###### Abstract  
The success of dental implant placement and prosthetic reconstruction relies on sufficient bone volume at the implant site. Contemporary implantology integrates prosthetic planning with implant placement, emphasizing the importance of pre-established prosthetic goals. Guided Bone Regeneration (GBR) techniques have become crucial for bone reconstruction. This study explores the use of custom-made GBR membranes, designed through CAD-CAM technology, in 10 patients with severe bone defects. Patients underwent meticulous preoperative planning, in which digital diagnostic wax-ups and RealGUIDETM software for implant positioning were used. The custom-made membranes, which were designed based on the individual defects, exhibited successful adaptation. Surgical phases involved membrane placement, bone grafting, and subsequent implant placement. Clinical-radiographic follow-ups demonstrated favorable bone gain outcomes, which enabled prosthetic rehabilitation. Despite membrane exposure occurring in 30% of cases, it did not compromise overall success. The study underscores the potential of custom-made GBR membranes in achieving prosthetic goals, though challenges like exposure and the need for a second surgery require further investigations. The results indicate a promising alternative for predictable bone regeneration in complex cases, shedding light on the prosthetically guided approach for optimal functional and aesthetic outcomes. b +
Footnote †: journal: Applied sciences  
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proliferation, including connective and epithelial tissues, from the bone defect so as to allow the osteogenic cells to repopulate the defect site [4]. The main properties of the membrane are biocompatibility, protection of bone graft, space creation and maintenance, easy clinical handling, tissue integration, and cell occlusion properties [5]. Moreover, in order to ensure the success and predictability of the GBR technique, four major biological PASS principles have to be followed: Primary wound coverage and tension-free wound closure, space creation/maintenance and exclusion of unwanted cells; Angiogenesis to provide sufficient blood supply, and stability of the wound and the implants [6]. In order to perform the GBR technique successfully, it is important to make the right choice in terms of the barrier membrane. Over the years, the development of GBR has been marked by the use of different types of membranes, which can be distinguished into resorbable and non-resorbable membranes. Both of them have advantages and disadvantages. The choice of the right membrane mainly depends on the dimension and type of bone defect, the aim of GBR therapy (vertical or horizontal augmentation), and the surgeon's preference [7]. In vertical bone augmentation, choosing non-resorbable membranes is recommended, while in combined defects, both types of membranes can be used as long as the space is maintained [8]. Traditional titanium mesh is a good alternative for restoring a bone defect. It has several advantages. First of all, titanium has key features that explain why it is widely used in surgical procedures: high rigidity, corrosion resistance, low density, and biocompatibility. The titanium mesh has good mechanical properties, such as high stiffness for maintaining space and good plasticity, for shaping and bending to be performed. Furthermore, studies suggest that the pores of titanium mesh guarantee blood support and nutrition to the soft tissue and the bone graft during the regeneration phase [9]. Although it offers convenience, traditional titanium mesh has some disadvantages. Titanium mesh requires membrane shaping and bending in order to fit the bone defect. A learning curve is needed for a practitioner to gain the skills to cut out, shape, and adapt the titanium mesh to the defects. There is an increased surgical operation time due to the trimming and shaping.