Bone Shell Technique with Relocated Crestal Ridge Segment for Anterior Horizontal Mandibular Ridge Atrophy: A Case...

Horizontal and vertical ridge augmentation via the bone shell technique provides predictable outcomes. The external oblique ridge is the most-used donor site for bone plate harvesting, followed by the mandibular symphysis. The lateral sinus wall and the palate have also been described as alternative donor sites. This preliminary case series reports a bone shell technique that used the coronal segment of the knife-edge ridge as a bone shell in five consecutive edentulous patients (20 sites) with severe mandibular horizontal ridge atrophy and adequate ridge height. The follow-up period was 1 to 4 years. The average horizontal bone gains at 1 mm and 5 mm below the newly formed ridge crest were 3.6 ± 0.76 mm and 3.4 ± 0.92 mm, respectively. Ridge volume was sufficiently restored in all patients to enable implant placement in a staged approach. In 2 of the 20 sites, additional hard tissue grafts were required at implant placement. The advantages of utilizing the relocated crestal ridge segment are as follows: The donor and recipient sites are the same, no major anatomical structures are compromised, periosteal releasing incisions and flap advancement are not required for primary wound closure, and the risk of wound dehiscence is minimized due to reduced muscle tension.