Modified Shell Technique Versus Onlay Bone Graft in Anterior Maxilla

Study Overview
=================
Brief Summary
-----------------
Amount of bone volume and (width and height): Will be measured using linear measurements from CBCT after 6 month from implant insertion. Will be measured using Histometric analysis of bone area percent sampling from recipient site after 6 months.

Detailed Description
-----------------
Augmentation of insufficient bone volume can be brought about by different methods, including, particulate and block grafting materials, Guided Bone Regeneration with or without growth and differentiation factors, ridge splitting, expansion and distraction osteogenesis, either alone or in combination. These techniques may be used for horizontal/vertical ridge augmentation Autograft is considered as the Gold Standard for bone transplantation and various studies have shown efficacy for it. It is osteogenic, osteoconductive and osteoinductive. Autografts can be derived from extra oral source (iliac crest, ribs) or intraoral source (chin, ramus). They can be used in block or particulate form. Corticocancellous block grafts are preferred because of enhanced revascularization of the cancellous portion, and mechanical support and rigidity of the cortical portion, which ensures optimal ridge augmentation. Fouad Khoury presented a three-dimensional (3D) reconstruction technique for atrophic ridges and complicated vertical bone defects using mandibular bone block graft the Gold standard. There are several possibilities for augmentation of bone volume depending on situation, indication and adequate diagnosis; the treatment options can be extended from minimally invasive procedures with locally harvested bone grafts in local anesthesia, to very sophisticated grafting techniques for 3D bone reconstruction with extra oral harvested bone grafts. Khoury reported that his ascending ramus grafts is almost 5 times more than chin grafts

Official Title
-----------------
Evaluation of Modified Shell Technique Versus Onlay Bone Graft for Reconstruction of Atrophic Anterior Maxilla

Conditions
-----------------
Implant Complication

Intervention / Treatment
-----------------
* Procedure: modified shell technique


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: patients with atrophic anterior maxilla No intraoral soft and hard tissue pathology No systemic condition that contraindicate implant placement Both sexes. Exclusion Criteria: Heavy smokers more than 20 cigarettes per day. Patients with systemic disease that may affect normal healing. Psychiatric problems Immunodeficiency pathology, bruxism, stress situation (socially or professionally), emotional instability, and unrealistic aesthetic demands.
Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: control group (modified shell technique) study group (onlay bone graft)
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: modified shell technique<br>block of bone from the mandibular ramus divided into two shells ,grafting one shell in the anterior maxilla to increase width | Procedure: modified shell technique<br>* divided block of bone into two shells and grafting one shell in anterior maxilla<br>|
| Active Comparator: onlay bone graft<br>grafting block of bone from the mandibular ramus in the atrophic anterior maxilla | Procedure: modified shell technique<br>* divided block of bone into two shells and grafting one shell in anterior maxilla<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Histomorphometric | Type of bone formed by graft, after 3 months biopsy from the bone formed | 3 months | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
anterior augmentation,shell technique,onlay bone graft