{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T05:46:05Z","timestamp":1791870365241,"version":"4.3.4"},"reference-count":48,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aap.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Adv Periodontics"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This study evaluated clinical, radiographic, and histologic outcomes of horizontal ridge augmentation using a layering technique with demineralized freeze\u2010dried bone allograft (DFDBA) internally and deproteinized bovine bone mineral (DBBM) buccally, covered by a native bilayer collagen membrane. Primary outcomes included horizontal bone gain, graft shrinkage, and vital bone formation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective single\u2010arm study, adult patients requiring horizontal ridge augmentation prior to implant placement were treated with the layering technique (DFDBA and DBBM). Cone beam computed tomography scans were obtained preoperatively (T0), immediately postoperatively (Tim), and after 6\u20139 months (T2). Ridge widths were measured at 3, 5, and 7\u00a0mm apical to the crest. Linear mixed\u2010effects models assessed dimensional changes and the influence of the DFDBA:DBBM ratio on the outcomes. Bone core biopsies were collected at implant placement for histologic and histomorphometric analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifteen patients completed the study. Mean horizontal bone gain was 3.68 \u00b1 1.20, 3.98 \u00b1 1.56, and 3.91 \u00b1 1.77\u00a0mm (all\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001) at 3, 5, and 7 mm respectively. Linear graft shrinkage was 1.76 \u00b1 0.95, 1.82 \u00b1 1.11, and 1.72 \u00b1 0.96\u00a0mm at the respective levels (all\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001). A higher DFDBA:DBBM ratio significantly increased shrinkage at 3\u00a0mm (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.015). Histology (\n                      <jats:italic>n<\/jats:italic>\n                      = 7) showed 30.97 \u00b1 16.71% vital bone, 21.41 \u00b1 10.63% residual graft, and 47.62 \u00b1 18.51% marrow\/connective tissue.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The DFDBA\u2010DBBM layering technique achieved significant horizontal bone gain with predictable modelling and favorable vital bone formation, supporting its use as a viable augmentation approach pending further comparative studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>The layering technique of internal demineralized freeze\u2010dried bone allograft and outer deproteinized bovine bone mineral for guided bone regeneration predictably increased horizontal ridge width, resulting in approximately 3.6 \u2010 4\u00a0mm of horizontal bone gain.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>The technique demonstrated favorable dimensional stability with graft shrinkage of approximately 1.7\u20131.8\u00a0mm.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>The augmented sites showed clinically relevant amounts of vital bone formation (approximately 31%), supporting the biological effectiveness of the layered grafting strategy.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  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