Osseointegrated implants for the replacement of missing teeth have recently become a routine treatment option [1, 2]. However, any tooth loss may be followed by extensive resorption of the alveolar ridge, which usually makes implant placement difficult or impossible because of the lack of bone volume. There are a variety of defect situations with increasing complexity, ranging from fenestrations, to dehiscences, to both horizontal and vertical deficiencies, while combinations of these also occur. Ridge augmentation techniques are available to effectively and predictably increase the width of the alveolar ridge in horizontal deficiencies. If vertical deficiencies are present, including in combination, the predictability of the techniques is usually substantially lower [3]. A significant bone defect is an anatomical limitation that can be overcome using different surgical techniques, including vertically guided bone regeneration. Several techniques are currently employed, using some combination of autologous bone or biomaterials, various vertical guided bone regeneration (GBR) procedures [4, 5], alveolar distraction osteogenesis [6], titanium mesh [7], and onlay bone graft [8].

While the vertical augmentation of the bone has been demonstrated with different techniques, the number of complications and failures of the augmentation procedure is still too high to recommend a widespread use of such procedures [9,10,11]. In addition, vertical augmentation procedures on compromised alveolar ridges are technically sensitive and might cause significant postoperative morbidity and complications, such as severe postoperative pain, swelling, or graft resorption. Furthermore, augmentation procedures always increase cost, morbidity, and treatment time [12].

Recently, rough-surface implants made with new technology have demonstrated better mechanical and biologic characteristics than traditional machined-surface implants. Several clinical studies have demonstrated high success rates and predictable clinical outcomes for placement of short implants. Short implants have been proposed as an alternative to avoid the problems associated with vertical augmentation [12,13,14]. Still, there is a need for more clinical studies to support this recent concept.