Comparative Effectiveness of Vertical Ridge Augmentation Techniques for Dental Implant Treatment: A Systematic Review

Patiphon Tangjitlikhitsakul, Chanchai Wongchuensoontorn, Marnisa Sricholpech, Chinnachote Khemla

Published Online: Aug 7, 2026 DOI DOI 10.12982/OSR.2026.034

Background: Dental implants placement in long-standing edentulous areas often encounter the problem of alveolar height deficiency from gradual bone resorption over time. Therefore, vertical bone augmentation prior to implant placement would be much needed.Objectives: To compare the effectiveness of various vertical ridge augmentation techniques.

Methods: This review followed the PRISMA guideline. Electronic and manual searches of randomized controlled trials (RCTs) were conducted through the MEDLINE, CENTRAL, Embase, and Scopus databases. The primary outcome was vertical bone gain. Secondary outcomes were bone resorption, complications, implant survival, and success rates. The Cochrane risk-of-bias assessment tool version 2 was used for quality assessment.

Results: Data analyses of the 29 included studies indicated that distraction osteogenesis (DO) provided the highest final vertical bone gain (8.38±1.74 mm.) followed by inlay bone grafting (2.69±0.37 to 7.00±1.76 mm) and guided bone regeneration (GBR) (1.50±1.60 to 6.86±0.94 mm). The highest degree of bone resorption was observed with onlay bone grafting (0.60±0.70 to 4.77±1.67 mm). The DO and GBR techniques demonstrated 20-60% and 0-47% complication rates, respectively. Implant survival and success rates for all ridge augmentation techniques were over 90% and 60%, respectively.

Conclusions: From this study, all vertical bone augmentation techniques can effectively increase the alveolar ridge height. While DO provides the greatest vertical bone gain, the GBR techniques might be a more clinically practical option. However, future well-planned RCTs to identify effective vertical bone augmentation techniques are still warranted.

systematic review guided bone regeneration Distraction Osteogenesis inlay graft onlay graft

References

  1. Gerritsen AE, Allen PF, Witter DJ, Bronkhorst EM, Creugers NH. Tooth loss and oral health-related quality of life: a systematic review and meta-analysis. Health Qual Life Outcomes. 2010;8:126.
  2. Saintrain MV, de Souza EH. Impact of tooth loss on the quality of life. Gerodontology. 2012;29(2):e632-6.
  3. Van der Weijden F, Dell'Acqua F, Slot DE. Alveolar bone dimensional changes of post-extraction sockets in humans: a systematic review. J Clin Periodontol. 2009;36(12):1048-58.
  4. Rocchietta I, Fontana F, Simion M. Clinical outcomes of vertical bone augmentation to enable dental implant placement: a systematic review. J Clin Periodontol. 2008;35(Suppl 8):203-15.
  5. Elnayef B, Monje A, Gargallo-Albiol J, Galindo-Moreno P, Wang HL, Hernandez-Alfaro F. Vertical ridge augmentation in the atrophic mandible: a systematic review and meta-analysis. Int J Oral Maxillofac Implants. 2017;32(2):291-312.
  6. Plonka AB, Urban IA, Wang HL. Decision tree for vertical ridge augmentation. Int J Periodontics Restorative Dent. 2018;38(2):269-75.
  7. Chin M. Distraction osteogenesis for dental implants. Atlas Oral Maxillofac Surg Clin North Am. 1999;7(1):41-63.
  8. Keestra JA, Barry O, Jong L, Wahl G. Long-term effects of vertical bone augmentation: a systematic review. J Appl Oral Sci. 2016;24(1):3-17.
  9. Urban IA, Montero E, Monje A, Sanz-Sanchez I. Effectiveness of vertical ridge augmentation interventions: A systematic review and meta-analysis. J Clin Periodontol. 2019;46 (Suppl 21):319-39.
  10. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi: 10.1136/bmj.n71.
  11. Sterne JAC, Savovic J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898.
  12. McGuinness LA, Higgins JPT. Risk-of-bias VISualization (robvis): an R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods. 2021;12(1):55-61.
  13. Abrahamsson P, Walivaara DA, Isaksson S, Andersson G. Periosteal expansion before local bone reconstruction using a new technique for measuring soft tissue profile stability: a clinical study. J Oral Maxillofac Surg. 2012;70(10):e521-30.
  14. Al-Dubai M, Mounir R, Ali S, Mounir M. Maxillary vertical alveolar ridge augmentation using sandwich osteotomy technique with simultaneous versus delayed implant placement: a proof of principle randomized clinical trial. Clin Implant Dent Relat Res. 2023;25(1):77-86.
  15. Bianchi A, Felice P, Lizio G, Marchetti C. Alveolar distraction osteogenesis versus inlay bone grafting in posterior mandibular atrophy: a prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105(3):282-92.
  16. Byun SH, Kim SH, Cho S, Lee H, Lim HK, Kim JW, et al. Tissue expansion improves the outcome and predictability for alveolar bone augmentation: prospective, multicenter, randomized controlled trial. J Clin Med. 2020;9(4):1143.
  17. Byun SH, Kim SY, Lee H, Lim HK, Kim JW, Lee UL, et al. Soft tissue expander for vertically atrophied alveolar ridges: prospective, multicenter, randomized controlled trial. Clin Oral Implants Res. 2020;31(7):585-94.
  18. Chiapasco M, Romeo E, Casentini P, Rimondini L. Alveolar distraction osteogenesis vs. vertical guided bone regeneration for the correction of vertically deficient edentulous ridges: a 1-3-year prospective study on humans. Clin Oral Implants Res. 2004;15(1):82-95.
  19. Chiapasco M, Zaniboni M, Rimondini L. Autogenous onlay bone grafts vs. alveolar distraction osteogenesis for the correction of vertically deficient edentulous ridges: a 2-4-year prospective study on humans. Clin Oral Implants Res. 2007;18(4):432-40.
  20. Cucchi A, Vignudelli E, Napolitano A, Marchetti C, Corinaldesi G. Evaluation of complication rates and vertical bone gain after guided bone regeneration with non-resorbable membranes versus titanium meshes and resorbable membranes. A randomized clinical trial. Clin Implant Dent Relat Res. 2017;19(5):821-32.
  21. Cucchi A, Vignudelli E, Franceschi D, Randellini E, Lizio G, Fiorino A, et al. Vertical and horizontal ridge augmentation using customized CAD/CAM titanium mesh with versus without resorbable membranes. A randomized clinical trial. Clin Oral Implants Res. 2021;32(12):1411-24.
  22. Cucchi A, Bettini S, Tedeschi L, Urban I, Franceschi D, Fiorino A, et al. Complication, vertical bone gain, volumetric changes after vertical ridge augmentation using customized reinforced PTFE mesh or Ti-mesh. A non-inferiority randomized clinical trial. Clin Oral Implants Res. 2024;35(12):1616-39.
  23. El Zahwy M, Taha S, Mounir R, Mounir M. Assessment of vertical ridge augmentation and marginal bone loss using autogenous onlay vs inlay grafting techniques with simultaneous implant placement in the anterior maxillary esthetic zone: a randomized clinical trial. Clin Implant Dent Relat Res. 2019;21(6):1140-7.
  24. Felice P, Marchetti C, Piattelli A, Pellegrino G, Checchi V, Worthington H, et al. Vertical ridge augmentation of the atrophic posterior mandible with interpositional block grafts: bone from the iliac crest versus bovine anorganic bone. Eur J Oral Implantol. 2008;1(3):183-98.
  25. Felice P, Pistilli R, Lizio G, Pellegrino G, Nisii A, Marchetti C. Inlay versus onlay iliac bone grafting in atrophic posterior mandible: a prospective controlled clinical trial for the comparison of two techniques. Clin Implant Dent Relat Res. 2009;11 (Suppl 1):e69-82.
  26. Felice P, Pistilli R, Pellegrino G, Bonifazi L, Tayeb S, Simion M, et al. A randomised controlled trial comparing the effectiveness of guided bone regeneration with polytetrafluoroethylene titanium-reinforced membranes, CAD/CAM semi-occlusive titanium meshes and CAD/CAM occlusive titanium foils in partially atrophic arches. Int J Oral Implantol (Berl). 2024;17(3):285-96.
  27. Fontana F, Santoro F, Maiorana C, Iezzi G, Piattelli A, Simion M. Clinical and histologic evaluation of allogeneic bone matrix versus autogenous bone chips associated with titanium-reinforced e-PTFE membrane for vertical ridge augmentation: a prospective pilot study. Int J Oral Maxillofac Implants. 2008;23(6):1003-12.
  28. Giragosyan K, Chenchev I, Ivanova V. Linear bone gain and healing complication rate comparative outcomes following ridge augmentation with custom 3D printed titanium mesh vs Ti-reinforced dPTFE. A randomized clinical trial. Folia Med (Plovdiv). 2024;66(4):505-14.
  29. Helal MH, Sheta MS, Alsherif AA, Hassan MA, Aboushelib MN, Ghouraba RF. The effectiveness of hyaluronic acid on prefabricated CAD CAM bone blocks for ridge augmentation: a split mouth study. Clin Implant Dent Relat Res. 2025;27(2):e70035.
  30. Kawakami PY, Dottore AM, Bechara K, Feres M, Shibli JA. Alveolar osteotomy associated with resorbable non-ceramic hydroxylapatite or intra-oral autogenous bone for height augmentation in posterior mandibular sites: a split-mouth prospective study. Clin Oral Implants Res. 2013;24(9):1060-4.
  31. Leong DJ, Oh TJ, Benavides E, Al-Hezaimi K, Misch CE, Wang HL. Comparison between sandwich bone augmentation and allogenic block graft for vertical ridge augmentation in the posterior mandible. Implant Dent. 2015;24(1):4-12.
  32. Maiorana C, Fontana F, Dal Polo MR, Pieroni S, Ferrantino L, Poli PP, et al. Dense polytetrafluoroethylene membrane versus titanium mesh in vertical ridge augmentation: clinical and histological results of a split-mouth prospective study. J Contemp Dent Pract. 2021;22(5):465-72.
  33. Merli M, Migani M, Esposito M. Vertical ridge augmentation with autogenous bone grafts: resorbable barriers supported by ostheosynthesis plates versus titanium-reinforced barriers. A preliminary report of a blinded, randomized controlled clinical trial. Int J Oral Maxillofac Implants. 2007;22(3):373-82.
  34. Morad G, Khojasteh A. Cortical tenting technique versus onlay layered technique for vertical augmentation of atrophic posterior mandibles: a split-mouth pilot study. Implant Dent. 2013;22(6):566-71.
  35. Moussa AK, Shawky M, Aly LAA, Mounir M, Esmael WF. Assessment of bone gain and neurosensory affection with the sandwich osteotomy technique for vertically deficient posterior mandible using a full digital workflow versus conventional protocol: a randomized split mouth study. Clin Implant Dent Relat Res. 2024;26(3):621-30.
  36. Moustafa A, Shawky M, Moshy SE, Mounir M, Nassar Y, Bahaa M. Bone marrow aspirate concentrate and xenograft vs. autograft and xenograft in 3D reconstruction of atrophic maxillary ridges: a split mouth randomized controlled trial. Int J Oral Maxillofac Implants. 2026;41(2):263-75.
  37. Roccuzzo M, Ramieri G, Bunino M, Berrone S. Autogenous bone graft alone or associated with titanium mesh for vertical alveolar ridge augmentation: a controlled clinical trial. Clin Oral Implants Res. 2007;18(3):286-94.
  38. Ronda M, Rebaudi A, Torelli L, Stacchi C. Expanded vs. dense polytetrafluoroethylene membranes in vertical ridge augmentation around dental implants: a prospective randomized controlled clinical trial. Clin Oral Implants Res. 2014;25(7):859-66.
  39. Shaker AE, Salem AS, El-Farag SA, Abdel-Rahman FH, El-Kenawy MH. Comparison of Khoury's bone shell technique vs titanium-reinforced polytetrafluoroethylene membrane for 3D-bone augmentation in atrophic posterior mandible: a randomized clinical trial. J Contemp Dent Pract. 2024;25(6):518-26.
  40. Shomurodov K, Mirkhusanova R. Application of the soft tissue expanding technique before guided bone regeneration of an atrophic alveolar ridge. J Health Transl Med. 2023;26(1):170-8.
  41. Urban IA, Serroni M, Dias DR, Barath Z, Forster A, Araujo TG, et al. Impact of collagen membrane in vertical ridge augmentation using Ti-Reinforced PTFE mesh: a randomised controlled trial. J Clin Periodontol. 2025;52(4):575-88.
  42. Marianetti TM, Leuzzi F, Foresta E, Gasparini G, Cervelli D, Amoroso PF, et al. Vertical distraction osteogenesis combined with bilateral 2-step osteotomy for preprosthetic rehabilitation of edentulous mandible. J Craniofac Surg. 2013;24(4):1175-8.
  43. Sezer B, Koyuncu BO, Gunbay T, Sezak M. Alveolar distraction osteogenesis in the human mandible: a clinical and histomorphometric study. Implant Dent. 2012;21(4):317-22.
  44. Mohanty R, Kumar NN, Ravindran C. Vertical alveolar ridge augmentation by distraction osteogenesis. J Clin Diagn Res. 2015;9(12):ZC43-6.
  45. Singh AK. Distraction histogenesis: The way ahead. Natl J Maxillofac Surg. 2015;6(2):135.
  46. Reininger D, Rodriguez-Grandjean A, Lopez-Quiles J. Analysis of resorption and need for overcorrection in alveolar distraction osteogenesis. Int J Oral Maxillofac Implants. 2016;31(4):865-9.
  47. Ettl T, Gerlach T, Schusselbauer T, Gosau M, Reichert TE, Driemel O. Bone resorption and complications in alveolar distraction osteogenesis. Clin Oral Investig. 2010;14(5):481-9.
  48. Enislidis G, Fock N, Millesi-Schobel G, Klug C, Wittwer G, Yerit K, et al. Analysis of complications following alveolar distraction osteogenesis and implant placement in the partially edentulous mandible. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100(1):25-30.
  49. Marchetti C, Corinaldesi G, Pieri F, Degidi M, Piattelli A. Alveolar distraction osteogenesis for bone augmentation of severely atrophic ridges in 10 consecutive cases: a histologic and histomorphometric study. J Periodontol. 2007;78(2):360-6.
  50. Uckan S, Haydar SG, Dolanmaz D. Alveolar distraction: analysis of 10 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94(5):561-5.
  51. Robiony M, Polini F, Costa F, Politi M. Osteogenesis distraction and platelet-rich plasma for bone restoration of the severely atrophic mandible: preliminary results. J Oral Maxillofac Surg. 2002;60(6):630-5.
  52. Bera RN, Tandon S, Singh AK, Bhattacharjee B, Pandey S, Chirakkattu T. Sandwich osteotomy with interpositional grafts for vertical augmentation of the mandible: a meta-analysis. Natl J Maxillofac Surg. 2022;13(3):347-56.
  53. El Hadidy MS, Mounir M, Abou-Elfetouh A, Barakat A. Assessment of vertical ridge augmentation and labial prominence using buccal versus palatal approaches for maxillary segmental sandwich osteotomy (inlay technique): a randomized clinical trial. Clin Implant Dent Relat Res. 2018;20(5):722-8.
  54. Monje A, Monje F, Hernandez-Alfaro F, Gonzalez-Garcia R, Suarez-Lopez del Amo F, Galindo-Moreno P, et al. Horizontal bone augmentation using autogenous block grafts and particulate xenograft in the severe atrophic maxillary anterior ridges: a cone-beam computerized tomography case series. J Oral Implantol. 2015;41:366-71.
  55. Pelo S, Boniello R, Moro A, Gasparini G, Amoroso PF. Augmentation of the atrophic edentulous mandible by a bilateral two-step osteotomy with autogenous bone graft to place osseointegrated dental implants. Int J Oral Maxillofac Surg. 2010;39(3):227-34.
  56. Esposito M, Pistilli R, Barausse C, Felice P. Three-year results from a randomised controlled trial comparing prostheses supported by 5-mm long implants or by longer implants in augmented bone in posterior atrophic edentulous jaws. Eur J Oral Implantol. 2014;7(4):383-95.
  57. Felice P, Cannizzaro G, Barausse C, Pistilli R, Esposito M. Short implants versus longer implants in vertically augmented posterior mandibles: a randomised controlled trial with 5-year after loading follow-up. Eur J Oral Implantol. 2014;7(4):359-69.
  58. Felice P, Barausse C, Pistilli V, Piattelli M, Ippolito DR, Esposito M. Posterior atrophic jaws rehabilitated with prostheses supported by 6 mm long x 4 mm wide implants or by longer implants in augmented bone. 3-year post-loading results from a randomised controlled trial. Eur J Oral Implantol. 2018;11(2):175-87.
  59. Gastaldi G, Felice P, Pistilli V, Barausse C, Ippolito DR, Esposito M. Posterior atrophic jaws rehabilitated with prostheses supported by $5\times5$ mm implants with a nanostructured calcium-incorporated titanium surface or by longer implants in augmented bone. 3-year results from a randomised controlled trial. Eur J Oral Implantol. 2018;11(1):49-61.
  60. Stellingsma C, Raghoebar GM, Meijer HJ, Batenburg RH. Reconstruction of the extremely resorbed mandible with interposed bone grafts and placement of endosseous implants. A preliminary report on outcome of treatment and patients' satisfaction. Br J Oral Maxillofac Surg. 1998;36(4):290-5.
  61. Felice P, Marchetti C, Iezzi G, Piattelli A, Worthington H, Pellegrino G, et al. Vertical ridge augmentation of the atrophic posterior mandible with interpositional bloc grafts: bone from the iliac crest vs. bovine anorganic bone. Clinical and histological results up to one year after loading from a randomized-controlled clinical trial. Clin Oral Implants Res. 2009;20(12):1386-93.
  62. Felice P, Pellegrino G, Checchi L, Pistilli R, Esposito M. Vertical augmentation with interpositional blocks of anorganic bovine bone vs. 7-mm-long implants in posterior mandibles: 1-year results of a randomized clinical trial. Clin Oral Implants Res. 2010;21(12):1394-403.
  63. Bormann KH, Suarez-Cunqueiro MM, von See C, Tavassol F, Dissmann JP, Ruecker M, et al. Forty sandwich osteotomies in atrophic mandibles: a retrospective study. J Oral Maxillofac Surg. 2011;69(6):1562-7.
  64. Barone A, Toti P, Menchini-Fabris GB, Felice P, Marchionni S, Covani U. Early volumetric changes after vertical augmentation of the atrophic posterior mandible with interpositional block graft versus onlay bone graft: a retrospective radiological study. J Craniomaxillofac Surg. 2017;45(9):1438-47.
  65. Marconcini S, Covani U, Giammarinaro E, Velasco-Ortega E, De Santis D, Alfonsi F, et al. Clinical success of dental implants placed in posterior mandible augmented with interpositional block graft: 3-year results from a prospective cohort clinical study. J Oral Maxillofac Surg. 2019;77(2):289-98.
  66. Pikos MA. Block autografts for localized ridge augmentation: part II. The posterior mandible. Implant Dent. 2000;9(1):67-75.
  67. Urban IA, Jovanovic SA, Lozada JL. Vertical ridge augmentation using guided bone regeneration (GBR) in three clinical scenarios prior to implant placement: a retrospective study of 35 patients 12 to 72 months after loading. Int J Oral Maxillofac Implants. 2009;24(3):502-10.
  68. 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 Oral Maxillofac Implants. 2014;29(1):185-93.
  69. Wang HL, Boyapati L. "PASS" principles for predictable bone regeneration. Implant Dent. 2006;15(1):8-17.
  70. Giannoudis PV, Dinopoulos H, Tsiridis E. Bone substitutes: an update. Injury. 2005;36 (Suppl 3):S20-7.

Tangjitlikhitsakul P, Wongchuensoontorn C, Sricholpech M, Khemla C. Comparative Effectiveness of Vertical Ridge Augmentation Techniques for Dental Implant Treatment: A Systematic Review: Systematic reviews. Oral Sci Rep [Internet]. 2026 Aug 07 [cited 2026 Aug 08];47(3):315-339. Available from: https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=558

Tangjitlikhitsakul, P., Wongchuensoontorn, C., Sricholpech, M. & Khemla, C. (2026). Comparative Effectiveness of Vertical Ridge Augmentation Techniques for Dental Implant Treatment: A Systematic Review. Oral Sci Rep, 47(3), 315-339. Retrieved from: https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=558

Tangjitlikhitsakul, P., Chanchai Wongchuensoontorn,Marnisa Sricholpech and Chinnachote Khemla. 2026. "Comparative Effectiveness of Vertical Ridge Augmentation Techniques for Dental Implant Treatment: A Systematic Review." Oral Sci Rep, 47(3), 315-339. https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=558

Tangjitlikhitsakul, P. et al. 2026. 'Comparative Effectiveness of Vertical Ridge Augmentation Techniques for Dental Implant Treatment: A Systematic Review', Oral Sci Rep, 47(3), 315-339. Retrieved from https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=558

Tangjitlikhitsakul, P., Wongchuensoontorn, C., Sricholpech, M. and Khemla, C. "Comparative Effectiveness of Vertical Ridge Augmentation Techniques for Dental Implant Treatment: A Systematic Review", Oral Sci Rep, vol.47, no. 3, pp. 315-339, Aug. 2026.

Tangjitlikhitsakul, P., Wongchuensoontorn, C., Sricholpech, M., et al. "Comparative Effectiveness of Vertical Ridge Augmentation Techniques for Dental Implant Treatment: A Systematic Review." Oral Sci Rep, vol.47, no. 3, Aug. 2026, pp. 315-339, https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=558