What is this about?
- Discover the allogeneic shell technique for managing horizontal ridge deficiencies.
- How to transform challenging edentulous ridge configurations into stable implant-supported restorations.
- See how the synergies between orthodontist, oral surgeon, and prosthodontist ensure excellent functional and esthetic outcomes.
Introduction
The following clinical case report describes the successful application of the allogeneic shell technique for horizontal bone augmentation in a posterior mandibular region. This approach was employed in preparation for implant placement in sites #36 and #37, overcoming significant horizontal bone deficiency. The reconstruction achieved stable functional and esthetic outcomes using Botiss maxgraft® cortico and granules in a first stage, and Straumann® Roxolid® BLT implants (#36: Ø3.3mm × 10mm; #37: Ø4.1mm × 10mm) in a second stage surgery, as well as screw-retained zirconia crowns for the final restoration.
Initial situation
A 40-year-old healthy, non-smoking female patient presented with an edentulous space in the left posterior mandible (teeth #36 and #37), at the terminal stage of orthodontic therapy. The primary concern was functional restoration with fixed prosthetics. No systemic diseases or medications were reported. Radiographic evaluation revealed significant horizontal bone loss: crestal bone width of approximately 2.5–2.6mm with progressive subcrestal widening. No active infections were noted. Diagnosis: partial edentulism with horizontal ridge deficiency.
Treatment planning
During the terminal stage of orthodontic therapy (by DDr. Alexander Schwärzler), a two-stage surgical protocol was planned (together with Dr.Markus Pifl):
- Horizontal bone augmentation using the allogeneic shell technique in the edentulous area of #36 and #37;
- Implant placement after graft healing.
A digital 3D-printed model was created using CBCT segmentation for surgical planning (Figure 1). Implant positions were determined via CoDiagnostics® for sites #36 and #37. Implant type: Straumann® BLT SLA® Roxolid® implants (#36: Ø3.3mm × 10mm; #37: Ø4.1mm × 10mm). Healing abutments and final restorations were planned accordingly. A delayed loading protocol was followed with fixed screw-retained prostheses.
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Figure 1: 3D-printed mandible model for surgical planning
Author’s testimonial
“The present case highlights the advantages of using allogeneic cortical plates for horizontal ridge augmentation in combination with Straumann dental implants. This approach significantly reduced surgical time and morbidity by eliminating the need for a donor site, while demonstrating stable outcomes in this case and supported by scientific evidence from various clinical trials.” Danijel Domic
Surgical procedure
Under local anesthesia (Ultracain dental forte, Sanofi-Aventis GmbH, Vienna, Austria), a full-thickness flap was raised (Figure 2).
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Figure 2: Clinical exposure of the defect
Decortication (perforations in a recipient site: #36 and #37) was performed to improve graft vascularization (Figure 3).
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Figure 3: Decortication of the recipient site
An allogeneic cortical plate (Botiss maxgraft® cortico, 25×10×1mm) was shaped and fixed with three Maxdrive screws (Figure 4).
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Figure 4: Adaptation and fixation of the allogeneic shell plate
The space between the plate and native bone was filled apically with 0.5ml of Botiss maxgraft® granules (<2 mm particle size) and crestally with autologous bone chips (harvested using Safescraper® from the left retromolar area) (Figure 5).
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Figure 5: Placement of graft material in two layers: allogeneic particles (<2mm size) in the “bottom” and autogenous bone chips “on the top”
Tension-free primary closure was achieved (Figure 6).
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Figure 6: Wound closure with tension-free suturing
Four months later, radiographs confirmed satisfactory graft integration (Figure 7-8).
Second-stage surgery involved implant bed preparation and placement of two Straumann® BLT SLA® Roxolid® implants (#36: Ø3.3mm × 10mm; #37: Ø4.1mm × 10mm) with primary stability > 35 Ncm (Figure 9-10).
Healing abutments were placed, and soft tissue closure was achieved with appropriate suturing technique (Figure 11), and implant positions were confirmed with panoramic and periapical radiographs (Figure 12-13).
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Figure 11: Healing abutments are placed and soft tissue is sutured
Prosthetic procedure
After a 3-month healing period, definitive screw-retained zirconia crowns were delivered (by DDr. Lana Cepic). Healing abutments were used (36: NC Ø5.5mm, gingival height 1.0mm; 37: RC Ø5.5mm, gingival height 0.8mm). A conventional impression-taking workflow was employed. Occlusion was checked and adjusted. Follow-up showed stable soft tissue health and functional prostheses (Figure 14-15).
Treatment outcomes
The last follow-up was performed at 12 months after implant placement (Figure 16-17). The presented allogeneic augmentation technique successfully restored horizontal ridge volume, allowing stable implant placement and final prosthetic restoration. Radiographic and clinical assessments showed excellent integration of graft and implants. The patient reported high satisfaction with function and esthetics.
Key takeaways
- Allogeneic shell technique provides reduced surgical time, no donor site, and lower morbidity compared to standard augmentation.
- Clinical observations confirm stable ridge dimensions and successful implant integration leading to predictable restorations.
- Scientific evidence and the outcomes from the present case highlight the reliability of this biologically driven approach in achieving functional and esthetic patient satisfaction.