An Autologous Tooth-Shell Technique for Ridge Reconstruction and Immediate Implant Placement: A Two-Case Technical Report and Review of the Literature
Background: Autologous dentin has emerged as a potential grafting material in regenerative oral surgery because of its structural and biological similarities to bone. This technical report describes a modified tooth-shell technique used for horizontal ridge reconstruction with simultaneous implant placement in two clinical cases involving the aesthetic zone. Case Presentation: The first case involved a 29-year-old female patient requiring extraction of a partially impacted, buccally positioned maxillary third molar (tooth 28). The extracted tooth was processed intraoperatively to obtain a dentin shell, which was fixed as a buccal plate during simultaneous implant placement. The remaining defect was filled with sticky bone prepared from biphasic calcium phosphate combined with platelet-rich fibrin. Radiographic evaluations performed at 4 and 6 months demonstrated stable ridge contours, while clinical follow-up continued for 2 years with maintenance of implant function and peri-implant tissue stability. The second case involved a 58-year-old female patient with a previous failure of immediate implantation in the anterior maxilla associated with implant overload, loss of implant stability, and buccal bone deficiency. After soft- and hard-tissue healing, ridge reconstruction was performed using a dentin shell prepared from tooth 18 together with simultaneous implant placement and immediate provisional restoration. Follow-up after 6 months revealed stable peri-implant tissues, a satisfactory aesthetic outcome, and successful prosthetic rehabilitation. Conclusions: The modified tooth-shell technique using autologous dentin provided satisfactory preliminary clinical and radiographic outcomes in both cases. These findings should be considered hypothesis-generating and require confirmation in larger prospective studies with longer follow-up periods.