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Treatment Algorithm · Module
Not enough bone: augment now or stage?
Choosing a ridge-augmentation strategy by defect direction and whether primary stability is achievable. Horizontal defects are predictable and often simultaneous; vertical defects are technique-sensitive and usually staged.
Use: Augmentation planning
Key driver: Defect type + stability
Imaging: CBCT mandatory
01 — Classify the Defect
Which dimension is deficient?
The defect direction governs predictability. Horizontal (width) augmentation has higher, more reliable success; vertical (height) gain is the most demanding and carries higher complication rates.
Most predictable
Horizontal deficiency
- Inadequate ridge width
- Target gain ~3–4 mm typical
- GBR, ridge split/expansion, block
- Often simultaneous with placement
Most demanding
Vertical deficiency
- Inadequate ridge height
- Higher complication / dehiscence risk
- Ti-reinforced membrane, tenting, block
- Usually staged
Complex
Combined / large defect
- Width and height loss
- Consider block / autogenous
- Staged reconstruction
- Refer for advanced grafting
02 — Decision Pathway
Interactive augmentation selector
The pivotal question after classifying the defect: can you place the implant in a prosthetically correct position with primary stability at the same time? If yes, augment simultaneously; if no, stage.
Tap the scenario from your CBCT-based assessment.
Step 1 — Deficiency type & achievable stability
ADEQUATE
Sufficient width & height
≥ ~6 mm width, adequate height.
HORIZONTAL + STABLE
Width deficit, dehiscence/fenestration, stable implant
Correct position with primary stability achievable.
WIDTH, STABILITY DOUBTFUL
Knife-edge ridge, cannot stabilize implant
Insufficient bone to place correctly now.
VERTICAL / COMBINED
Height loss or large combined defect
Demanding reconstruction.
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03 — Technique Reference
Matching technique to defect
| Technique | Best for | Notes |
|---|
| GBR (particulate + membrane) | Dehiscence/fenestration, moderate width | Simultaneous or staged; workhorse technique |
| Ridge split / expansion | Width gain with adequate height | Needs enough cancellous bone between plates |
| Autogenous block / onlay | Larger horizontal & some vertical gain | Higher morbidity, donor site, resorption risk |
| Ti-reinforced membrane / mesh, tenting | Vertical augmentation | Technique-sensitive; exposure = main complication |
| Distraction osteogenesis | Large vertical defects | Specialist; specific indications |
Reference
Sources & clinical disclaimer
For licensed clinicians — educational use only. This algorithm summarizes published consensus and is not a substitute for individual clinical judgment, examination, or the standard of care in your jurisdiction. Augmentation outcomes are highly operator- and technique-dependent; refer advanced vertical/combined defects to an experienced surgeon.
- Jensen SS, Terheyden H. Bone augmentation procedures in localized defects in the alveolar ridge — systematic review. Int J Oral Maxillofac Implants. 2009;24(Suppl):218–236.
- Hämmerle CHF, Jung RE, et al. ITI Consensus — guided bone regeneration. Clin Oral Implants Res.
- Thoma DS, et al. Group 1 ITI Consensus Report: bone dimensions & augmentation outcomes. Clin Oral Implants Res. 2023;34(Suppl 26).
Last reviewed: June 2026 · Next review due: June 2027 · Version 1.0