Khoury technique, which employs autogenous bone blocks harvested from the patient, has been widely used for horizontal and vertical ridge augmentation. This method introduces critical limitations, including the technical complexity, morbidity associated with donor site harvesting, such as infection, neurosensory disturbances, and post-operative discomfort

This clinical case series aims to demonstrate how customized pours zirconium shell could be an alternative technique for ridge augmentation to overcome the limitations of Khoury shell technique.

Ridge augmentation is a surgical procedure designed to increase the height and width of the alveolar ridge to provide adequate bone volume for the placement of dental implants. Deficient alveolar ridges are treated using various surgical techniques to restore adequate bone volume for dental implant placement. These techniques include guided bone regeneration (GBR), ridge splitting, distraction osteogenesis, autogenous block bone grafting, onlay bone grafting, and maxillary sinus lifting.

The Khoury technique is a widely recognized approach in dental implantology for horizontal and vertical ridge augmentation. This technique involves the use of autogenous bone blocks harvested from the patient, typically from the mandibular symphysis or ramus. These bone blocks are split into thin laminae and stabilized with micro screws to reconstruct deficient alveolar ridges , and the voids created between the bone blocks are filled with autogenous bone chips to promote regeneration .

This approach is associated with risks, such as donor site morbidity, infection, and potential neurosensory disturbances, sever post operative pain, also technical complexity of the procedure also restricts its application to highly skilled clinicians and patients with adequate donor sites.

These challenges highlight the need for alternative techniques or improved strategies to overcome the limitations of the Khoury technique while achieving predictable outcomes in ridge augmentation procedures.

Zirconia is utilized in the fabrication of zirconia crowns and dental implants, among other dental replacement components. This material is a polycrystalline ceramic with high strength and rigidity, even at small thickness, and bio inertness, among other interesting properties.

The structural integrity of zirconium membranes makes them an excellent choice as non-resorbable membrane for GBR. Studies have demonstrated their excellent biocompatibility, optimal tissue integration, high mechanical strength that ensured effective space maintenance for bone formation, smooth surface that minimized soft tissue ingrowth. Additionally, zirconia's customizable nature allows for precise defect contouring, leading to improved aesthetic outcomes. Overall, zirconia membranes present a valuable tool in GBR procedures, offering potential advantages over traditional materials like titanium meshes .

All those studies used the zirconia as an occlusive 3D non-resorbable membrane except on animal study evaluated the effect of the porous zirconia membrane in comparison to the occlusive one .

In an attempt to overcome the limitation of Khoury technique, zirconia can be used as a shell to augment the deficient alveolar ridges. Hence the purpose of this clinical case series is to introduce a novel customized pours zirconium shell and to tomographically assess the bone gain after horizontal ridge augmentation for deficient mandibular ridges.

Inclusion Criteria:

• Age more than 18 years old.
• Deficient lower posterior area (Seibert class I).
• Enough inter-arch space for placement of implant-supported prosthesis.
• Motivated the patient to have the treatment.
• Good oral hygiene.

Exclusion Criteria:

• Patient with systematic conditions that could interfere with healing process.
• Pregnant females
• Smokers.
• Poor oral hygiene.

Study results will be shared via publication in dental journal.