This clinical trial aims to compare and evaluate the clinical outcomes between two distinct treatment sequences: free gingival graft surgery preceding guided bone regeneration and guided bone regeneration followed by free gingival graft.
Who can participate
Age range18 Years
SexALL
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Inclusion Criteria:
* • At least 18 years old
* No uncontrolled medical conditions or medications that will affect their bone healing.
* Good oral hygiene is defined as a full-mouth plaque score ≤25%11.
* Must be able to read and understand the informed consent document.
* Has a need for implants to replace missing tooth/teeth in at least 1 quadrant of the mouth.
* Insufficient alveolar ridge width for endosseous implant placement, defined as 5 mm or less, as determined by bone sounding and CBCT scan.
* The patient and/or guardian is willing and able to comply with pre-operative and post-operative diagnostic and clinical evaluations required.
* The patient is not pregnant or breastfeeding.
Exclusion Criteria:
* Active infectious diseases.
* Liver or kidney dysfunction/failure.
* Uncontrolled diabetes (HbA1c ≥ 8.5).
* Active cancer treatment - such as active chemotherapy radiation therapy, or radiotherapy performed within ≤12 months from the procedure.
* Taking medications that will affect their bone healing (for example, bisphosphonates and long-term anti-inflammatory medications).
* Metabolic bone diseases that affect bone healing such as osteoporosis.
* Pregnant or lactating women (self-reported).
* Current tobacco and Marijuana smokers have 10 or more cigarettes per day, and former smokers (\> 10 cigarettes) who quit \< 10 ago (self-reported).
* Poor oral hygiene.
* Vertical loss of bone at the edentulous ridge.
* History of per…