Background <p>This study was designed to evaluate the clinical and radiographical outcome of tooth shell for maxillary alveolar ridge augmentation as an alternative to traditional autogenous bone shell graft.</p> Materials and methods <p>Twenty eight patients with one or two maxillary extracted teeth (esthetic zone) in need for horizontal bone augmentation were divided into two groups (14 patients each). Group I (control group): bone augmentation was done by using bone shell technique (BST). Group II (study group): bone augmentation was done by using tooth shell technique (TST). Implant stability was evaluated at the time of implant placement, after 4 months (loading time), and 4 months after loading.</p> <p>Radiographic evaluation was made using Cone beam computed tomography (CBCT) scans before grafting (T0), immediately (T1), and 6 months post grafting (T2).</p> Results <p>In this study, 30 implants were inserted in the esthetic zone. All implants were successfully osseointegrated. No statistically significant difference was found between the studied groups as regards implant stability (<i>P</i> &gt; 0.05) assessed baseline, 4 months after implant placement, and 4 months after loading. The radiographic evaluation demonstrated a statistically significant lower median amount of graft resorption at 1 mm, 5 mm, and 10 mm &amp; total among the study than the control group (<i>p</i> = 0.001, 0.001, 0.04 &amp; 0.001 respectively).</p> Conclusion <p>TST used for lateral ridge augmentation has excellent dimensional stability and the least amount of graft resorption.</p> Trial registration <p>This study was retrospectively registered on <a href="http://www.clinicaltrials.gov">www.clinicaltrials.gov</a> with registration number (NCT06416605) on 16 /5 /2024.</p>