The TESS technique: Tensioned engineered shell system for three-dimensional alveolar ridge reconstruction – A case series

Objectives Complex horizontal and vertical alveolar ridge defects remain challenging in implant dentistry due to limited graft stability and unpredictable contour maintenance. This case series presents the TESS (Tensioned Engineered Shell System) technique, a resorbable shell-based augmentation approach utilizing a polydioxanone (PDS) shell stabilized with fixation screws to establish a biologically favorable three-dimensional regenerative compartment. Materials and methods Three patients presenting with combined horizontal and vertical alveolar ridge deficiencies underwent reconstruction using a 0.5 mm resorbable PDS shell fixed orally and vestibularly using a titanium fixation system. The created compartment was filled with autologous particulate bone alone or combined with xenograft material. In one maxillary case, bilateral sinus floor elevation was performed simultaneously. Cone beam computed tomography (CBCT) measurements were obtained preoperatively and postoperatively at standardized levels using implant-axis–based measurements. Results All cases demonstrated successful ridge contour reconstruction with substantial crestal bone gain. In the bilateral maxillary reconstruction case, discontinuous crestal defects were successfully bridged. The most pronounced augmentation was consistently observed at the crestal level, while basal ridge dimensions remained comparatively stable. Implant placement with adequate primary stability was achieved in two cases. No postoperative infections, graft failures, or wound dehiscence occurred. Conclusions The TESS technique appears to provide predictable three-dimensional contour stabilization and effective space maintenance for complex alveolar ridge reconstruction. The use of a resorbable PDS shell may represent a biologically favorable alternative to non-resorbable rigid barrier systems by supporting the fundamental surgical principles of stability, trophic integration, and protected healing.