{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:30:37Z","timestamp":1787725837557,"version":"build-2784847793"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Bioeng. Biotechnol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Titanium mesh\/tray systems have been used with bone grafting for mandibular continuity reconstruction, but evidence is scattered across small cohorts and device eras. We systematically reviewed this literature and quantified device-related complications while accounting for cohort overlap and outcome-specific denominators.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      PubMed, Embase, Web of Science, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL), and\n                      <jats:ext-link>ClinicalTrials.gov<\/jats:ext-link>\n                      were searched for human clinical studies evaluating titanium mesh\/tray systems used as graft-containing reconstruction chambers for segmental or continuity mandibular defects. Representative independent cohorts were selected to avoid double-counting. The primary outcomes were device exposure, infection, mechanical failure, and unplanned reoperation or device removal. Pooled proportions were estimated using logistic-normal generalized linear mixed models. Risk of bias and certainty of evidence were assessed using JBI, ROBINS-I, and GRADE.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After screening 736 unique records and assessing 53 full-text reports, 40 reports were retained for quantitative synthesis, qualitative interpretation, evidence mapping, or cohort adjudication. Ten representative independent cohorts were included, of which eight contributed to at least one primary pooled outcome. In the primary analyses, the pooled proportions were 8.8% (95% CI, 3.7%\u201319.4%) for device exposure, 14.5% (95% CI, 8.4%\u201323.8%) for infection, 5.3% (95% CI, 2.0%\u201313.2%) for mechanical failure, and 14.5% (95% CI, 8.0%\u201324.9%) for unplanned reoperation or device removal. Sensitivity analyses incorporating one cohort without confirmable minimum follow-up, and excluding the single cohort reported using reconstruction-site-level denominators, were directionally consistent. Graft consolidation or mandibular continuity restoration, implant placement, and prosthetic rehabilitation were summarized as exploratory downstream outcomes. Only two cohorts used additively manufactured patient-specific systems, precluding reliable subgroup inference. Certainty of evidence was very low for all primary outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Titanium mesh\/tray systems may be considered in selected clinical contexts for mandibular continuity reconstruction, but exposure, infection, and unplanned reoperation or device removal remain important concerns. Current estimates should be interpreted as exploratory clinical benchmarks rather than definitive evidence of safety or effectiveness. Prospective multi-institutional studies with standardized outcome definitions and appropriate comparator groups are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fbioe.2026.1915266","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:04:43Z","timestamp":1787724283000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Titanium mesh and tray systems for mandibular continuity reconstruction with bone grafting: a systematic review and proportional meta-analysis of device-related complications"],"prefix":"10.3389","volume":"14","author":[{"given":"Tingting","family":"Hou","sequence":"first","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Dandong Central Hospital","place":["Dandong, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinrui","family":"Yin","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Aerospace Center Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Dandong Central Hospital","place":["Dandong, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/2046-4053-1-2","article-title":"The nuts and bolts of PROSPERO: an international prospective register of systematic reviews","volume":"1","author":"Booth","year":"2012","journal-title":"Syst. Rev."},{"key":"B2","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1016\/j.bjoms.2016.12.010","article-title":"Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years","volume":"55","author":"Brown","year":"2017","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"B3","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/s0901-5027(05)80686-1","article-title":"Recurrence of an odontogenic keratocyst in a bone graft. Report of a case","volume":"20","author":"DeGould","year":"1991","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"B4","doi-asserted-by":"publisher","first-page":"e1895","DOI":"10.1002\/rcs.1895","article-title":"Immediate mandibular reconstruction via patient-specific titanium mesh tray using electron beam melting\/CAD\/rapid prototyping techniques: one-year follow-up","volume":"14","author":"Farid Shehab","year":"2018","journal-title":"Int. J. Med. Robot."},{"key":"B5","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1097\/00001665-200205000-00014","article-title":"Human segmental mandibular defects treated with naturally derived bone morphogenetic proteins","volume":"13","author":"Ferretti","year":"2002","journal-title":"J. Craniofac Surg."},{"key":"B6","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: an emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"Bmj"},{"key":"B7","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1016\/j.acra.2017.08.003","article-title":"Logistics of three-dimensional printing: primer for radiologists","volume":"25","author":"Hodgdon","year":"2018","journal-title":"Acad. Radiol."},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijom.2026.06.012","article-title":"Distress monitoring during surgical treatment of patients with primary head and neck tumors of oral cavity and oropharynx: a prospective pilot study","author":"Hoefert","year":"2026","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1100155","DOI":"10.3389\/fbioe.2023.1100155","article-title":"Additive manufacturing technologies in the oral implant clinic: a review of current applications and progress","volume":"11","author":"Huang","year":"2023","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1016\/j.tripleo.2008.12.018","article-title":"Evaluation of 15 mandibular reconstructions with dumbach Titan mesh-system and particulate cancellous bone and marrow harvested from bilateral posterior ilia","volume":"107","author":"Iino","year":"2009","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod."},{"key":"B11","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1016\/j.jpor.2016.01.009","article-title":"Computer assisted mandibular reconstruction using a custom-made Titan mesh tray and removable denture based on the top-down treatment technique","volume":"60","author":"Ikawa","year":"2016","journal-title":"J. Prosthodont Res."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1002\/9781119536604.ch1","article-title":"Starting a review","author":"Lasserson","year":"2019","journal-title":"Cochrane Handb. Syst. Rev. Interventions"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1315","DOI":"10.1016\/0895-4356(94)90137-6","article-title":"Modelling observer agreement--an alternative to kappa","volume":"47","author":"May","year":"1994","journal-title":"J. Clin. Epidemiol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1097\/ID.0000000000000041","article-title":"Evaluation of mandibular reconstruction with particulate cancellous bone marrow and titanium mesh after mandibular resection due to tumor surgery","volume":"23","author":"Miyamoto","year":"2014","journal-title":"Implant Dent."},{"key":"B15","doi-asserted-by":"publisher","first-page":"2127","DOI":"10.11124\/JBISRIR-D-19-00099","article-title":"Methodological quality of case series studies: an introduction to the JBI critical appraisal tool","volume":"18","author":"Munn","year":"2020","journal-title":"JBI Evid. Synth."},{"key":"B16","doi-asserted-by":"publisher","first-page":"467","DOI":"10.11124\/JBIES-22-00224","article-title":"Assessing the risk of bias of quantitative analytical studies: introducing the vision for critical appraisal within JBI systematic reviews","volume":"21","author":"Munn","year":"2023","journal-title":"JBI Evid. Synth."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1122","DOI":"10.3390\/jcm12031122","article-title":"Towards optimum mandibular reconstruction for dental occlusal rehabilitation: from preoperative virtual surgery to autogenous particulate cancellous bone and marrow graft with custom-made titanium Mesh-A retrospective study","volume":"12","author":"Onodera","year":"2023","journal-title":"J. Clin. Med."},{"key":"B18","doi-asserted-by":"publisher","first-page":"991821","DOI":"10.3389\/fbioe.2023.991821","article-title":"Bioprinting and biomaterials for dental alveolar tissue regeneration","volume":"11","author":"Ostrovidov","year":"2023","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"Bmj"},{"key":"B20","doi-asserted-by":"publisher","first-page":"174","DOI":"10.5195\/jmla.2021.962","article-title":"PRISMA-S: an extension to the PRISMA statement for reporting literature searches in systematic reviews","volume":"109","author":"Rethlefsen","year":"2021","journal-title":"J. Med. Libr. Assoc."},{"key":"B21","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1016\/j.cytogfr.2009.10.016","article-title":"Bone morphogenetic proteins, cementogenesis, myoblastic stem cells and the induction of periodontal tissue regeneration","volume":"20","author":"Ripamonti","year":"2009","journal-title":"Cytokine Growth Factor Rev."},{"key":"B22","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1007\/s00784-025-06698-3","article-title":"Prospective functional assessment after mandible reconstruction and bone healing assessment","volume":"30","author":"Ruf","year":"2025","journal-title":"Clin. Oral Investig."},{"key":"B23","doi-asserted-by":"publisher","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"Bmj"},{"key":"B24","doi-asserted-by":"publisher","first-page":"3046","DOI":"10.1002\/sim.4040","article-title":"Random effects meta-analysis of event outcome in the framework of the generalized linear mixed model with applications in sparse data","volume":"29","author":"Stijnen","year":"2010","journal-title":"Stat. Med."},{"key":"B25","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1002\/9781119536604.ch2","article-title":"Determining the scope of the review and the questions it will address","author":"Thomas","year":"2019","journal-title":"Cochrane Handb. Syst. Rev. Interventions"},{"key":"B26","doi-asserted-by":"publisher","first-page":"761911","DOI":"10.3389\/fbioe.2021.761911","article-title":"Modifying a 3D-Printed Ti6Al4V implant with polydopamine coating to improve BMSCs growth, osteogenic differentiation, and in situ osseointegration in vivo","volume":"9","author":"Wang","year":"2021","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"586","DOI":"10.1097\/SCS.0000000000002472","article-title":"Clinical usefulness of mandibular reconstruction using custom-made titanium mesh tray and autogenous particulate cancellous bone and marrow harvested from tibia and\/or ilia","volume":"27","author":"Yamada","year":"2016","journal-title":"J. Craniofac Surg."},{"key":"B28","doi-asserted-by":"publisher","first-page":"681","DOI":"10.1186\/s12903-023-03386-0","article-title":"Three-dimensional printed titanium mesh combined with iliac cancellous bone in the reconstruction of mandibular defects secondary to ameloblastoma resection","volume":"23","author":"Zhao","year":"2023","journal-title":"BMC Oral Health"},{"key":"B29","doi-asserted-by":"publisher","first-page":"2115","DOI":"10.1016\/j.joms.2009.09.033","article-title":"Accurate reconstruction of discontinuous mandible using a reverse engineering\/computer-aided design\/rapid prototyping technique: a preliminary clinical study","volume":"68","author":"Zhou","year":"2010","journal-title":"J. Oral Maxillofac. Surg."}],"container-title":["Frontiers in Bioengineering and Biotechnology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2026.1915266\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:04:44Z","timestamp":1787724284000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2026.1915266\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,26]]},"references-count":29,"alternative-id":["10.3389\/fbioe.2026.1915266"],"URL":"https:\/\/doi.org\/10.3389\/fbioe.2026.1915266","relation":{},"ISSN":["2296-4185"],"issn-type":[{"value":"2296-4185","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,26]]},"article-number":"1915266"}}