This study was designed to assess peri-implant soft tissue health, volume and marginal stability at implants sites which presented small buccal bone dehiscences (<3mm evaluated in a vertical direction) at the time of insertion. Patients will be then randomly allocated to receive grafting with connective tissue graft or guided bone regeneration and evaluated at 3 months after surgery and at 12 months of follow up after crown placement

Inclusion Criteria:

• Adults ≥18 years of age
• Patients requiring a single dental implant in a healed site in the posterior region (premolar or molar areas)
• Presence of a buccal bone dehiscence defect at implant placement, defined as a vertical defect of the buccal bone plate ≥1 mm and ≤3 mm measured from the implant shoulder after implant insertion
• Adequate residual bone to allow implant placement with primary stability (insertion torque ≥25 Ncm or ISQ ≥60)
• Full-mouth plaque score (FMPS) and full-mouth bleeding score (FMBS) ≤20%
• Patients able to understand and sign informed consent
• Patients willing to comply with study procedures and follow-up visits

Exclusion Criteria:

• Uncontrolled systemic diseases (e.g., uncontrolled diabetes mellitus, HbA1c >7.5%)
• Immunocompromised patients
• History of radiotherapy in the head and neck region
• Use of medications affecting bone metabolism (e.g., bisphosphonates, denosumab)
• Pregnancy or lactation