*4.5. Limitations*

It must be taken into account the heterogeneity in design, data collection methods, and analyses performed across the included studies. Moreover, the lack of RTCs with a large sample is observed. Most of the included articles were case series, and some of them did not report the bone gain obtained.

Despite the differences regarding the surgical protocols (collagen membrane association, different timing of mesh removal, different graft materials) results were similar. Therefore, it was not easy to identify the most successful surgical technique when a titanium mesh is used.

Only four studies performed controlled randomization [20,24,33,35], and in one of them, the implant timing, the follow-up, and survival/success implant rates were not specified [20].

#### **5. Conclusions**

Based on the literature presented, it is possible to assess that the use of a titanium mesh in combination with autologous and/or heterologous particulate grafts represent a safe and predictable technique to increase vertical and/or horizontal bone volume in cases of defects in partially edentulous patients, in the treatment of small and medium-sized defects around dental implants and alveolar ridge preservation after tooth extraction.

However, the use of titanium meshes presented disadvantages related to the necessity of the second-stage surgical procedure, with increased patient morbidity and rehabilitation time. Furthermore, it has a high risk of soft tissue dehiscence and membrane exposure.

The membrane exposure rate of this technique reaches 28% of the cases. The optimal management of membrane exposition permits obtaining a sufficient bone regeneration volume and prevents compromising the final treatment outcome.

The implant survival and implant success values are similar to those described for implants placed into the native bone and when performing other GBR techniques. No significant differences were observed between the implant survival and implant success rates between simultaneous and delayed implant placement.

**Author Contributions:** Conceptualization, R.A.-A. and B.G.-N.; methodology, R.A.-A. and B.G.-N.; validation, R.A.-A., B.G.-N. and J.L.-L.; formal analysis, R.A.-A.; investigation, R.A.-A. and E.R.-M.; resources, J.L.-L.; data curation, R.A.-A., E.R.-M. and J.L.-L.; writing—original draft preparation, R.A.-A. and E.R.-M.; writing—review and editing, R.A.-A.; visualization, B.G.-N. and J.L.-L.; project administration, A.M.-R., E.V.-O. and J.L.-L.; All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Institutional Review Board Statement:** Not applicable.

**Informed Consent Statement:** Not applicable.

**Data Availability Statement:** Data is contained within the article.

**Conflicts of Interest:** The authors declare no conflict of interest.
