Ridge Augmentation

The goal of this clinical trial is to learn if shell technique is useful for implant placement site preparation in adults. The main questions it aims to answer are: Does using xenograft in this technique can reduce the amount of bone harvested from intra oral sites and reduce postoperative complications while offering enough bone to support endosseous implants with long term success? Researchers will compare autogenous bone blocks to xenograft bone blocks in the shell technique ridge augmentation. Participants will undergo ridge augmentation surgery, then have implants placed in the augmented area, then receive implant supported restorations afterwards.

Background: Teeth loss in the posterior mandible initiates residual ridge resorption, this causes difficulty in implant placement so ridge augmentation must be done either simultaneous with implant placement or in a staged approach Aim: To evaluate the effect of autogenous sticky bone with PRF membrane and xenograft with collagen membrane with simultaneous implant placement clinically on primary and secondary implant stability, and radiographically on bucco-lingual width gain, bone density and crestal bone loss

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.

The selected patients will be informed of the nature of the research work and informed consent will be obtained. The control group ridge splitting with simultaneous implants using the conventional technique and study group ridge splitting with simultaneous implants using the piezo surgery. * Pre operative procedures Patients of both groups will be subjected to CBCT. * Intra operative procedures (for both groups) followed by CBCT will be taken for every patient after 4 months. * Infiltration local anesthesia will be given to the patient (Articaine 4% 1:100 000 epinephrine). Both the study and control group will receive: * In Recipient site, incision of full thickness mucoperiosteal flap inorder to obtain, three-line pyramidal flap, followed by flap reflection. * The defective site is reevaluated. * Flap advancement using periosteal releasing incision. * In the Study group: Piezo surgery bone inserts are used. * In the Control group: Bone discs diameter are used. * Followed by bone chisels. * The point and pilot implant drills are used followed by the sequential use of bone expanders. Based on the preexisting bone, the defect morphology and bone quality. The implant is submerged below the alveolar crest. * The fixture is inserted submerged below the alveolar bone crest followed by bone smoothening and roundation under external saline irrigation at recommended speed of 38000rpm and gear ratio 1:1 calibrated on fesiodespenser. * Xenogenic bone particle size of 0.5 mm to 1mm is going to be condensed into the dead space. * Recheck adequate flap advancement. * Double line closure using horizontal mattress sutures followed by interrupted sutures on top to allow contact area and wound edge eversion.

* The selected patients will be informed of the nature of the research work and informed consent will be obtained. * Patients of both groups will be subjected to CBCT. * Intra operative procedures (for both groups) followed by CBCT will be taken for every patient after 4 months. * Infiltration local anesthesia will be given to the patient (Articaine 4% 1:100 000 epinephrine) Both the study and control group will receive: * In Recipient site, full thickness mucoperiosteal flap pyramidal flap, reflection using mucoperiosteal elevator. * The defective site is reevaluated. * Flap advancement inorder to allow tension free flap closure. * In the Study group: Piezo surgery bone inserts is used to cut crestal osteotomies. * In the Control group: Bone discs diameter is used. * Followed by, the use of bone chisels. * The point and pilot implant drills are used followed by bone expanders. Based on the preexisting bone, the defect morphology and bone quality. The implant is submerged below the alveolar crest to compensate for crestal bone resorption. * Following partial immobilization of the buccal bone segment either book or island pattern. The fixture is inserted submerged below the alveolar bone crest. Followed by bone smoothening and roundation under external saline irrigation at recommended speed of 38000rpm and gear ratio 1:1 calibrated on fesiodespenser. * Xenogenic bone particle size of 0.5 mm to 1mm is going to be condensed into the dead space. * Recheck adequate flap advancement to allow tension free closure. * Double line closure using horizontal mattress followed by interrupted sutures to allow contact area and wound edge eversion.

patients will be informed of the nature of the research work and informed consent will be obtained then randomized in 2 groups. Mixture 1:1 autogenous and xenogenic bone covered with Polytetrafluoroethylene membrane control group and study group p covered with native collagen membrane. * Patients of both groups will be subjected to CBCT (diagnostic for upper arch), diagnostic wax-up and stent fabrication. * Intra operative procedures (for both groups) followed by CBCT will be taken for every patient after 4 months. Both the study and control group will receive: * In Recipient site, using 15C blade on Bard Parker handle incision of full thickness mucoperiosteal flap inorder to obtain, three-line pyramidal flap, reflection using mucoperiosteal elevator molt 9. * The defective site is reevaluated after its primary evaluation on CBCT using UNC (University of North Carolina) periodontal probe and a template is cut using sterile suture pack, prior to donor site preparation. * Flap advancement using periosteal releasing incision inorder to allow later tension free flap closure. * In Donor site, mucoperiosteal flap is done, auto chip maker (ACM) is used for autogenous bone harvesting. * Autogenous particulate bone graft is obtained using auto chip maker bur (ACM), in implant contra 20:1 using surgical motor recommended drilling speed 100 rpm and maximum torque 50 Ncm. as well as, using bone scrapper in push direction. * Xenogenic bone graft particles (De-proteinized bovine bone mineral small granules (0.25-1 mm). is added to the autogenous bone particles to obtain homogenous mixture ratio 1:1. * The gold standard is a mixture of autogenous bone containing viable cells and xenogenic bone which has slower rate of resorption is to be placed in recipient decorticated site and covered by PTFE membrane. * The assemble is to be fixed by titanium bone tacks of diameter 2.5 mm and length 3.5 mm, to avoid micro movements of particulate bone assembly. * In the Study group: The assemble is going to be covered by resorbable collagen membrane and fixed by tacks. * Recheck adequate flap advancement by visualizing passive flap approximation, to allow tension free closure. * Double line closure using horizontal mattress placed 5mm away from flap margins followed by interrupted sutures on top to allow contact area which is preferred to point contact and wound edge eversion.

This is a prospective randomized controlled parallel trial. The aim of this study is to evaluate bone formation and soft tissue healing after 4 and 8 months in patients with ridge deficiencies in simultaneous implantation approach. The trial will compare a (sugar cross linked) - SCL pericardium membrane OSSIX® Breeze vs native pericardium membrane (Jason®).