Background: The aim of this retrospective study was to evaluate the horizontal bone gain at the different level of alveolar bone using titanium screw as a reference plane by titanium mesh with tent screw (exposed or not) and autologous bone grafting.Methods: 16 patients and 23 measured points were enrolled in this study. CBCT data of immediately and 6 months after bone grafting were measured at crestal (CW), midway (MW), and basal (BW) level and reconstructed for area measurement using titanium screw as reference plane. The exposure of titanium mesh or not had been evaluated.Results: The area of bone gained and absorption ratio were almost the same without statistical different. There were not statistical different between the titanium mesh and onlay grafting, and measured level at CW, MW, and BW, and the exposed titanium mesh and not exposed one. The width absorption ratio of titanium mesh and onlay grafting group or at CW, MW, and BW were almost the same. However, the width absorption ratio of the exposed titanium mesh at CW, MW, and BW were significantly higher than the not exposed one. Thin biotype was a main factor of the exposure of titanium mesh. The exposed titanium mesh at late phase also can achieve clinically accepted bone gained after certain anti-inflammatory treatment. Conclusions: Ti-mesh with tenting screw could achieve the same bone augmentation effect as the autogenous bone block did, even it is exposed at late phase. However, the absorption ratio significantly increased if exposed.