Horizontal Ridge Augmentation with Xenogeneic Bone, Hyaluronic Acid, and Dermal Matrix by Tunnel Technique: A Case Series

<b>Background</b>: Several minimally invasive techniques have been introduced to augment horizontal ridge volume for prosthetically driven implant placement, utilizing different biomaterials to enhance regenerative outcomes. This article presents two clinical cases illustrating a tunneling approach for horizontal alveolar ridge augmentation using a combination of xenogeneic bone graft, hyaluronic acid, and an acellular dermal matrix. <b>Methods</b>: A single vertical incision was made mesial to the bone defect and a dermal matrix was suitably shaped and positioned into the subperiosteal tunnel. Subsequently, the bone graft was inserted between the dermal matrix and the buccal bone plate. Primary wound closure was achieved. After six months, implants were placed. For each patient, an optical scan was performed at baseline (T₀), at six months post-operative ridge augmentation surgery (T₁) and at two months post-implant insertion (T₂). A digital measurement of the horizontal ridge thickness was performed at each inserted implant site. Clinical parameters and patient postoperative morbidity were recorded. <b>Results</b>: The procedure was well tolerated by the patients. No postoperative clinical complications were observed. The mean tissue thickness achieved at T1 was recorded to be 13.3 mm. The same value was recorded at T2. <b>Conclusions</b>: This technique allowed the placement of prosthetically guided implants, with minimal morbidity and no observed complications. Further studies analyzing the histology of newly formed bone and performing three-dimensional radiological examinations to confirm the effectiveness of the surgical technique are warranted to validate these preliminary findings. Clinical Trial Number (NIH): NCT06424223.