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

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.

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.

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.

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.