized bone regeneration in connection with implantations is desirable. Long-term and follow-up studies would be of particular interest. Topics for titanium meshes in the future will be different surface coatings to avoid dehiscences [27], resorbable materials and the ideal thickness of the mesh [28]. Conclusion Many implantations would not be possible without the use of bone augmentation. Three-dimensional defects remain a challenge in everyday implant surgery. In this case report it was shown that a complex defect could be reconstructed by using a patient-specific titanium mesh. Using the digital surgical workflow, the clinician was involved in the design process, the implantation was planned virtually and the intervention time was shortened as a result. [1] Pobloth AM, Checa S, Razi H, Petersen A, Weaver JC, Schmidt-Bleek K, et al. 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