Resident student UCONN Health Farmington, Connecticut, United States
Purpose of the Study: To present a clinical case demonstrating simultaneous vertical and horizontal ridge augmentation in the anterior maxilla using a tenting screw, titanium-reinforced non-resorbable membrane, and a mixed allograft/xenograft, and to compare the achieved gains with values reported in the literature (1–5).
Methods: A 52-year-old medically healthy female presented with a non-restorable maxillary right central incisor (#8) and a chief complaint of mobility and spacing. After extraction of tooth #8 and a six-week soft-tissue healing period, a full-thickness flap was reflected to expose the deficient ridge. Decortication was performed, and a tenting screw was placed to maintain space. The defect was grafted with a mixture of allograft and xenograft particles and covered with a titanium-reinforced non-resorbable membrane plus a collagen membrane overlay. Primary closure was achieved with tension-free suturing. Baseline CBCT was obtained before augmentation, and follow-up CBCT was taken at nine months to evaluate dimensional changes.
Results: At nine months post-augmentation, CBCT revealed a vertical bone gain of 6.8 mm and horizontal gain of 1.3 mm compared with baseline. Clinically, there was a coronal displacement of the mucogingival junction, a thicker band of keratinized tissue, and improved gingival contours. No membrane exposure, infection, or major complications occurred during healing. These outcomes exceed average gains reported in systematic reviews of vertical ridge augmentation (1–3).
Conclusion: This case demonstrates that tenting screw–assisted guided bone regeneration with a titanium-reinforced membrane can produce substantial, stable three-dimensional ridge augmentation and favorable soft-tissue changes in the esthetic zone (1–5). Such an approach allows prosthetically driven implant placement in severely resorbed sites and may improve long-term esthetic outcomes.
Articles: 1. Urban IA, Monje A, Lozada JL, Wang HL. Vertical ridge augmentation interventions: A systematic review and meta-analysis. J Clin Periodontol. 2019;46(Suppl 21):319-339.
2. Esposito M, Grusovin MG, Coulthard P, Worthington HV. The efficacy of various bone augmentation procedures for dental implants: A Cochrane systematic review of randomized controlled clinical trials. Eur J Oral Implantol. 2009;2(3):167-184.
3. Urban IA, Lozada JL, Jovanovic SA, Nagursky H, Nagy K. Vertical ridge augmentation with titanium-reinforced, dense PTFE membranes and a combination of particulated autogenous bone and anorganic bovine bone-derived mineral: A prospective case series in 19 patients. Int J Periodontics Restorative Dent. 2015;35(6):613-623.
4. Chacón G, Khouly I, Neiva R. Tenting screw–assisted guided bone regeneration: A systematic review. Int J Periodontics Restorative Dent. 2024;44(1):81-89.
5. Wang S, Horowitz R, Urban IA. Vertical ridge augmentation using titanium-reinforced nonresorbable membranes: A multicenter prospective clinical study. Clin Oral Implants Res. 2025;36(7):821-834.
