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Evaluating Techniques for Vertical Ridge Augmentation via Comparative Study of Clinical Outcomes: A Systematic

Ioannis Frantzopoulos1, Mihaela Băciuț2, Oana Almășan3

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Guided Bone Regeneration (GBR) and the Shell Technique (ST) both achieve vertical bone augmentation for dental implants. The Shell Technique may offer greater bone gain, but GBR is a versatile alternative with fewer donor-site issues.

Keywords:
alveolar ridge augmentationbone regenerationcortical bone plateimplant survivalpatient-reported outcomesshell (Khoury) techniquetitanium-reinforced d-PTFE membrane

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Area of Science:

  • Dental Implantology
  • Periodontology
  • Regenerative Medicine

Background:

  • Severe alveolar bone atrophy often necessitates vertical ridge augmentation (VRA) prior to dental implant placement.
  • The optimal VRA technique, comparing Guided Bone Regeneration (GBR) and the Shell Technique (ST), remains debated.
  • This review systematically evaluates GBR and ST for vertical bone gain, bone quality, complications, and patient outcomes.

Purpose of the Study:

  • To systematically compare the efficacy and safety of Guided Bone Regeneration (GBR) and the Shell Technique (ST) for vertical ridge augmentation (VRA).
  • To assess vertical bone gain (VBG), bone quality, complication rates, patient-reported outcomes (PROMs), and implant survival for both techniques.
  • To provide evidence-based guidance for selecting the most predictable VRA approach.

Main Methods:

  • Systematic literature review adhering to PRISMA 2020 guidelines.
  • Searched PubMed and Scopus databases for studies on VRA in adults requiring augmentation before implants.
  • Included studies comparing GBR (using PTFE or collagen membranes) with ST (using autogenous or allogeneic cortical plates).

Main Results:

  • Both GBR and ST yielded clinically significant vertical bone gain, with median VBG of 4.24 mm (GBR) and 5.16 mm (ST) at re-entry.
  • Long-term data indicated sustained bone gain for ST up to 10 years and multi-year stability for GBR.
  • Major complications were infrequent; GBR showed a trend towards more minor soft-tissue issues like exposures and infections.

Conclusions:

  • Both GBR and ST are effective for VRA, enabling dental implant placement.
  • ST demonstrated higher median VBG but involves greater technical demand and potential donor-site morbidity (if autogenous).
  • GBR offers a versatile, donor-site-sparing option; further head-to-head trials with standardized PROMs are needed.