Computer-guided vs. Conventional Cortical Shell Technique for Horizontal Augmentation
Condition: Alveolar Bone Resorption; Horizontal Ridge Deficiency
MeSH terms: Bone Resorption
Study type: Interventional

Summary: 
      this study aims to evaluate horizontal bone augmentation achieved at the anterior maxilla
      using computer-guided cortical shell bone technique and accuracy of fixation of the bone
      shell away from the atrophic ridge by a calculated distance which is always a challenging
      step for inexperienced surgeons to fix a cortical shell at the ideal position in the
      conventional protocol it was never guided to be precisely fixed at the proper position and
      angulation the problem is if it fixed with insufficient distance with proposed volume loss
      leads to totally insufficient volume gain for future implant placement also to evaluate the
      efficacy of the CAD/CAM surgical guide during chin harvesting procedures in reducing the risk
      of anatomical structure damage and patient morbidity with more accuracy compared with the
      standard technique. this trial versus free hand conventional cortical shell bone technique
      both harvested from symphysis area (chin).
    

Detailed description: 
      Tooth extraction may be due to a variety of causes such as badly decayed, periodontal
      disease, and trauma whatever the reason tooth loss is always followed by loss of masticatory
      force and muscle stimulation to the alveolar bone so according to Wolff's Law (Wolff, 1892)
      loss of mechanical stimulation is followed by the reduction of bone mass.

      Several surgical protocols have been used to manage horizontal maxillary alveolar bone
      atrophy such as bone splitting and bone spreading techniques with or without filling the
      created space, onlay bone graft, guided bone regeneration using resorbable or non-resorbable
      membrane, distraction osteogenesis, and shell bone block technique which use a thin cortical
      bone shell to reshape the atrophied ridge and protect the particulate bone graft.

      Despite the popularity of this technique, it usually requires high surgical skills, prolonged
      intra-operative time, and unfortunately has some technical drawbacks. Such as lack of
      anatomical guidance during bone harvesting which may lead to injury to the important vital
      structure and lack of guidance during fixation may lead to improperly positioned, tilted, or
      rotated shell or even leaving an undesired distance between the shell and deficient ridge

      With the increasing use of cone-beam computed tomography (CBCT), intra and extra oral scanner
      for patient data acquisition, and complete digital workflow in clinical practice and it is
      rapidly becoming the standard of care in dentistry. Regarding bone augmentation as
      preparation for future implant placement. computer-aided surgery has been an innovation that
      enables clinicians to have firm and accurate treatment planning. Also, milling or 3D printing
      methods allow variable techniques for the fabrication of surgical templates.

      This study aims to fully digitalize such technique using patient-specific surgical guides to
      allow for accurate graft harvesting and positioning and to minimize intraoperative time and
      complications associated with this procedure
    

Intervention name(s): Augmentation of horizontal deficient anterior maxilla with a cortical shell harvested from a chin; Augmentation of horizontal deficient anterior maxilla with a cortical shell harvested from a chin using patient specific surgical guide then positioned with another guide
Intervention type(s): Procedure; Procedure
Intervention description(s): Augmentation of horizontal deficient anterior maxilla using the conventional protocol of cortical shell technique; using a patient-specific surgical guide to harvest bone cortical shell from the chin and another patient-specific surgical guide to fix it in the atrophied maxillary anterior area
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: alveolar ridge deficiency; computer guided surgery; chin graft