Auxetic structures are additively manufactured metamaterials distinguished by a negative Poisson’s ratio and atypical deformation mechanisms. Components incorporating auxetic mesostructures have been shown to exhibit negative thermal expansion behaviour and enhanced energy dissipation. These attributes enable purposeful tuning of structural behaviour primarily through geometry. This study investigates whether targeted geometric optimisation of auxetic mesostructures can enhance the macroscopic thermomechanical response of dental implant drills through different auxetic mesostructural configurations under thermal loading. Thermal effects are clinically relevant, as frictional heat during osteotomy may increase local bone temperature, elevating the risk of temperature-dependent necrosis and impaired healing. Owing to their structure, certain auxetic architectures exhibit negative thermal expansion, which may provide deformation pathways to reduce local temperature rise. A structured workflow is employed in which the mechanical response is optimised solely by modifying the structural layout and geometry, enabling the investigation of multiple auxetic architectures for the considered load case. First, a parametric optimisation is carried out to determine favourable geometric characteristics of different auxetic unit-cell types. These results are further refined using an advanced shape-optimisation method enabling region-specific adaptation of the mesostructure. The same procedure is applied to conventional honeycomb and auxetic mesostructures to isolate the influence of different auxetic mechanisms. The optimised designs are subsequently compared to identify the configuration offering the most advantageous thermomechanical characteristics, with particular emphasis on minimising local temperature rise. This work provides new insights into the comparative implementation of optimised auxetic mesostructures and highlights their potential to mitigate friction-induced thermal loading in dental implant drills, thereby supporting improved conditions for bone tissue healing. The results further suggest that auxetic architectures may represent a promising alternative to conventional cellular designs across thermomechanically loaded engineering applications.