An autologous soft tissue graft was harvested from the patient’s palate using a soft tissue punch (Biopsy Punch, kai Europe GmbH, Solingen, Germany) (Fig. 9). The graft had a comparable dimension as the recipient site. The gingival graft was placed on top of the augmentation material, adapted and carefully sutured to the marginal gingiva after the sulcus epithelium was removed with a rotating diamond (Vicryl 6-0, Ermed AG, Schleithem, Switzerland) (Fig. 10).

In order to evaluate the ridge preservation properly, a cone beam computed tomography (CBCT, 3D Accuitomo, J. Morita Mfg. Corp., Kyoto, Japan) was taken post-surgery with a resolution of 0.25 mm (scan time 17.5 s, 90 kV, 5 mA). The findings were assessed on a computer (HP Compaq 6200 Pro Microtower PC, graphics card: Intel HD Graphics 2000 Dynamic Video Memory Technology, mouse: HP Compaq DC 172B; Hewlett Packard, Palo Alto, CA, USA) with a calibrated monitor (HP Compaq LA 2306x; Hewlett Packard, Palo Alto, CA, USA) using the reconstruction software Morita version I Dixel (J. Morita Mfg. Corp., Kyoto, Japan) (Figs. 11 and 12).

The patients received antibiotics peri-operatively and for 7 days post-surgery (Amoxicillin® 750 mg 1-1-1).

The first follow-up consultation was 7 days post-surgery. The patients did not report any discomfort, and wound healing was regular in all four cases. No clinical signs of significant infection or graft loss were present. The sutures were removed 14 days post-surgery. Consecutive follow-up examinations did not show any complications, and implant placement was performed after 3 to 4 months (Fig. 13a, b).

The height and width of the ridge were sufficient prior to implant placement, which left at least 2 mm of buccal bone after implant placement.