Summary

Purpose

This prospective case series shows how digital planning can fully guide the shell technique for horizontal bone augmentation, using allogeneic cortical plates.

Materials and methods

Ten patients who needed bone augmentation before implant placement were treated. Each allogeneic cortical plate was designed with CAD/CAM to match the thickness of the patient's native cortical bone, then positioned and shaped virtually around the defect based on the existing anatomy. From this digital plan, a cutting pattern for the plate and a surgical template to hold it in place were fabricated.

Results

Twelve horizontal grafts were performed. All were considered successful and allowed the implants to be placed in the ideal three-dimensional position. In 3 of the 12 procedures, the plate needed a small adjustment to reach its ideal position.

Conclusion

A digitally designed template can hold the allogeneic plate in its planned position, making the shell technique more predictable and simpler to perform. The authors note that larger studies are needed to confirm these results.

What this means for your practice

Bone grafting can be planned from the final implant position, the same way the implant itself is planned: the graft is shaped for where the implant needs to go.

Keywords

guided bone regeneration, shell technique, allogeneic cortical plate, CAD/CAM, prosthetically driven planning, surgical template

Source: Int J Oral Maxillofac Implants, 2024 (PubMed)