Evaluation of Free Gingival Graft Timing

This clinical trial aims to compare and evaluate the clinical outcomes between two distinct treatment sequences: free gingival graft surgery preceding guided bone regeneration and guided bone regeneration followed by free gingival graft.

Inclusion Criteria: * • At least 18 years old * No uncontrolled medical conditions or medications that will affect their bone healing. * Good oral hygiene is defined as a full-mouth plaque score ≤25%11. * Must be able to read and understand the informed consent document. * Has a need for implants to replace missing tooth/teeth in at least 1 quadrant of the mouth. * Insufficient alveolar ridge width for endosseous implant placement, defined as 5 mm or less, as determined by bone sounding and CBCT scan. * The patient and/or guardian is willing and able to comply with pre-operative and post-operative diagnostic and clinical evaluations required. * The patient is not pregnant or breastfeeding. Exclusion Criteria: * Active infectious diseases. * Liver or kidney dysfunction/failure. * Uncontrolled diabetes (HbA1c ≥ 8.5). * Active cancer treatment - such as active chemotherapy radiation therapy, or radiotherapy performed within ≤12 months from the procedure. * Taking medications that will affect their bone healing (for example, bisphosphonates and long-term anti-inflammatory medications). * Metabolic bone diseases that affect bone healing such as osteoporosis. * Pregnant or lactating women (self-reported). * Current tobacco and Marijuana smokers have 10 or more cigarettes per day, and former smokers (\> 10 cigarettes) who quit \< 10 ago (self-reported). * Poor oral hygiene. * Vertical loss of bone at the edentulous ridge. * History of periodontal disease. * The patient is pregnant or breastfeeding