Shell technique

  • Shell technique - maxgraft® cortico
    Narrow ridge in posterior mandible
  • Shell technique - maxgraft® cortico
    Fixation of maxgraft® cortico with distance to the ridge
  • Shell technique - maxgraft® cortico
    Smoothen the edge and covering with Jason® membrane
  • Shell technique - maxgraft® cortico
    Filling with particulated grafting material
  • Shell technique - maxgraft® cortico
    Covering the defect with tension-free sutures
The shell technique is a typical method for hard tissue augmentation. The concept of the shell technique relies on the preparation of a biological container, which creates the necessary space for the full incorporation of the particulate bone graft material. The shells consist of thin bone plates made of autologous bone that are shaped according to the defect size and position. Subsequently, these are fixed with osteosynthesis screws at a certain distance to the local bone, thus providing structural support for the autologous bone chips. Beside vertical and horizontal reconstructions, this technique enables complex three-dimensional augmentations when dealing with large bony defects. To avoid the time-consuming harvesting and splitting of autologous bone blocks and to prevent the risk of donor-site morbidity, botiss deisgned and developed maxgraft® cortico—a prefabricated bone plate made of allogenic donor bone.
Augmentation with maxgraft® cortico - Dr. K. Chmielewski

Preparation of a single tooth defect with severely resorbed vestibular wall

Three-dimensional augmentation with maxgraft® cortico - Dr. R. Würdinger

Model of the initial defect computed from a CBCT scan - buccal view

Three-dimensional augmentation with maxgraft® cortico - M.Sc. E. Kapogianni

Initial clinical situation – missing bonein regio 11, 12, 21, 22 and scarred soft tissue

Horizontal ridge augmentation with maxgraft® cortico - M.Sc. E. Kapogianni

OPG of the initial situation – provision of missing denture in regio 44 to 47 by a resin-retained bridge

Rehydration of cortical plates

The production process of maxgraft® cortico preserves the natural collagen and maintains a residual moisture of <5%. According to our clinical users, rehydration is not necessary; the product is ready for immediate use.

maxgraft® cortico - horizontal augmentation
maxgraft® cortico - horizontal augmentation

A microsaw is typically used to harvest a bone block, which is then split into two to three thin bone plates. The thickness of these bone plates can be further reduced with a safescraper or a bone mill. The harvesting process, although ensuring excellent results, presents several issues, i.e., it is time consuming, may causes more discomfort to the patient than the augmentation itself, and is a possible source of complications.

As an alternative to the harvesting of autologous bone, maxgraft® cortico is an excellent option: Its natural origin (e.g., the human bone) ensures a high osteoconductivity, controlled remodeling, and biomechanical properties, making maxgraft® cortico the material of choice for bone augmentation; maxgraft® cortico is a sterile product (e.g., no antigenicity) with a high stability and a shelf life of 5 years.

After plate fixation, the space between local bone and cortical plate can be filled with a variety of different particulate bone grafting materials. To facilitate osteosynthesis, allogenic particles (e.g., maxgraft® granules) can be used to fill the defect. The preserved human collagen provides an excellent osteoconductivity and enables a complete remodeling. Mixing with autologous chips or particulate PRF matrices can also support the ossification. At the end of the procedure, the augmentation area is covered with a barrier membrane (e.g., Jason® membrane); a tension-free and saliva-proof closure is finally applied.

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