Tooth shell technique: A proof of concept with the use of autogenous dentin block grafts

Abstract

Background: Autogenous bone block graft is considered the gold standard for lateral bony defects. Dentin has been identified to be a suitable autogenous bone graft material due to its structural and chemical similarities to the alveolar bone. Methods: This proof of concept study describes the clinical application of the tooth shell technique in 24 sites with 27 implants of 22 patients. A tooth shell was fixed laterally to the defect with microscrews. Distance between the shell and the residual bone was filled with particulate remnants of the tooth root. Implant was inserted simultaneously. Cone beam computed tomography was done after implant insertion (T1) and 3 months later at time of implant exposure (T2). Target parameters were biological complications and the resorption of hard tissue graft. Results: Even though a graft exposure occurred in one case (4.5% on patient-level), all implants showed enough implant stability and were able to be loaded. At T2, the evaluation of the X-rays showed no case with hard tissue loss at the mesial or distal implant shoulder. All implants were completely osseointegrated. Conclusions: The tooth shell technique showed promising results for the reconstruction of lateral alveolar crest defects. It may be considered to serve as an alternative material to avoid bone harvesting procedures.

The allogeneic shell technique for alveolar ridge augmentation: a multicenter case series and experiences of more than 300 cases

“…It has been assumed that AUG do not cause further costs such as bone substitutes or allografts. In full-cost accounting, this must be critically discussed since AUG are associated with a potential donor site morbidity leading to indirect health costs such as prolonged treatment or even hospitalization time (e.g., due to iliac crest harvesting) [ 7 , 8 ]. Further limitations of AUG are an increased resorption rate and a limited availability [ 8 , 9 ].…”

“…In full-cost accounting, this must be critically discussed since AUG are associated with a potential donor site morbidity leading to indirect health costs such as prolonged treatment or even hospitalization time (e.g., due to iliac crest harvesting) [ 7 , 8 ]. Further limitations of AUG are an increased resorption rate and a limited availability [ 8 , 9 ]. Next, surgery time is often prolonged that might be associated with further costs and an increased infection risk [ 10 ].…”

“…There is evidence that allogeneic shell technique seems to be equivalent to autogenous shells concerning vertical and horizontal bone gain [28]. Next to autogenous and allogeneic CP, autogenous dentin blocks, three-dimensionally (3D) printed templates and rigid resorbable barrier systems were reported to be applied as shells with different clinical results [8,[31][32][33][34]. Following the principles of guided bone regeneration (GBR), cortical shells are used to create a three-dimensionally secluded and stable space between the shell and the local bone.…”

Bone augmentation with autologous tooth shell in the esthetic zone for dental implant restoration: a pilot study

“…Thus, re-entry at the 4th month is safe and time-saving for clinical treatment. Though TS augmentation allows for simultaneous dental implantation [39,40], high risks of complications will occur, especially graft exposure. Graft exposure also happens during AB grafting and it will result in incomplete integration of graft, graft resorption and host site infection.…”

Frozen Stored Teeth: Autogenous Dentin as an Alternative Augmentation Material in Dentistry

“…This important property of autologous bone is an advantage for the restoration of complex volume defects, which secures it the designation of gold standard [ 8 ]. Dentin has similar properties due to its structural similarity to the inorganic matrix and behaves in the same way [ 9 , 10 , 11 ]. This quality characteristic makes the careless discarding of the biological material of extracted teeth seem increasingly questionable.…”