BIOBRIEF

Vertical Ridge Augmentation in the Anterior Maxilla

Muhammad Saleh, BDS, MSD, PhD

Karim Ghishan, BDS, MS

THE SITUATION

The site of tooth 7* had a history of peri-implantitis followed by implant removal, with severe vertical bone deficiency & insufficient bone for implant placement.

*Universal Numbering System

THE RISK PROFILE

	Low Risk	Medium Risk	High Risk
Patient’s health	Intact immune system/ Non-smoker	Light smoker Impaired immune system/	Heavy smoker
Patient’s esthetic requirements	Low	Medium	High
Height of the smile line	Low	Medium	High
Gingival biotype	Thick – “low scalloped”	Medium – “medium scalloped”	Thin – “high scalloped”
Infection at implant sight	None	Chronic	Acute
Bone height at adjacent tooth	≤ 5 mm from contact point	5.5 – 6.5 mm from contact point	≥ 7 mm from contact point
Restorative status of adjacent tooth	Intact		Restored
Width of tooth gap	1 tooth (≥ 7 mm)	1 tooth (≤ 7 mm)	2 teeth or more
Soft-tissue anatomy	Intact		Compromised
Bone anatomy of the alveolar ridge	No defect	Horizontal defect	Vertical defect

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THE APPROACH

The goal was to achieve adequate ridge width and height to place the implant in a prosthetically driven position.

Six week healing at the site of tooth 7* following implant removal – frontal (labial) view

Six-week healing at the site of tooth 7* following implant removal – occlusal view.

Site condition prior to vertical ridge augmentation. The 8 mm defect (from bony peaks) indicates the need for vertical augmentation.

Ridge augmentation was performed using vallos® mineralized cortical-cancellous granules, autogenous bone and RPM™ Reinforced PTFE Mesh to support bone regeneration.

Adaptation and fixation of the RPM™ Reinforced PTFE Mesh over the grafted site using titanium screws to ensure space maintenance and graft stability.

Adaptation and stabilization of Geistlich Bio Gide® Forte over the augmented site.

Eighteen-day postoperative view demonstrating early soft tissue healing and wound closure over the augmented site.

Five month follow up evaluation. Favorable hard and soft tissue healing is observed at the regenerated site – frontal (labial) view

Five-month follow-up evaluation – occlusal view demonstrating favorable ridge contour and soft tissue maturation at the regenerated site.

Five month radiographic evaluation of the regenerated site. Restored ridge volume is evident, supporting readiness for implant placement.

Six months after bone augmentation before removal of RPM™ Reinforced PTFE Mesh– Frontal (labial) view

Six months after bone augmentation after removal of RPM™ Reinforced PTFE Mesh– Showing vertical bone gain– Frontal (labial) view

Occlusal view – Six months after bone augmentation – Showing horizontal bone gain.

Occlusal view – Placement of a 3.75×10 mm Straumann BLC implant.

Occlusal view – Suturing using 5-0 polypropylene.

“Geistlich Bio-Gide® Forte is a versatile membrane that can be used in more indications than other membranes. It can be tacked, it can be screwed, it can be stitched or simply laid flat on a contained defect. It will behave well regardless of how you treat it.”
— Dr. Muhammad Saleh

THE OUTCOME

The use of Geistlich Bio-Gide® Forte, vallos® & RPM™ in guided bone regeneration led to significant horizontal and vertical bone gain, allowing for prosthetically driven implant placement.

Adequate flap release and respecting biology were ensured by avoiding overgrafting outside the bone housing and contour.”
Muhammad Saleh, BDS, MSD, PhD

Muhammad Saleh, BDS, MSD, PhD

Dr. Muhammad H. Saleh, Diplomate of the American Board of Periodontology, is a full-time faculty member at the University of Michigan and an internationally recognized lecturer in periodontology and implant dentistry. He has published over 140 peer-reviewed articles and reviews for leading Q1 journals. His numerous honors include the 2021 AAPF Schoor Award, 2022 Ramfjord Symposium Award, 2022 AAP Institute Award, 2024 AAPF LEAD and Nevins Awards, and the 2025 Roy H. Roberts Award.

Karim Ghishan, BDS, MS

Dr. Karim Ghishan is a specialist in Periodontology and Implant Dentistry. He earned his Doctor of Dental Medicine degree from Jordan University of Science and Technology in 2020, completed a two-year Visiting Scholar Program in Periodontics at the University of Iowa in 2023, and completed a Certificate in Periodontics and Master’s Degree at the University of Michigan in 2026. He has advanced training in periodontal plastic surgery, dental implant therapy, and regenerative procedures and currently practices in East Lansing, Michigan.