Periosteal Sutures Versus Titanium Tacks for Guided Bone Regeneration in the Aesthetic Zone: A Pilot Randomized Controlled Trial

Background/Objectives: Stable graft fixation is a key determinant for predictable guided bone regeneration (GBR) performed simultaneously with implant placement. Titanium tacks are commonly used for graft and membrane stabilization but require additional hardware and may necessitate removal at re-entry. Periosteal mattress sutures have been proposed as a hardware-free alternative; however, clinical evidence comparing both ap-proaches remains limited. The objective of this randomized clinical trial was to compare postoperative buccal bone dimensions following horizontal GBR in the aesthetic zone us-ing periosteal mattress sutures versus titanium tacks for graft stabilization. Methods: This pilot randomized controlled clinical trial included patients requiring horizontal GBR with simultaneous implant placement in the anterior maxilla. Participants were randomly al-located to graft stabilization using either periosteal mattress sutures (S) or titanium tacks (T). In all cases, a composite xenogeneic collagenated bovine block graft was applied and covered with a resorbable collagen membrane, followed by tension-free flap closure. Cone-beam computed tomography (CBCT) was obtained after 6 months. Buccal bone thickness was measured at 1, 3, and 6 mm apical to the implant platform. Mean buccal bone thickness and reconstructed buccal bone area between 1 and 6 mm were calculated and compared between groups. Results: Thirty implants were included in the final analy-sis (S, n = 16; T, n = 14). Mean buccal bone thickness was 1.16 ± 1.01 mm in the periosteal suture group and 1.23 ± 1.16 mm in the titanium tack group, with no statistically signifi-cant differences between groups. No significant intergroup differences were observed at any individual measurement level or in the reconstructed buccal bone area. Conclusions: Within the limitations of this pilot trial, periosteal mattress sutures provided buccal bone regeneration outcomes comparable to titanium tacks during GBR with simultaneous im-plant placement. Periosteal suturing may represent a reliable hardware-free alternative for graft stabilization in horizontal ridge augmentation.