Khoury's Bone Shell Technique Versus Titanium-Reinforced Polytetrafluoroethylene for Augmentation of Horizontal Deficiency in Posterior Mandible (Histomorphometry Analysis)

The aim of this study is to assess the bone gained histologically when comparing the following different techniques:

One of the techniques that is used for bone augmentation is the Khoury technique which entails that a split cortical bone shell obtained from the ramus area through piezoelectric surgery. The thin laminae of bone obtained is stabilized in the defect area labially through micro screws and the generated gap is filled through a mixture of autogenous that could be obtained from the retromolar area through special burs as the auto chip maker (ACM) or via bone scrapper. The obtained is mixed with an equal ratio with xenograft or bone obtained from animal source to fill the created gap.

Another technique involves the usage of a non-resorbable membrane known as reinforced titanium PTFE that is stabilized from both the lingual and labial aspects via micro screws .It's then filled with a mixture of both autogenous and xenograft for maximizing the bone formation capability. In some cases, the reinforced titanium PTFE is covered with collagen membrane to avoid one of the common drawbacks of this technique which is wound dehiscence.

This study aims to evaluate the bone quality gained from both techniques.

Inclusion criteria

• Have two or more missing teeth in the posterior mandibular segment.
• The patients age of 18 and above.
• The alveolar ridge in the edentulous site of the selected patients will have a buccolingual width of less than 4mm.
• Sufficient vertical bone height.
• Free of any local or systemic condition that may contraindicate ridge expansion procedure.

Exclusion criteria

• Patients taking any medication that may interfere with bone healing or bone biology.
• Patients with any systemic disease that may affect bone healing.
• Any patients with any previous bone grafting procedure at the site of interest.
• Smokers.
• Patient's that have been diagnosed with periodontal disease, as sufficient ridge height would be improbable.
• Patients with significant vitamin D deficiency.