## 3 Case Presentation  
### Clinical History  
A 61-year-old female patient came to our attention. The clinical evaluation revealed a severe atrophic ridge in the left posterior mandible (Figure 2a). The patient stated that the teeth were extracted 5 years before and the first bicuspid only a month before the consultation. The radiographic evaluation showed the presence of a residual root fragment (Figure 2b). It was also possible to observe the radiolucency of the healing socket of the first bicuspid. The patient was further evaluated with a CBCT to complete the case documentation and data collection. The CBCT showed a severely atrophic ridge with an unfavorable anatomy for dental implant insertion (Figure 3).  
The treatment plan for the edentulous area was formulated in subsequent steps (Table 1). First, mucogingival surgery was required to enhance both the quantity and quality of the soft tissue using a long and thick free gingival graft. This procedure allows for an increase in the quantity of keratinized gingiva and soft tissue thickness in the area, thereby favoring future GBR. After three months, once the soft tissue maturation was complete, the hard tissue regeneration (GBR) of the atrophic ridge was performed. Finally, dental implants were inserted for fixed prosthetic rehabilitation.  
Figure 1: Flex Cortical Sheet: (**a**) Once the FCS was hydrated for a few seconds in a sterile saline solution, the sheet became flexible. (**b**) Appearance of FCS as provided by the manufacturer. A special indentation (*) is placed on one side of the FCS, indicating the direction of the parallel bone fibers and providing an indication to the surgeon about how to fold the FCS, i.e., exert traction forces parallel to the bone fibers.  
The patient did not suffer from any local or systemic contraindications to surgical procedures. The present study was performed in a private clinic, in compliance with the  
\begin{table}
\begin{tabular}{c c c} \hline \hline
**Time Point (T)** & \multicolumn{2}{c}{**Therapeutic Intervention**} \\ \hline \multirow{2}{*}{T0} & \multirow{2}{*}{Initial Evaluation} & Periapical status and CBCT \\  & & Risk assessment \\  & & Mucoginguival evaluation \\ \hline \multirow{2}{*}{T1} & Mucoginguival Surgery & \multirow{2}{*}{Free gingival graft} \\  & (0 months) & \\ \hline \multirow{2}{*}{T2} & Guided Bone Regeneration & GBR with Flex Cortical Sheet \\  & (3 months) & (Bioteck SpA, Arcugnano, Italy) \\ \hline \multirow{2}{*}{T3} & Implant Placement & [PERSON] implant (Institute \\  & (11 months) & Straumann, Basel, Switzerland) \\ \hline \multirow{2}{*}{T4} & Prosthetic Phase & \multirow{2}{*}{Delivery of the final restoration} \\  & (14 months) & \\ \hline \multirow{2}{*}{T5} & Follow-up & Clinical and radiographic \\  & (26 and 32 months) & evaluations \\ \hline \hline \end{tabular}
\end{table}
Table 1: Checklist of the therapeutic interventions followed during case management. The time relative to baseline (T0) was reported for each time point (T1, T2, T3, T4, and T5).  
Figure 3: CBCT at baseline: (**a**) volumetric reconstruction of the edentulous area; (**b**) cross-section of the area.  
Figure 2: Consultation visit: (**a**) clinical evaluation at baseline; (**b**) periapical radiograph revealed the presence of a residual fragment of the root.  
principles of the Declaration of Helsinki on medical protocol and ethics. Written informed consent was obtained for both the clinical procedures and the present study.