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Review
. 2026 Jan 5;18(1):e100809.
doi: 10.7759/cureus.100809. eCollection 2026 Jan.

Assessment of Vertical/Horizontal Ridge Augmentation in Atrophic Alveolar Ridge Using Autogenous Onlay Versus Inlay Grafting Techniques: A Systematic Review

Harshda S Mahajan  1 , Rajesh Gaikwad  1 , Akshaya Banodkar  1 , Shubham B Tale  1 , Madhumitha Chidambaram  1 , Monisha Iyer  1 , Sanpreet S Sachdev  2
Affiliations
Review

Assessment of Vertical/Horizontal Ridge Augmentation in Atrophic Alveolar Ridge Using Autogenous Onlay Versus Inlay Grafting Techniques: A Systematic Review

Harshda S Mahajan et al. Cureus. .

Abstract

Alveolar ridge atrophy presents a major challenge in implant dentistry, often necessitating surgical augmentation to restore adequate bone volume for predictable implant placement. Among the various autogenous grafting approaches, the inlay and onlay techniques are widely utilized, yet their comparative clinical efficacy remains unclear. This systematic review aimed to evaluate the outcomes of vertical and horizontal ridge augmentation using inlay versus onlay grafting techniques in atrophic alveolar ridges. An extensive electronic and manual search of major databases was conducted in accordance with PRISMA guidelines, and eligible randomized controlled trials and comparative clinical studies assessing autogenous grafts were included. Six studies met the inclusion criteria. Both techniques produced appreciable gains in bone height and width; however, the inlay technique demonstrated more favorable results in terms of graft stability, reduced volumetric resorption, and improved soft tissue healing. Inlay grafts benefited from superior vascularization and mechanical protection due to their placement within the osteotomized host bone, resulting in fewer complications and better preservation of augmented volume. By contrast, onlay grafts showed higher rates of resorption, flap dehiscence, and graft exposure, particularly in vertical augmentations where soft tissue tension and limited vascular supply are significant challenges. Despite promising findings, heterogeneity among studies and limited long-term data restrict definitive conclusions. Further well-designed randomized controlled trials with standardized protocols and extended follow-up are needed to strengthen the evidence base. Overall, the inlay technique appears to offer predictable and stable outcomes, particularly in complex augmentation scenarios.

Keywords: atrophic ridges; inlay grafting technique; jawbones; onlay grafting technique; ridge augmentation procedures.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. PRISMA flow diagram indicating the selection process of the articles in the present systematic review
Figure 2
Figure 2. Risk of bias of the randomized controlled trials using the Cochrane RoB-2 tool
[27-30]
See this image and copyright information in PMC

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