Background and objectives: Resorption of the alveolar bone creates anatomically less favorable foundation for ideal implant placement. Many different predictable ARR techniques have been developed and autogenous bone is still considered ‘the golden standard’ for oral bone reconstruction. However, its application in some cases is objectionable due to an unavoidable second surgical-donor site, meaning morbidity and possible complications related to it and relatively invasive procedure. Still, recently developed ARR according to ‘shell’ technique is preferred for regeneration of small to medium defects for its optimal outcome results. Therefore, when ARR and open sinus floor elevation procedures are indicated for the same patient, it is reasonable to perform both procedures simultaneously. In such case, BP can be used for ARR, thus, the second surgical-donor site can be avoided. The aim of this study was to develop and apply clinically a new surgical protocol that optimizes the clinical outcome results of ARR: by reducing operation morbidity, risk of complications, time and cost compared to conventional ARR techniques.

Methods: A systematic review of the latests research data was conducted and fundamental principles allowing to achieve optimal clinical results for ARR were excluded. An ARR according to ‘shell’ technique was modified and tested in 4 clinical cases.

Results: The clinical results of modified technique were identical to conventional ARR techniques, but the big advantage was the avoidance of the second surgical-donor site and all the negative effects associated with it.

Conclusions: In certain clinical situations this modified ARR technique helps to avoid the second surgical-donor site. Herewith, it provides the predictable clinical outcomes with a minimum resorption, reduced operation time, price and a post-operative morbidity. The results emphasize the possible use of BP for ARR, but stress the need for further clinical studies.

Key words: reconstruction of the alveolar ridge; sinus wall