{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T20:53:57Z","timestamp":1790628837381,"version":"4.1.0"},"reference-count":39,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,4]],"date-time":"2026-01-04T00:00:00Z","timestamp":1767484800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dentistry Journal"],"abstract":"<jats:p>Background: 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. Methods: 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. Results: 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. Conclusions: 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<\/jats:p>","DOI":"10.3390\/dj14010025","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T10:03:48Z","timestamp":1767607428000},"page":"25","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Horizontal Ridge Augmentation with Xenogeneic Bone, Hyaluronic Acid, and Dermal Matrix by Tunnel Technique: A Case Series"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3577-3711","authenticated-orcid":false,"given":"Giuseppe","family":"D\u2019Albis","sequence":"first","affiliation":[{"name":"Department of Interdisciplinary Medicine, University of Bari \u201cAldo Moro\u201d, Piazza Giulio Cesare, 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7323-6405","authenticated-orcid":false,"given":"Marta","family":"Forte","sequence":"additional","affiliation":[{"name":"Department of Interdisciplinary Medicine, University of Bari \u201cAldo Moro\u201d, Piazza Giulio Cesare, 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6662-2644","authenticated-orcid":false,"given":"Lorenzo","family":"Marini","sequence":"additional","affiliation":[{"name":"Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4283-499X","authenticated-orcid":false,"given":"Kezia Rachellea","family":"Mustakim","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Hasanuddin University, Jl. Perintis Kemerdekaan No.KM.10, Tamalanrea Indah, Kec. Tamalanrea, Kota Makassar 90245, Sulawesi Selatan, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Pilloni","sequence":"additional","affiliation":[{"name":"Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0521-1363","authenticated-orcid":false,"given":"Massimo","family":"Corsalini","sequence":"additional","affiliation":[{"name":"Department of Interdisciplinary Medicine, University of Bari \u201cAldo Moro\u201d, Piazza Giulio Cesare, 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9819-6229","authenticated-orcid":false,"given":"Saverio","family":"Capodiferro","sequence":"additional","affiliation":[{"name":"Department of Interdisciplinary Medicine, University of Bari \u201cAldo Moro\u201d, Piazza Giulio Cesare, 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1902\/jop.2007.060048","article-title":"Bone Augmentation Techniques","volume":"78","author":"McAllister","year":"2007","journal-title":"J. Periodontol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2161","DOI":"10.1097\/SCS.0000000000008743","article-title":"Tapered, Sand-Blasted, Large-Grit, and Acid-Etched Surfaced Internal Dental Implant in the Diverse Pathologic Jaw","volume":"33","author":"Mustakim","year":"2022","journal-title":"J. Craniofac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"161","DOI":"10.5125\/jkaoms.2020.46.3.161","article-title":"Minimally invasive surgery in implant dentistry","volume":"46","author":"Kim","year":"2020","journal-title":"J. Korean Assoc. Oral Maxillofac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"48","DOI":"10.54527\/jdir.2021.40.2.48","article-title":"Tunnel accessfor ridge augmentation: A review","volume":"40","year":"2021","journal-title":"J. Dent. Implant Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e14","DOI":"10.1016\/j.tripleo.2006.10.019","article-title":"Augmentation of deficient lateral alveolar ridge using the subperiosteal tunneling dissection approach","volume":"103","author":"Hasson","year":"2007","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1513","DOI":"10.1016\/j.joms.2013.05.015","article-title":"Horizontal posterior ridge augmentation: The use of a collagen membrane over a bovine particulate graft: Technique note","volume":"71","author":"Block","year":"2013","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"223","DOI":"10.11607\/prd.4508","article-title":"Tunnel technique with a subperiosteal bag for horizontal ridge augmentation","volume":"40","author":"Karmon","year":"2020","journal-title":"Int. J. Periodontics Restor. Dent."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s40902-018-0142-8","article-title":"Lateral alveolar ridge augmentation procedure using subperiosteal tunneling technique: A pilot study","volume":"40","author":"Kakar","year":"2018","journal-title":"Maxillofac. Plast. Reconstr. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1097\/ID.0b013e3182805bec","article-title":"Minimally invasive ridge augmentation using xenogenous bone blocks in an atrophied posterior mandible: A clinical and histological study","volume":"22","author":"Li","year":"2013","journal-title":"Implant Dent."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1902\/cap.2017.170032","article-title":"Tunnel access for guided bone regeneration in the maxillary anterior","volume":"8","author":"Johnson","year":"2018","journal-title":"Clin. Adv. Periodontics"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1752","DOI":"10.1016\/j.joms.2016.04.031","article-title":"Is the tunnel technique more effective than open augmentation with a titanium-reinforced polytetrafluoroethylene membrane for horizontal ridge augmentation?","volume":"74","author":"Deeb","year":"2016","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_12","first-page":"1370","article-title":"Vertical Bone Augmentation with GBR Pocket Technique: Surgical Procedure and Preliminary Results","volume":"22","author":"Scavia","year":"2021","journal-title":"J. Contemp. Dent. Pract."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Venet, L., Perriat, M., Mangano, F.G., and Fortin, T. (2017). Horizontal ridge reconstruction of the anterior maxilla using customized allogeneic bone blocks with a minimally invasive technique\u2014A case series. BMC Oral Health, 17.","DOI":"10.1186\/s12903-017-0423-0"},{"key":"ref_14","first-page":"6","article-title":"Horizontal ridge augmentation using PDLLA fixing screw in combination with a block graft in a tunnel technique to replace amaxillary anterior missing tooth\u2014A case report","volume":"7","author":"Alghamdi","year":"2020","journal-title":"J. Oral Biol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1097\/ID.0b013e3181e40166","article-title":"Bone grafting by means of a tunnel dissection: Predictable results using stem cells and matrix","volume":"19","author":"Soltan","year":"2010","journal-title":"Implant Dent."},{"key":"ref_16","first-page":"371","article-title":"Minimally invasive alveolar ridge augmentation procedure (tunneling technique) using rhPDGF-BB in combination with three matrices: A case series","volume":"29","author":"Nevins","year":"2009","journal-title":"Int. J. Periodontics Restor. Dent."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"165","DOI":"10.11607\/prd.3171","article-title":"Subperiosteal minimally invasive aesthetic ridge augmentation technique (SMART): A new standard for bone reconstruction of the jaws","volume":"37","author":"Lee","year":"2017","journal-title":"Int. J. Periodontics Restor. Dent."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Sivolella, S., Brunello, G., Castagna, D.A., Cavallin, F., and Consolo, U. (2024). Tunnel Technique in Bone Augmentation Procedures for Dental Implant Rehabilitation: A Systematic Review. Dent. J., 12.","DOI":"10.3390\/dj12120405"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1563\/1548-1336(2007)33[205:MIGBR]2.0.CO;2","article-title":"Minimally invasive guided bone regeneration","volume":"33","author":"Kfir","year":"2007","journal-title":"J. Oral Implantol."},{"key":"ref_20","unstructured":"TREND Statement Checklist, Available online: https:\/\/stacks.cdc.gov\/view\/cdc\/149677 (accessed on 15 September 2025)."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e77","DOI":"10.11607\/jomi.7524","article-title":"Volumetric Changes Following Lateral Guided Bone Regeneration","volume":"35","author":"Mordini","year":"2020","journal-title":"Int. J. Oral Maxillofac. Implants"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1111\/prd.12414","article-title":"Complications in bone-grafting procedures: Classification and management","volume":"88","author":"Molina","year":"2022","journal-title":"Periodontology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1007\/s40496-019-00231-8","article-title":"Tunneling Techniques for Root Coverage","volume":"6","author":"Wang","year":"2019","journal-title":"Curr. Oral Health Rep."},{"key":"ref_24","first-page":"e65641","article-title":"Subperiosteal Ridge Augmentation Technique Utilizing Sticky Bone: A Case Series","volume":"16","author":"Yazhini","year":"2024","journal-title":"Cureus"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1111\/clr.13809","article-title":"Impact of timing of dental implant placement and loading: Summary and consensus statements of group 1-The 6th EAO Consensus Conference 2021","volume":"32","author":"Donos","year":"2021","journal-title":"Clin. Oral Implants Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.ijom.2020.07.002","article-title":"Early implant placement and peri-implant augmentation with a porcine-derived acellular dermal matrix and synthetic bone in the aesthetic area: A 2-year follow-up prospective cohort study","volume":"50","author":"Papi","year":"2020","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1097\/ID.0000000000000796","article-title":"Acellular Dermal Matrix as a Barrier for Guided Bone Regeneration of Dehiscence Defects Around Dental Implants: A Clinical and Histological Report","volume":"27","author":"Peters","year":"2018","journal-title":"Implant Dent."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1111\/j.1600-0501.2009.01731.x","article-title":"Acellular dermal matrix as a barrier in guided bone regeneration: A clinical, radiographic and histomorphometric study in dogs","volume":"20","author":"Borges","year":"2009","journal-title":"Clin. Oral Implant Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1563\/aaid-joi-D-21-00021","article-title":"Efficacy of Acellular Dermal Matrix in Soft Tissue Augmentation Around Dental Implants: A Systematic Review and Meta-Analysis","volume":"49","author":"Yaghini","year":"2023","journal-title":"J. Oral Implantol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Hachinohe, Y., Taira, M., Hoshi, M., Yoshida, D., Hatakeyama, W., Sawada, T., and Kondo, H. (2023). Self-Prepared Hyaluronic Acid\/Alkaline Gelatin Composite with Nano-Hydroxyapatite and Bone Morphogenetic Protein for Cranial Bone Formation. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24021104"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e23497","DOI":"10.1002\/dvg.23497","article-title":"Use of hyaluronic acid for regeneration of maxillofacial bones","volume":"60","author":"Palma","year":"2022","journal-title":"Genesis"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Carton, F., and Malatesta, M. (2024). Nanotechnological Research for Regenerative Medicine: The Role of Hyaluronic Acid. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25073975"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Lorenzi, C., Leggeri, A., Cammarota, I., Carosi, P., Mazzetti, V., and Arcuri, C. (2024). Hyaluronic Acid in Bone Regeneration: Systematic Review and Meta-Analysis. Dent. J., 12.","DOI":"10.3390\/dj12080263"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1563\/1548-1336(2008)34[275:ANTTWA]2.0.CO;2","article-title":"A new tunnel technique with acellular dermal matrix for soft tissue preparation prior to symphyseal block graft--a description of technique and case report","volume":"34","author":"AlGhamdi","year":"2008","journal-title":"J. Oral Implantol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e167","DOI":"10.11607\/jomi.8987","article-title":"The Association Between Suppuration on Palpation and Diagnosis of Peri-implantitis: A Cross-sectional Study","volume":"36","author":"Holtzman","year":"2021","journal-title":"Int. J. Oral Maxillofac. Implant"},{"key":"ref_36","first-page":"209","article-title":"Xenograft Combined with a Mixture of Polynucleotides and Hyaluronic Acid (PN-HA) for Horizontal Alveolar Bone Regeneration: Clinical and Histologic Assessments in a Case Series","volume":"45","author":"Beretta","year":"2025","journal-title":"Int. J. Periodontics Restor. Dent."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1111\/cid.13289","article-title":"Injectable platelet rich fibrin versus hyaluronic acid with bovine derived xenograft for alveolar ridge preservation. A randomized controlled clinical trial with histomorphometric analysis","volume":"26","author":"Abaza","year":"2024","journal-title":"Clin. Implant Dent. Relat. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.1177\/09544089221144189","article-title":"Finite element analysis and topology optimization of Ti-6Al-4V hip implant fabricated by laser powder bed fusion process","volume":"239","author":"Jhunjhunwala","year":"2022","journal-title":"Proc. Inst. Mech. Eng. Part E J. Process Mech. Eng."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2430","DOI":"10.1177\/09544089231197857","article-title":"Finite element analysis of the effect of porosity on biomechanical behaviour of functionally graded dental implant","volume":"239","author":"Elleuch","year":"2023","journal-title":"Proc. Inst. Mech. Eng. Part E J. Process Mech. Eng."}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/1\/25\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T10:31:07Z","timestamp":1767609067000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/1\/25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,4]]},"references-count":39,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["dj14010025"],"URL":"https:\/\/doi.org\/10.3390\/dj14010025","relation":{},"ISSN":["2304-6767"],"issn-type":[{"value":"2304-6767","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,4]]}}}