Guided bone regeneration with simultaneous implant placement initiated during orthodontic retention in a patient with severe developmental mandibular ridge atrophy: A case report with 31-month follow-up

Aim To present a concurrent paradigm in which sausage guided bone regeneration (GBR) and implant placement are initiated at the orthodontic active-to-retention transition for severe developmental mandibular ridge atrophy, shortening treatment duration. Material & Methods A 21-year-old female with congenitally missing mandibular anterior teeth and right premolar (tooth 44 extracted due to caries), presenting with severe horizontal ridge deficiency, underwent three procedures coordinated with the end of active orthodontic treatment. At Month 0, four BEGO Semados® RS implants were placed at sites 32, 41, 44, and 45, followed by sausage GBR using a bovine pericardium membrane (Tutopatch®) with a 50:50 mix of anorganic bovine bone mineral (ABBM) and autograft. At Month 6, free gingival graft (FGG) and apically positioned flaps were performed at implant re-entry. At Month 8, implant-supported fixed prostheses were delivered, coinciding with completion of orthodontic retention. OPGs were obtained pre-operatively and at 31 months post-loading. Results All implants achieved osseointegration. Re-entry at Month 6 confirmed substantial horizontal bone gain. FGG and apically positioned flaps established 4-5 mm of keratinized buccal mucosa bilaterally. Prosthesis delivery coincided with orthodontic retention completion, providing a permanent anterior stop and eliminating the need for a mandibular retainer. Radiography at 31 months post-loading confirmed stable crestal bone levels and complete graft consolidation. Total treatment duration was 9 months. Conclusion Initiating sausage GBR and implant placement at the orthodontic active-to-retention transition is safe and clinically effective, shortening treatment duration. The implant-supported prosthesis enhances orthodontic stability. This protocol offers a reproducible, patient-centered solution for severe developmental mandibular ridge defects.