Radiographic Assessment of Guided Cortical Shell Technique for Horizontal Ridge Augmentation

Cairo University (CU)

Status: Not yet enrolling

Conditions: Horizontal Ridge Deficiency

Treatments: Device: Computer-Guided Autogenous Cortical Shell Technique (Study Group); Procedure: Free-Hand Autogenous Cortical Shell Technique (Control group)

Study type: Interventional

Funder types: Other

Identifiers

NCT06942013

Cortical Shell Technique

Details and patient eligibility

About

The protocol outlines a randomized clinical trial comparing two surgical techniques for horizontal ridge augmentation in the anterior mandible:

Computer-Guided Autogenous Cortical Shell Technique (using a patient-specific guide for precise placement).

Free-Hand Autogenous Cortical Shell Technique (traditional approach without a guiding template).

Key Points:

The study aims to determine which method provides better accuracy and bone volume stability.

Cone Beam CT scans (CBCT) will assess horizontal bone gain preoperatively and six months postoperatively.

The trial is conducted at Cairo University's Faculty of Dentistry. Participants: Patients with pure horizontal bone loss in the anterior mandible.

Outcomes:

Primary: Bone width gain in millimeters. Secondary: Accuracy of augmentation and surgical time.

Methodology:

The study group will use computer-designed surgical osteotomy guides to harvest and place bone grafts with improved precision.

The control group will rely on the conventional free-hand approach. Both groups will undergo bone grafting using autogenous cortical bone shells.

Data Collection & Analysis:

Participants will be randomized and blinded. Data will be analyzed using statistical methods to compare effectiveness.

Full description

This randomized controlled trial evaluates the clinical effectiveness and surgical accuracy of a computer-guided versus a conventional free-hand approach for horizontal ridge augmentation in the anterior mandible using the autogenous cortical shell technique.

Participants presenting with horizontal alveolar bone deficiency in the anterior mandible are randomly assigned to one of two groups:

Study Group: A fully digital workflow is employed, including CBCT-based virtual planning and the use of 3D-printed, patient-specific stereolithographic guides for both bone harvesting and graft placement.

Control Group: The traditional free-hand technique is used without computer-guided assistance.

The study is designed to assess whether the digital, guided approach enhances horizontal bone gain, optimizes graft placement accuracy, reduces operative time, and lowers complication rates compared to the free-hand protocol.

The intervention involves preoperative 3D planning, surgical guide fabrication, and intraoperative bone harvesting and grafting. Both groups receive autogenous cortical bone blocks harvested from the mandibular symphysis and secured at the recipient site with mini screws. Bone particulate (autogenous + xenograft, 1:1 ratio) is used to augment volume.

Primary outcome is the amount of horizontal bone gain measured via CBCT superimposition at baseline and 6 months postoperatively. Secondary outcomes include surgical time, accuracy of graft placement, and incidence of postoperative complications such as pain, swelling, infection, dehiscence, or graft exposure.

This single-center, single-blinded equivalence trial uses a 1:1 randomization ratio. Ethical approval has been obtained, and participants provide informed consent prior to enrollment. The results are expected to inform surgical best practices and improve the predictability of mandibular ridge augmentation procedures.This randomized controlled trial evaluates the clinical effectiveness and surgical accuracy of a computer-guided versus a conventional free-hand approach for horizontal ridge augmentation in the anterior mandible using the autogenous cortical shell technique.

Participants presenting with horizontal alveolar bone deficiency in the anterior mandible are randomly assigned to one of two groups:

Study Group: A fully digital workflow is employed, including CBCT-based virtual planning and the use of 3D-printed, patient-specific stereolithographic guides for both bone harvesting and graft placement.

Control Group: The traditional free-hand technique is used without computer-guided assistance.

The study is designed to assess whether the digital, guided approach enhances horizontal bone gain, optimizes graft placement accuracy, reduces operative time, and lowers complication rates compared to the free-hand protocol.

The intervention involves preoperative 3D planning, surgical guide fabrication, and intraoperative bone harvesting and grafting. Both groups receive autogenous cortical bone blocks harvested from the mandibular symphysis and secured at the recipient site with mini screws. Bone particulate (autogenous + xenograft, 1:1 ratio) is used to augment volume.

Primary outcome is the amount of horizontal bone gain measured via CBCT superimposition at baseline and 6 months postoperatively. Secondary outcomes include accuracy of graft placement, and surgical time.

This single-center, single-blinded equivalence trial uses a 1:1 randomization ratio. Ethical approval has been obtained, and participants provide informed consent prior to enrollment. The results are expected to inform surgical best practices and improve the predictability of mandibular ridge augmentation procedures.

Enrollment: 20 estimated patients

Sex: All

Ages: 20 to 60 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• • Anterior mandible with horizontal deficient alveolar ridge that is from 2 to 4 mm measured from the crest of the alveolar ridge buccolingually.

  • Class IV and V according to Cawood and Howell classification.
  • No sex predilection.
  • Patients free from any systemic conditions and bone metabolism diseases that might interfere with the surgical intervention, soft tissue or hard tissue healing.
  • The minimum number of missing teeth in the anterior mandible alveolar ridge is two adjacent teeth.
  • Normal vertical dimension with normal inter-arch space.

Exclusion criteria

• • Intra-bony lesions (e.g. cysts) or infections (e.g. abscess) that may retard the osteotomy healing.

  • General contraindications to implant surgery.
  • Subjected to irradiation in the head and neck area less than 1 year before implantation.
  • Untreated periodontitis.
  • Poor oral hygiene and motivation.
  • Uncontrolled diabetes.
  • Pregnant or nursing females.
  • Immunosuppressed or immunocompromised
  • Heavy smokers
  • Patients who undergo medication interfere with bone healing
  • Previous grafting procedures in the edentulous area.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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20 participants in 2 patient groups

Full Digital Workflow

Experimental group

Description:

Study Group (Computer-Guided Autogenous Cortical Shell Technique) Bone harvesting and fixation are done using patient-specific guides , chin harvesting guide and bone block fixation guide. Uses a 3D-printed, patient-specific surgical guide for precise bone harvesting and placement. Piezo drill cuts are guided to ensure accurate osteotomy and graft positioning. The labial cortical shell is fixated using pre-planned screw holes for better stability. Bone particulate grafting (autogenous + xenograft, 50:50) is packed into the defect. Enhances accuracy, reduces surgical time, and minimizes complications

Treatment:

Device: Computer-Guided Autogenous Cortical Shell Technique (Study Group)

Free Hand Protocol

Active Comparator group

Description:

Control Group (Free-Hand Autogenous Cortical Shell Technique) Bone harvesting and fixation are done manually, relying on the surgeon's experience. Osteotomy is performed free-hand, increasing the risk of inaccurate graft placement. The labial cortical shell is manually fixated, potentially leading to misalignment. Bone particulate grafting (autogenous + xenograft, 50:50) is used, similar to the study group. Higher risk of human error, longer surgical time, and greater variability in outcomes

Treatment:

Procedure: Free-Hand Autogenous Cortical Shell Technique (Control group)