Research interest and trends in alveolar ridge augmentation and evidence-based evaluation of articles: a bibliometric analysis

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Methods A database search was performed in the Web of Science Core Collection to retrieve relevant research published from 1990 to 2024. Bibliometric and statistical network analyses were conducted using R language, CiteSpace, and VOSviewer. Scientific maps were then constructed for journals, countries, institutions, authors, keywords, and citations, respectively. Results A total of 4487 papers were published from 1990 to 2024. Both annual publication output and citations exhibited sustained growth until 2021, followed by stabilization from 2021 to 2024. The journal with the most publications and citations was Clinical Oral Implants Research. At the country level, the United States ranked first with 1000 publications, while Europe was the most productive continent. Sixty-six high-frequency keywords were selected, among which 3D printing and polycaprolactone (PCL) emerged as the most recent high-frequency keywords. Thirty papers with the strongest citation bursts were selected. Additionally, 16 reference clusters were extracted, among which dental implants (#1), titanium mesh (#2), and tooth extraction (#5) gained prominence over the past decade. Conclusion This study provides a comprehensive overview of the development and research trends of ARA. The findings indicate strong contributions from the United States and Europe. Guided bone regeneration (GBR) was the most widely used technique for ARA, and alveolar ridge preservation (ARP) has also received increasing attention. Current pivotal research themes focus on advances in GBR membrane techniques, including 3D printing, PCL, and electrospinning. Bibliometrics alveolar ridge augmentation mapping guided bone regeneration Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Background Alveolar ridge augmentation (ARA) refers to surgical procedures aimed at increasing the bone volume and dimensions of the atrophic alveolar ridge to facilitate dental implant placement (Urban et al., 2021). Clinically, ARA is performed to reconstruct horizontal, vertical, and combined 3D ridge deficiencies that compromise implant positioning and long-term prosthetic outcomes. As a result, it has become an essential component of pre-implant therapy in modern implant dentistry. A number of studies have demonstrated that ARA can improve implant stability, long-term success rates, and prosthodontic outcomes (Benic and Hämmerle 2014, Mardas et al., 2023, Urban et al., 2023). A variety of procedures have been employed to maximize the effect of ARA. Alveolar ridge split expansion, alveolar distraction osteogenesis (ADO), guided bone regeneration (GBR), sinus floor augmentation, and alveolar ridge preservation (ARP) have often been used for ARA. Technological advancement of ARA has paralleled the rapid progress of bioengineering. With continued advances in biomaterials and digital technologies, these procedures have shown enhanced predictability and reduced complications (Tolstunov et al., 2019, Mardas et al., 2023). The evolution of ARA reflects a transition from empirical surgical techniques to evidence-based regenerative approaches, driven by the growing demand for predictable dental implant rehabilitation. Since the mid-20th century, autologous bone grafting has been regarded as the gold standard for the reconstruction of atrophic ridges. Early grafting procedures relied on intraoral and extraoral donor sites and provided favorable osteogenic potential, but they were also associated with donor-site morbidity, graft resorption, and technical complexity (Boyne and James 1980, Sakkas et al., 2017). Subsequently, the clinical potential of the membrane concept was recognized in periodontal regeneration. A paradigm shift occurred in the 1970s with the advent of membrane techniques, building on Melcher's pioneering work on tissue compartmentalization (Melcher 1976). In the 1980s and 1990s, Dahlin and colleagues established guided bone regeneration (GBR) as a biologically driven approach for promoting new bone formation around implants and within alveolar defects (Dahlin et al., 1989, Dahlin et al., 1990, Dahlin et al., 1991). Early GBR protocols relied primarily on non-resorbable expanded polytetrafluoroethylene membranes (ePTFE) to exclude soft tissue invasion, thereby allowing selective repopulation by osteogenic cells and greatly enhancing bone healing without interference (Dahlin et al., 1989). Later developments introduced resorbable collagen membranes (e.g., Bio-Gide®) and a broad range of bone substitutes, thereby simplifying procedures while maintaining efficacy (Zitzmann et al., 1997). Grafting materials such as xenografts (deproteinized bovine bone mineral, DBBM) and synthetic materials (biphasic calcium phosphate, BCP; β-tricalcium phosphate, β-TCP) became increasingly important alternatives to autogenous bone grafts (Hämmerle et al., 1998). The bibliometric analysis published in 2023 demonstrated that xenograft materials for horizontal and/or vertical ridge augmentation were the most prominent (Dos Anjos et al., 2023). The 21st century ushered in biologic enhancements and digital innovations. Growth factors, such as recombinant human bone morphogenetic protein-2 (rhBMP-2) and platelet-rich fibrin (PRF), have been reported to exhibit potent osteoinductive capabilities and regenerative potential (Boyne et al., 2005, Al-Maawi et al., 2021, Tavelli et al., 2021). During the same period, digital workflows incorporating cone-beam computed tomography (CBCT) and 3D printing enabled more precise defect assessment and increasingly patient-specific treatment planning (Lizio et al., 2022). With the recent emphasis on minimally invasive and personalized approaches, 3D-printed and customized scaffolds have expanded the therapeutic possibilities for severe alveolar defects (El Morsy et al., 2020, Chiapasco et al., 2021). Recently, ARA procedures have integrated multidisciplinary strategies. Hybrid techniques for 3D reconstruction (e.g., the "shell technique") have pushed the boundaries of predictability (Shaker et al., 2024, Saveinai et al., 2025). From its early developmental stages to the current era of precision medicine and personalized regenerative strategies, ARA exemplifies the synergy between surgical ingenuity and regenerative science. In addition to the continuous innovation of biomaterials, the technical philosophy of ARA has also evolved significantly. The concept of socket preservation has gained increasing attention. Studies demonstrated that immediate alveolar ridge preservation (ARP) following tooth extraction can effectively reduce bone resorption (Cardaropoli et al., 2003). The therapeutic approaches for ARA have therefore become increasingly diversified. Given the diversity of surgical techniques and biomaterials in ARA, it is necessary and valuable to assess and summarize previous high-quality articles. Numerous studies have discussed the grafting materials and procedures used in ARA, yet relatively few bibliometric analyses have mapped this field as a whole. Existing bibliometric analyses have focused on narrower topics. The bibliometric study published in 2023 analyzed the 100 most-cited articles on bone grafting in dentistry (Dos Anjos et al., 2023). In addition, Dadvand et al. analyzed trends in biomaterials for bone regeneration in 2026 (Dadvand et al., 2026). However, there is still a lack of a field-wide evaluation of ARA. The aim of this study was to analyze the literature related to ARA between 1990 and 2024, to describe the development and evolution of ARA techniques and related biomaterials, and to characterize the most influential research and top-trending keywords, with the hope of offering valuable insights for clinicians. Materials and Methods Data source and search strategy An electronic search was performed based on the Science Citation Index Expanded (SCIE) of the Web of Science (WoS) Core Collection from 01.01.1990 to 31.12.2024; the search date was 24 April 2025. Title search (TI), abstract search (AB), and author keyword search (AK) were used simultaneously, and the complete search strategy is shown in Supplemental Material 1. Publications in English were selected. The publication types were limited to articles and reviews. The export type was “Plain Text File”, and the export content was “Full Record and Cited References”. Details of each publication, including the title, year of publication, authors’ names, nationality, institutions, journal name, keywords, abstract, and citation information (average citations per item, H-index, and total citation count), were obtained from the WoS analysis results and WoS citation reports. The electronic search and article download were conducted and completed within one day to avoid the impact of time-related database updates. For the present bibliometric analysis, only studies or reviews reporting on alveolar ridge augmentation before implantation, as well as alveolar bone repair in conjunction with implant placement, were included. Therefore, the topic of peri-implantitis was not considered in this bibliometric study. In addition, topics such as alveolar cleft, cranial surgery, and apicectomy, which were unrelated to the ARA process before implantation, were excluded. The flowchart of article selection is shown in Fig. 1. VOSviewer (version 1.6.15) was used to establish network visualization maps of countries, institutions, authors, and their collaborations, as well as the keyword co-occurrence visualization map. In the software, "full counting" was selected as the counting method. The minimum threshold for national cooperation was set at 10, that for institutional cooperation at 15, that for author cooperation at 10, and that for author keyword co-occurrence at 30. In the VOSviewer network visualization map, the circle denotes the occurrence subject, the size of the circle represents the frequency of occurrence, the lines connecting the circles represent the co-occurrence relationships between them, and the node color signifies the average publication year. Synonyms in the analysis were manually merged. The bibliometrix package (version 4.2) in R (version 4.2.1) was used to calculate the specific data, including journals of published articles, authors, author influence, and publication timelines, and to generate yearly occurrence data for journals, countries, institutions, authors, and author keywords. CiteSpace (version 6.3.R3 Advanced) was used for burstiness analysis and cluster analysis. A burst is a symbol reflecting the importance of the literature (Kleinberg 2002), especially during a specific period. The beginning of the blue line indicates the publication of an article. The beginning of a red segment represents the start of a citation burst period, and the end of the red segment represents the end of that period. The selected duration was eight years. For clustering, the algorithm used was the G-index. The quality of clustering information was determined by the silhouette value and modularity value (Rousseeuw 1987, Newman 2006). Visualization software: Scimago Graphica (1.0.41) was used for visualization processing. Adobe Illustrator (2003) was used for the preliminary visualization of data related to national publications and national cooperation, as well as for refining data details. Results Amount and publishing trends of global publications From 1990 to 2024, a total of 4487 articles related to ARA were published, consisting of 4092 research articles and 395 review articles. These publications involved 13,796 authors in this field, including 99 individual authors, with an average of 5.48 co-authors per article and an international co-authorship rate of 28.5%. Additionally, there were 5935 author keywords and 74,489 references, with an average of 30.37 citations per document. The number of published articles gradually increased at an annual growth rate of 3.64% (Fig. 2A). Correspondingly, the number of citations has steadily increased since 1990. A notable upward curve was observed from 2018 to 2021, indicating a significant increase in citation numbers; the trend remained stable from 2021 to 2024 and peaked in 2023 (Fig. 2B). In terms of publication count, Clinical Oral Implants Research (Impact Factor, IF = 5.5) published the greatest number of papers. The International Journal of Oral & Maxillofacial Implants (IF = 2.2) and the International Journal of Periodontics & Restorative Dentistry (IF = 1.5) ranked second and third, respectively. The 4th to 7th journals were the Journal of Periodontology (IF = 4.3), Clinical Implant Dentistry and Related Research (IF = 4.3), Journal of Oral and Maxillofacial Surgery (IF = 2.3), and International Journal of Oral and Maxillofacial Surgery (IF = 2.7) (Fig. 3). Continents and Countries Europe was the main source of publications, and more than 20 countries published more than 20 papers (Fig. 4A). The top ten contributing countries included five countries from Europe: Italy, Germany, Switzerland, Sweden, and Spain. The other five were the United States of America (USA) in North America, Brazil in South America, and China, Japan, and South Korea in Asia. The United States ranked first with 1000 publications, followed by China with 663 papers and Italy with 516 papers (Fig. 4B). Furthermore, according to the visualization map, Europe could be considered the core and has established cooperation with countries worldwild. In addition, China, Egypt, Yemen, Chile, and Croatia presented an orange node color, indicating a noteworthy increase in publication numbers in recent years (Fig. 4B). Institutions Among the top ten institutions with the highest number of publications, two were from Switzerland, two from the USA, and the other six were from Sweden, Italy, China, South Korea, Israel, and Brazil, respectively (Fig. 5A). The University of Bern in Switzerland and the University of Michigan in the United States ranked first and second with 151 and 150 publications, respectively, followed by the University of Gothenburg, the University of Zurich, Sichuan University, and the University of Milano. The top six universities published more than 100 papers in this area. The visualization map revealed that institutions from China, such as Sichuan University, Peking University, Chongqing Medical University, and Sun Yat-sen University, formed the China institutional cooperation network, represented by red circles, which indicated an active research status in the last five years (Fig. 5B). In addition, the University of Michigan and the University of Bern served as centers, while the University of Zurich, the University of Milano, the University of Gothenburg, New York University, and International University of Catalonia from served as hubs, forming an extensive collaborative network with research institutions globally (Fig. 5B). Authors In terms of the top ten authors, nine were from Europe and only one was from the USA (Fig. 6A). Wang, Hom-Lay, from the University of Michigan in the USA, ranked first with 95 publications. Jung, Ronald E., and Buser, Daniel, from the University of Zurich and the University of Bern in Switzerland, ranked second and third with 46 and 45 papers, respectively. However, in terms of citations, Buser, Daniel ranked first with 4327, followed by Esposito, Marco, with 3562, while Wang, Hom-Lay ranked third with 3313. The visualization map showed that the co-author networks were consistent with the institutional networks. According to the color coding, Barbeck Mike and Jung Ole at the University Medical Center Rostock in Germany, Windisch Peter at Semmelweis University in Hungary, and Cha Jae-kook at Yonsei University College of Dentistry in Korea have been particularly productive in recent years (Fig. 6B). Keywords A total of 66 author keywords were identified based on the statistical threshold for co-occurrences. According to total link strength (TLS), “guided bone regeneration,” “dental implants,” and “bone regeneration” were the top three keywords, with TLS values of 1489, 1486, and 959, respectively (Suppl. 2). Moreover, 5 clusters were identified (Fig. 7B), including three large clusters and two small ones. The first cluster was marked in green and included 23 author keywords represented by “dental implants.” Author keywords with strong TLS, such as “bone augmentation” and “bone grafting,” as well as a series of keywords related to bone grafts and sinus augmentation, were grouped in this cluster. The second cluster included 21 keywords represented by “guided bone regeneration” and “bone regeneration.” In addition, the latest hotspot keywords, “3D printing,” “polycaprolactone,” and “electrospinning,” were included in this cluster. Cutting-edge technologies and biomaterials were mainly covered in this cluster. The third cluster included 16 keywords, with “alveolar ridge augmentation,” “bone substitute,” “CBCT,” and “tooth extraction” being representative terms. The fourth and fifth clusters each contained 3 keywords, including “collagen membrane,” “bone defects,” and “animal studies,” and “ridge augmentation,” “ridge preservation,” and “socket preservation,” respectively. According to the timeline circular overlay visualization map, red denotes the most recent keywords, whereas green signifies the earliest keywords from 1990. Among the top 66 author keywords, two keywords were marked in red: “3D printing” and “polycaprolactone,” and the top ten keywords included “alveolar ridge preservation,” “alveolar bone grafting,” “CBCT,” “electrospinning,” “bone tissue engineering,” “xenograft,” “sinus floor augmentation,” and “vertical bone augmentation” (Fig. 7C). Citations References were clustered using CiteSpace, and a total of 16 clusters were obtained (Fig. 8A), including grafts (#0), dental implants (#1), titanium mesh (#2), guided bone regeneration (#3), animal study (#4), tooth extraction (#5), cross-linking (#6), distraction osteogenesis (#7), hydroxyapatite (#8), bone morphogenetic protein (#9), maxilla (#10), short implants (#11), mandibular defect (#12), human bone-derived cells (#13), polycaprolactone (#15), and clinical trials (#17). Grafts (#0) stood out as the largest cluster. Based on the timeline visualization map, we could unveil the evolution of treatments and research in a certain domain. According to the timeline view of co-citation clustering, grafts (#0) received sustained attention over a long period, spanning from 1985 to 2005 (Fig. 8B). From 2000 to 2020, guided bone regeneration (#3), animal study (#4), cross-linking (#6), bone morphogenetic protein (#9), short implants (#11), and polycaprolactone (#15) received more attention. In recent years, dental implants (#1), titanium mesh (#2), and tooth extraction (#5) have stood out and gained substantial attention from 2015 to 2024 (Fig. 8B). The CiteSpace results showed that 30 articles presented citation bursts (Fig. 8C). The list of these 30 papers is provided in Supplemental Material 3. The paper with the strongest burst was a review published in 2007, “Bone Augmentation Techniques” (McAllister and Haghighat 2007). Among the top 30 articles, 15 were clinically related (Adell et al., 1990, Becker and Becker 1990, Nyman et al., 1990, Becker et al., 1994, Simion et al., 1994, Buser et al., 1995, Hämmerle et al., 1996, Anitua 1999, Fiorellini et al., 2005, Chiapasco et al., 2007, Bianchi et al., 2008, Esposito et al., 2011, Jung et al., 2013, Ronda et al., 2014, Urban et al., 2014), of which 3 were randomized clinical trials (RCTs) (Fiorellini et al., 2005, Esposito et al., 2011, Ronda et al., 2014), 3 were case reports (Becker and Becker 1990, Nyman et al., 1990, Becker et al., 1994) , and 1 was a case series (Urban et al., 2014). In addition, 13 articles were animal studies (Becker et al., 1990, Dahlin et al., 1990, Seibert and Nyman 1990, Schenk et al., 1994, Berglundh and Lindhe 1997, Caplanis et al., 1997, Hämmerle et al., 1997, Block et al., 1998, Cochran et al., 1999, von Arx et al., 2001, Jovanovic et al., 2007, Lee et al., 2009), and 2 were reviews (Esposito et al., 1998, McAllister and Haghighat 2007). Discussion The results showed a gradual increase in the number of publications and citations from 1995 to 2021. During these three decades, ARA techniques entered a period of rapid development. Supported by advances in biomaterials, regenerative concepts, and implant-driven treatment planning, ARA techniques have undergone rapid development in this period. Publication output remained at a high level between 2021 and 2024, which may reflect stabilization after this rapid development in the most recent years. Clinical Oral Implants Research, the International Journal of Oral & Maxillofacial Implants, the International Journal of Periodontics & Restorative Dentistry, and the Journal of Periodontology were regarded as the leading journals with the most publications and citations. Europe showed a clear leadership position in ARA when considering countries, institutions, and authors. In terms of national distribution, the USA and China contributed the highest numbers of publications. This finding was consistent with the previous results of a bibliometric analysis of periodontal regeneration (Hu et al., 2025). This result reflects the large number of universities, strong research infrastructure, and substantial academic resources in these countries. By contrast, the strength of Europe appears to lie in the broad and coordinated contributions of multiple countries. More than 20 countries in Europe have published over 20 related studies. In addition, several leading institutions, including the University of Bern, the University of Gothenburg, the University of Zurich, and the University of Milano, formed an active and collaborative research network, which was clearly presented in the institutional visualization map. The analysis of authors further supported this finding. Nine out of the top ten authors were from Europe, which further illustrates the dominant position of Europe in GBR. These results are consistent with the previously published bibliometric analysis of the top 100 articles on bone grafting and sinus lift, in which 62% of publications originated from Europe (Dos Anjos et al., 2023). In addition, the overlay maps indicated growing activity in developing regions, particularly in Asia and Africa, suggesting that the global research landscape of ARA is continuing to expand. Frequency and visualization analysis of keywords are considered useful not only for revealing the current research status in a specific domain, but also for understanding the historical development trajectory of a field and predicting future trends. According to our results, “guided bone regeneration,” “dental implants,” and “bone regeneration” were the top three terms, which is consistent with the results of the previous bibliometric analysis in 2023 (Dos Anjos et al., 2023). However, that study lacked an analysis of the timeline co-occurrence overlay visualization map. Beyond simple frequency counts, our analysis also highlighted the temporal evolution of keyword clusters. In the timeline keyword circle visualization map (Fig. 7B), “xenograft” was identified as the hottest keyword among grafting materials, in agreement with previous bibliometric evidence showing that 22% of studies used only xenogeneic grafts (5130 citations), followed by alloplastic grafts (3398 citations; 14% of total), autogenous grafts (2410 citations; 12% of total), and allogeneic grafts (2397 citations; 8% of total citations) (Dos Anjos et al., 2023). Of particular interest, the latest keywords, “3D printing,” “polycaprolactone,” and “electrospinning,” in our analysis were all strongly related to the membrane technique in GBR. These terms may be viewed as representing three complementary dimensions of membrane research: design, materials, and fabrication. These results are consistent with the bibliometric analysis of biomaterials for bone regeneration published in 2026, which indicated that newer advances, especially polycaprolactone (PCL), gained more interest, whereas traditional biomaterials and collagen membranes showed declining interest (Dadvand et al., 2026). Although resorbable collagen membranes remain the standard of care in many GBR procedures and generally provide bone regeneration outcomes comparable to those of non-resorbable membranes (Zitzmann et al., 1997, Hämmerle and Karring 1998), they also have recognized limitations, including loss of space-maintaining ability, rapid biodegradation, and limited osteogenic activity (Allan et al., 2021, Shiroud Heidari et al., 2024). To overcome these drawbacks, a synthetic resorbable membrane with desirable properties is needed as an alternative barrier membrane. PCL, a synthetic aliphatic polyester, exhibits remarkable advantages, including high biocompatibility, slow and controlled degradability, suitability as a drug and growth factor delivery system, and customizability for 3D printing (Gedik and Erdem 2025, Liu et al., 2025, Xie et al., 2025). Although most studies on these novel biomaterials remain preclinical, a controlled clinical study showed that one year after GBR, the PCL membrane achieved therapeutic effects comparable to those of the collagen membrane (Kusirisin et al., 2023). Electrospinning technology, with its ability to create fibers spanning the micron-to-nanometer range, has emerged as a highly promising fabrication strategy in bioengineering (Tardy et al., 2021). PCL-based electrospun nanofibers have attracted significant interest because of their excellent mechanical properties and highly adjustable three-dimensional porous structures that closely resemble the extracellular matrix (ECM). These characteristics make them particularly suitable as scaffolds for tissue engineering and regenerative medicine (Dutcher 2018). In addition, combinations of multiple emerging technologies have gained attention. Multilayer membrane techniques and functionalized membranes combined with antibacterial agents or growth factors have been reported in a growing number of studies (Gedik and Erdem 2025, Liu et al., 2025, Xie et al., 2025). Together, these developments suggest that GBR is moving toward intelligent, multifunctional, and patient-specific scaffolds with optimized structure, biological performance, and controlled release properties. Citation analysis provided a complementary perspective to the keyword analysis. According to the co-citation visualization maps, “Grafts” stood out as the largest cluster, highlighting the historical centrality of grafting materials in ARA research. However, the influence of this cluster has decreased over the past 15 years, while clusters including dental implants (#1), titanium mesh (#2), and tooth extraction (#5) have gained substantially more attention (Fig. 8B). It is worth noting that the sustained prominence of the tooth extraction cluster over the past two decades aligns with the emergence and development of ARP. In the 1990s, the concept of proactively preventing bone resorption rather than reconstructing bone defects later began to gain popularity. ARP was frequently mentioned and clearly defined in the literature of this period and has since developed into a key component of pre-implant alveolar bone management (Lekovic et al., 1997, Iasella et al., 2003). Among the top 30 references with bursts, two papers were related to ARP, and more recent randomized clinical trials and systematic reviews have further supported its effectiveness (Avila-Ortiz et al., 2019, Atieh et al., 2022). In contrast, techniques such as ADO reached their peak of attention around 1995 to 2003, and studies on ADO have declined substantially over the past 20 years. This interpretation is consistent with the keyword timeline circle map, in which ADO appeared at the end of the circle marked in light green (Fig. 7B). Conclusion This study provides a comprehensive bibliometric overview of ARA research published from 1990 to 2024 and outlines the major trends shaping the field. Publication output and citation activity increased steadily through 2021 and stabilized from 2021 to 2024. Europe showed a leadership position in this domain, while the United States made particularly strong contributions at the country, institutional, and author levels. GBR remains the most established and widely used surgical approach for ARA. Our analysis identified “3D printing” and “polycaprolactone” as the most prominent emerging keywords, and xenogeneic grafts as the most commonly used grafting materials. Overall, membrane techniques received the most attention. The application of 3D printing combined with PCL and electrospinning in GBR appears to represent the hottest current research trend in this domain. Abbreviations ARA alveolar ridge augmentation GBR guided bone regeneration PCL polycaprolactone ADO alveolar distraction osteogenesis ARP༚alveolar ridge preservation༛ePTFE polytetrafluoroethylene membranes DBBM deproteinized bovine bone mineral BCP biphasic calcium phosphate β-TCP β-tricalcium phosphate SCIE Science Citation Index-Expanded WoS Web of Science TI title search AK author keyword search IF impact factor RCTs randomized controlled trials. Impact Factor, IF USA United States of America ECM extracellular matrix Declarations Funding No funding was received for this study. Author Contribution A: conceptualization, data review, draft preparation and critical revisionB: strategy design, data collection, data acquisition, investigating and manuscript revisionC: Software, Data curation, data collection, programming, visualization, formal analysisD: conceptualization and design, data acquisition, draft preparation，investigating, writing--original manuscript References References were clustered using CiteSpace, and a total of 16 clusters were obtained (Fig. 8A), including grafts (#0), dental implants (#1), titanium mesh (#2), guided bone regeneration (#3), animal study (#4), tooth extraction (#5), cross-linking (#6), distraction osteogenesis (#7), hydroxyapatite (#8), bone morphogenetic protein (#9), maxilla (#10), short implants (#11), mandibular defect (#12), human bone-derived cells (#13), polycaprolactone (#15), and clinical trials (#17). Grafts (#0) stood out as the largest cluster. Based on the timeline visualization map, we could unveil the evolution of treatments and research in a certain domain. According to the timeline view of co-citation clustering, grafts (#0) received sustained attention over a long period, spanning from 1985 to 2005 (Fig. 8B). From 2000 to 2020, guided bone regeneration (#3), animal study (#4), cross-linking (#6), bone morphogenetic protein (#9), short implants (#11), and polycaprolactone (#15) received more attention. In recent years, dental implants (#1), titanium mesh (#2), and tooth extraction (#5) have stood out and gained substantial attention from 2015 to 2024 (Fig. 8B). The CiteSpace results showed that 30 articles presented citation bursts (Fig. 8C). The list of these 30 papers is provided in Supplemental Material 3. The paper with the strongest burst was a review published in 2007, “Bone Augmentation Techniques” (McAllister and Haghighat 2007). Among the top 30 articles, 15 were clinically related (Adell et al., 1990, Becker and Becker 1990, Nyman et al., 1990, Becker et al., 1994, Simion et al., 1994, Buser et al., 1995, Hämmerle et al., 1996, Anitua 1999, Fiorellini et al., 2005, Chiapasco et al., 2007, Bianchi et al., 2008, Esposito et al., 2011, Jung et al., 2013, Ronda et al., 2014, Urban et al., 2014), of which 3 were randomized clinical trials (RCTs) (Fiorellini et al., 2005, Esposito et al., 2011, Ronda et al., 2014), 3 were case reports (Becker and Becker 1990, Nyman et al., 1990, Becker et al., 1994), and 1 was a case series (Urban et al., 2014). In addition, 13 articles were animal studies (Becker et al., 1990, Dahlin et al., 1990, Seibert and Nyman 1990, Schenk et al., 1994, Berglundh and Lindhe 1997, Caplanis et al., 1997, Hämmerle et al., 1997, Block et al., 1998, Cochran et al., 1999, von Arx et al., 2001, Jovanovic et al., 2007, Lee et al., 2009), and 2 were reviews (Esposito et al., 1998, McAllister and Haghighat 2007). Discussion The results showed a gradual increase in the number of publications and citations from 1995 to 2021. During these three decades, ARA techniques entered a period of rapid development. Supported by advances in biomaterials, regenerative concepts, and implant-driven treatment planning, ARA techniques have undergone rapid development in this period. Publication output remained at a high level between 2021 and 2024, which may reflect stabilization after this rapid development in the most recent years. Clinical Oral Implants Research, the International Journal of Oral & Maxillofacial Implants, the International Journal of Periodontics & Restorative Dentistry, and the Journal of Periodontology were regarded as the leading journals with the most publications and citations. Europe showed a clear leadership position in ARA when considering countries, institutions, and authors. In terms of national distribution, the USA and China contributed the highest numbers of publications. This finding was consistent with the previous results of a bibliometric analysis of periodontal regeneration (Hu et al., 2025). This result reflects the large number of universities, strong research infrastructure, and substantial academic resources in these countries. By contrast, the strength of Europe appears to lie in the broad and coordinated contributions of multiple countries. More than 20 countries in Europe have published over 20 related studies. In addition, several leading institutions, including the University of Bern, the University of Gothenburg, the University of Zurich, and the University of Milano, formed an active and collaborative research network, which was clearly presented in the institutional visualization map. The analysis of authors further supported this finding. Nine out of the top ten authors were from Europe, which further illustrates the dominant position of Europe in GBR. These results are consistent with the previously published bibliometric analysis of the top 100 articles on bone grafting and sinus lift, in which 62% of publications originated from Europe (Dos Anjos et al., 2023). In addition, the overlay maps indicated growing activity in developing regions, particularly in Asia and Africa, suggesting that the global research landscape of ARA is continuing to expand. Frequency and visualization analysis of keywords are considered useful not only for revealing the current research status in a specific domain, but also for understanding the historical development trajectory of a field and predicting future trends. According to our results, “guided bone regeneration,” “dental implants,” and “bone regeneration” were the top three terms, which is consistent with the results of the previous bibliometric analysis in 2023 (Dos Anjos et al., 2023). However, that study lacked an analysis of the timeline co-occurrence overlay visualization map. Beyond simple frequency counts, our analysis also highlighted the temporal evolution of keyword clusters. In the timeline keyword circle visualization map (Fig. 7B), “xenograft” was identified as the hottest keyword among grafting materials, in agreement with previous bibliometric evidence showing that 22% of studies used only xenogeneic grafts (5130 citations), followed by alloplastic grafts (3398 citations; 14% of total), autogenous grafts (2410 citations; 12% of total), and allogeneic grafts (2397 citations; 8% of total citations) (Dos Anjos et al., 2023). Of particular interest, the latest keywords, “3D printing,” “polycaprolactone,” and “electrospinning,” in our analysis were all strongly related to the membrane technique in GBR. These terms may be viewed as representing three complementary dimensions of membrane research: design, materials, and fabrication. These results are consistent with the bibliometric analysis of biomaterials for bone regeneration published in 2026, which indicated that newer advances, especially polycaprolactone (PCL), gained more interest, whereas traditional biomaterials and collagen membranes showed declining interest (Dadvand et al., 2026). Although resorbable collagen membranes remain the standard of care in many GBR procedures and generally provide bone regeneration outcomes comparable to those of non-resorbable membranes (Zitzmann et al., 1997, Hämmerle and Karring 1998), they also have recognized limitations, including loss of space-maintaining ability, rapid biodegradation, and limited osteogenic activity (Allan et al., 2021, Shiroud Heidari et al., 2024). To overcome these drawbacks, a synthetic resorbable membrane with desirable properties is needed as an alternative barrier membrane. PCL, a synthetic aliphatic polyester, exhibits remarkable advantages, including high biocompatibility, slow and controlled degradability, suitability as a drug and growth factor delivery system, and customizability for 3D printing (Gedik and Erdem 2025, Liu et al., 2025, Xie et al., 2025). Although most studies on these novel biomaterials remain preclinical, a controlled clinical study showed that one year after GBR, the PCL membrane achieved therapeutic effects comparable to those of the collagen membrane (Kusirisin et al., 2023). Electrospinning technology, with its ability to create fibers spanning the micron-to-nanometer range, has emerged as a highly promising fabrication strategy in bioengineering (Tardy et al., 2021). PCL-based electrospun nanofibers have attracted significant interest because of their excellent mechanical properties and highly adjustable three-dimensional porous structures that closely resemble the extracellular matrix (ECM). These characteristics make them particularly suitable as scaffolds for tissue engineering and regenerative medicine (Dutcher 2018). In addition, combinations of multiple emerging technologies have gained attention. Multilayer membrane techniques and functionalized membranes combined with antibacterial agents or growth factors have been reported in a growing number of studies (Gedik and Erdem 2025, Liu et al., 2025, Xie et al., 2025). Together, these developments suggest that GBR is moving toward intelligent, multifunctional, and patient-specific scaffolds with optimized structure, biological performance, and controlled release properties. Citation analysis provided a complementary perspective to the keyword analysis. According to the co-citation visualization maps, “Grafts” stood out as the largest cluster, highlighting the historical centrality of grafting materials in ARA research. However, the influence of this cluster has decreased over the past 15 years, while clusters including dental implants (#1), titanium mesh (#2), and tooth extraction (#5) have gained substantially more attention (Fig. 8B). It is worth noting that the sustained prominence of the tooth extraction cluster over the past two decades aligns with the emergence and development of ARP. In the 1990s, the concept of proactively preventing bone resorption rather than reconstructing bone defects later began to gain popularity. ARP was frequently mentioned and clearly defined in the literature of this period and has since developed into a key component of pre-implant alveolar bone management (Lekovic et al., 1997, Iasella et al., 2003). Among the top 30 references with bursts, two papers were related to ARP, and more recent randomized clinical trials and systematic reviews have further supported its effectiveness (Avila-Ortiz et al., 2019, Atieh et al., 2022). In contrast, techniques such as ADO reached their peak of attention around 1995 to 2003, and studies on ADO have declined substantially over the past 20 years. This interpretation is consistent with the keyword timeline circle map, in which ADO appeared at the end of the circle marked in light green (Fig. 7B). Conclusion This study provides a comprehensive bibliometric overview of ARA research published from 1990 to 2024 and outlines the major trends shaping the field. Publication output and citation activity increased steadily through 2021 and stabilized from 2021 to 2024. Europe showed a leadership position in this domain, while the United States made particularly strong contributions at the country, institutional, and author levels. GBR remains the most established and widely used surgical approach for ARA. Our analysis identified “3D printing” and “polycaprolactone” as the most prominent emerging keywords, and xenogeneic grafts as the most commonly used grafting materials. Overall, membrane techniques received the most attention. The application of 3D printing combined with PCL and electrospinning in GBR appears to represent the hottest current research trend in this domain. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 28 Apr, 2026 Reviews received at journal 27 Apr, 2026 Reviewers agreed at journal 23 Apr, 2026 Reviews received at journal 21 Apr, 2026 Reviewers agreed at journal 20 Apr, 2026 Reviewers invited by journal 15 Apr, 2026 Editor assigned by journal 05 Apr, 2026 Submission checks completed at journal 05 Apr, 2026 First submitted to journal 24 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9206753","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":627037670,"identity":"394cdebf-46d4-4deb-91fd-201d3121e988","order_by":0,"name":"Jingchao Hu","email":"","orcid":"","institution":"Beijing Stomatological Hospital, School of Stomatology, Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jingchao","middleName":"","lastName":"Hu","suffix":""},{"id":627037671,"identity":"65f82454-8988-49bb-9abe-8d412646b0dd","order_by":1,"name":"Li Zhao","email":"","orcid":"","institution":"Stomatological Hospital of Chongqing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Zhao","suffix":""},{"id":627037672,"identity":"c400698e-24d0-4f06-9d79-d56d61ed5e8c","order_by":2,"name":"Xu Liu","email":"","orcid":"","institution":"Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xu","middleName":"","lastName":"Liu","suffix":""},{"id":627037673,"identity":"e9c764ad-c90c-4637-adc2-1d70d6c4fdcf","order_by":3,"name":"Han Zhao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIie3RMQrCMBSA4RcCcXmDY0SoJxAeBBx7lgZBFwdHR4vQLtU5padwcTXi4OQB3Fo8gDmAoJ0Fadwc8s3vJ3kJQBD8o9HjXif0QpanaeP8moUgt+QRL84bJT0TGBjHVc/Msz563Wt9tQpJ6G3ZZCAhjsbrjoSlu+SOhLqsdFYvYaomtiPhHKg9Rep9pXOSYPWhKxECaIhE+ng7ZRJ9EkSkgaFEMcM8EynFjBzZiBW6fWTy2GVk+LlOnrb9ykvTuFUcdSYf6LfxIAiC4Is3TqFB7ch7r0gAAAAASUVORK5CYII=","orcid":"","institution":"Beijing Stomatological Hospital, School of Stomatology, Capital Medical University","correspondingAuthor":true,"prefix":"","firstName":"Han","middleName":"","lastName":"Zhao","suffix":""}],"badges":[],"createdAt":"2026-03-24 04:53:54","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9206753/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9206753/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107530381,"identity":"27c4af61-bd6c-4c6a-962a-248cc00102dd","added_by":"auto","created_at":"2026-04-22 10:22:51","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":133016,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of the article identification\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9206753/v1/31b9b5fe50d77df2186bad2e.png"},{"id":107705814,"identity":"fb4a3065-05a1-40cc-88df-dce3c339604b","added_by":"auto","created_at":"2026-04-24 09:15:23","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":167012,"visible":true,"origin":"","legend":"\u003cp\u003eAnalysis of main information of publications and publishing trends. A Main information of publications. B publication and citation records from 1990 to 2024.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9206753/v1/59df5bcbdea4478c037c189d.png"},{"id":107530382,"identity":"f4de090a-7509-43b6-a87e-92460ab6ee21","added_by":"auto","created_at":"2026-04-22 10:22:51","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":74635,"visible":true,"origin":"","legend":"\u003cp\u003eAnalysis of the journals with the highest number of publications and citations. Top 7 journal titles according to the publication records\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-9206753/v1/6a54de046f3ec13dc336ce11.png"},{"id":108490566,"identity":"e09a78f1-38c2-440c-83f2-049d769f5609","added_by":"auto","created_at":"2026-05-05 09:44:29","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":379744,"visible":true,"origin":"","legend":"\u003cp\u003eAnalysis of countries. A. The distribution of country records. The colours represent the publication volume; dark blue represents greater publication volume, and yellow represent lower publication volume. B. Overlay visualization map of the countries. The circle size represents the publication volume, the circle colour represents the average publication year, light green represents earlier publication, and red represents closer publication.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-9206753/v1/4083855b18a3e2c432d58543.png"},{"id":107530383,"identity":"43c495d8-d807-46ac-a2f5-6880e1812a54","added_by":"auto","created_at":"2026-04-22 10:22:51","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":305071,"visible":true,"origin":"","legend":"\u003cp\u003eAnalysis of Institution. A. Yearly number of publications of the top ten institutions. The colours represent different institutions. B. Overlay visualization map of the institutions. The node size signifies the number of publications, the lines connecting the circles represent the co-occurrence relationships between them, and the node colour signifies the average publication year. Blue represents earlier time, and red represents closer time.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-9206753/v1/a14d40c23b019fad1358ccc8.png"},{"id":108181078,"identity":"5a86a5e5-e6d3-45a3-9e33-9291ba750e15","added_by":"auto","created_at":"2026-04-30 08:57:02","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":152844,"visible":true,"origin":"","legend":"\u003cp\u003eAnalysis of authors. A. Information of the top then authors. D. Overlay visualization map of authors. The size of the circle denotes the frequency of authors, the lines connecting the circles represent the co-occurrence relationships between them, and the node colour signifies the average publication year. Blue represents earlier time, and red represents closer time.\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-9206753/v1/a5fcb7a101d0de4e63f5f5d3.png"},{"id":107530384,"identity":"8d651f64-0d8f-4ed3-af47-fcc02c84c52c","added_by":"auto","created_at":"2026-04-22 10:22:51","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":410380,"visible":true,"origin":"","legend":"\u003cp\u003eAnalysis of author keywords. A. The author keyword overlay visualization map. The size of the circle represents the frequency of keywords, the lines connecting the circles represent the co-occurrence relationships, and the node colour represents the average publication year. The colours from dark blue to red represent early to late stages, respectively. B. The cluster circle map. Five clusters are identified according to their color coding. C. The timeline circle map. The colours from red to light green represent closer time to earlier time, respectively.\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-9206753/v1/9495d8f64dcce1f90589589f.png"},{"id":107530386,"identity":"4ab32626-0f8a-4365-aa7b-258fbf37fd3c","added_by":"auto","created_at":"2026-04-22 10:22:51","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":533448,"visible":true,"origin":"","legend":"\u003cp\u003eCo-citation analysis.A. Network of the main co-citation clusters. B. Visualization map of the timeline. Each horizontal line identifies a cluster. The size of nodes along the lines is proportional to the number of references. The years at the top of the figure indicate the date of paper publication. The colours of nodes from purple to dark red represent early to recent literatures, respectively. Links connecting the circles indicate co-citations. C. Top 30 References with the strongest citation bursts. The blue line indicates the time span of 1990-2024. The red segment represents the period of burst. The selected duration was 8 years, references are arranged in order of publication date.\u003c/p\u003e","description":"","filename":"8.png","url":"https://assets-eu.researchsquare.com/files/rs-9206753/v1/bdc3b7cbb9d071394abc9fb4.png"},{"id":108494296,"identity":"597ab149-13c5-45f7-bb96-925a98b6953f","added_by":"auto","created_at":"2026-05-05 10:03:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2019967,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9206753/v1/cdc6160c-7b71-47dd-b962-e8cf5bb75b25.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Research interest and trends in alveolar ridge augmentation and evidence-based evaluation of articles: a bibliometric analysis","fulltext":[{"header":"Background","content":"\u003cp\u003eAlveolar ridge augmentation (ARA) refers to surgical procedures aimed at increasing the bone volume and dimensions of the atrophic alveolar ridge to facilitate dental implant placement (Urban et al., 2021). Clinically, ARA is performed to reconstruct horizontal, vertical, and combined 3D ridge deficiencies that compromise implant positioning and long-term prosthetic outcomes. As a result, it has become an essential component of pre-implant therapy in modern implant dentistry. A number of studies have demonstrated that ARA can improve implant stability, long-term success rates, and prosthodontic outcomes (Benic and H\u0026auml;mmerle 2014, Mardas et al., 2023, Urban et al., 2023).\u003c/p\u003e \u003cp\u003eA variety of procedures have been employed to maximize the effect of ARA. Alveolar ridge split expansion, alveolar distraction osteogenesis (ADO), guided bone regeneration (GBR), sinus floor augmentation, and alveolar ridge preservation (ARP) have often been used for ARA. Technological advancement of ARA has paralleled the rapid progress of bioengineering. With continued advances in biomaterials and digital technologies, these procedures have shown enhanced predictability and reduced complications (Tolstunov et al., 2019, Mardas et al., 2023).\u003c/p\u003e \u003cp\u003eThe evolution of ARA reflects a transition from empirical surgical techniques to evidence-based regenerative approaches, driven by the growing demand for predictable dental implant rehabilitation. Since the mid-20th century, autologous bone grafting has been regarded as the gold standard for the reconstruction of atrophic ridges. Early grafting procedures relied on intraoral and extraoral donor sites and provided favorable osteogenic potential, but they were also associated with donor-site morbidity, graft resorption, and technical complexity (Boyne and James 1980, Sakkas et al., 2017). Subsequently, the clinical potential of the membrane concept was recognized in periodontal regeneration. A paradigm shift occurred in the 1970s with the advent of membrane techniques, building on Melcher's pioneering work on tissue compartmentalization (Melcher 1976). In the 1980s and 1990s, Dahlin and colleagues established guided bone regeneration (GBR) as a biologically driven approach for promoting new bone formation around implants and within alveolar defects (Dahlin et al., 1989, Dahlin et al., 1990, Dahlin et al., 1991). Early GBR protocols relied primarily on non-resorbable expanded polytetrafluoroethylene membranes (ePTFE) to exclude soft tissue invasion, thereby allowing selective repopulation by osteogenic cells and greatly enhancing bone healing without interference (Dahlin et al., 1989). Later developments introduced resorbable collagen membranes (e.g., Bio-Gide\u0026reg;) and a broad range of bone substitutes, thereby simplifying procedures while maintaining efficacy (Zitzmann et al., 1997). Grafting materials such as xenografts (deproteinized bovine bone mineral, DBBM) and synthetic materials (biphasic calcium phosphate, BCP; β-tricalcium phosphate, β-TCP) became increasingly important alternatives to autogenous bone grafts (H\u0026auml;mmerle et al., 1998). The bibliometric analysis published in 2023 demonstrated that xenograft materials for horizontal and/or vertical ridge augmentation were the most prominent (Dos Anjos et al., 2023).\u003c/p\u003e \u003cp\u003eThe 21st century ushered in biologic enhancements and digital innovations. Growth factors, such as recombinant human bone morphogenetic protein-2 (rhBMP-2) and platelet-rich fibrin (PRF), have been reported to exhibit potent osteoinductive capabilities and regenerative potential (Boyne et al., 2005, Al-Maawi et al., 2021, Tavelli et al., 2021). During the same period, digital workflows incorporating cone-beam computed tomography (CBCT) and 3D printing enabled more precise defect assessment and increasingly patient-specific treatment planning (Lizio et al., 2022). With the recent emphasis on minimally invasive and personalized approaches, 3D-printed and customized scaffolds have expanded the therapeutic possibilities for severe alveolar defects (El Morsy et al., 2020, Chiapasco et al., 2021). Recently, ARA procedures have integrated multidisciplinary strategies. Hybrid techniques for 3D reconstruction (e.g., the \"shell technique\") have pushed the boundaries of predictability (Shaker et al., 2024, Saveinai et al., 2025). From its early developmental stages to the current era of precision medicine and personalized regenerative strategies, ARA exemplifies the synergy between surgical ingenuity and regenerative science.\u003c/p\u003e \u003cp\u003eIn addition to the continuous innovation of biomaterials, the technical philosophy of ARA has also evolved significantly. The concept of socket preservation has gained increasing attention. Studies demonstrated that immediate alveolar ridge preservation (ARP) following tooth extraction can effectively reduce bone resorption (Cardaropoli et al., 2003). The therapeutic approaches for ARA have therefore become increasingly diversified.\u003c/p\u003e \u003cp\u003eGiven the diversity of surgical techniques and biomaterials in ARA, it is necessary and valuable to assess and summarize previous high-quality articles. Numerous studies have discussed the grafting materials and procedures used in ARA, yet relatively few bibliometric analyses have mapped this field as a whole. Existing bibliometric analyses have focused on narrower topics. The bibliometric study published in 2023 analyzed the 100 most-cited articles on bone grafting in dentistry (Dos Anjos et al., 2023). In addition, Dadvand et al. analyzed trends in biomaterials for bone regeneration in 2026 (Dadvand et al., 2026). However, there is still a lack of a field-wide evaluation of ARA.\u003c/p\u003e \u003cp\u003eThe aim of this study was to analyze the literature related to ARA between 1990 and 2024, to describe the development and evolution of ARA techniques and related biomaterials, and to characterize the most influential research and top-trending keywords, with the hope of offering valuable insights for clinicians.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData source and search strategy\u003c/h2\u003e \u003cp\u003eAn electronic search was performed based on the Science Citation Index Expanded (SCIE) of the Web of Science (WoS) Core Collection from 01.01.1990 to 31.12.2024; the search date was 24 April 2025. Title search (TI), abstract search (AB), and author keyword search (AK) were used simultaneously, and the complete search strategy is shown in Supplemental Material 1. Publications in English were selected. The publication types were limited to articles and reviews. The export type was \u0026ldquo;Plain Text File\u0026rdquo;, and the export content was \u0026ldquo;Full Record and Cited References\u0026rdquo;. Details of each publication, including the title, year of publication, authors\u0026rsquo; names, nationality, institutions, journal name, keywords, abstract, and citation information (average citations per item, H-index, and total citation count), were obtained from the WoS analysis results and WoS citation reports. The electronic search and article download were conducted and completed within one day to avoid the impact of time-related database updates. For the present bibliometric analysis, only studies or reviews reporting on alveolar ridge augmentation before implantation, as well as alveolar bone repair in conjunction with implant placement, were included. Therefore, the topic of peri-implantitis was not considered in this bibliometric study. In addition, topics such as alveolar cleft, cranial surgery, and apicectomy, which were unrelated to the ARA process before implantation, were excluded. The flowchart of article selection is shown in Fig.\u0026nbsp;1.\u003c/p\u003e \u003cp\u003eVOSviewer (version 1.6.15) was used to establish network visualization maps of countries, institutions, authors, and their collaborations, as well as the keyword co-occurrence visualization map. In the software, \"full counting\" was selected as the counting method. The minimum threshold for national cooperation was set at 10, that for institutional cooperation at 15, that for author cooperation at 10, and that for author keyword co-occurrence at 30. In the VOSviewer network visualization map, the circle denotes the occurrence subject, the size of the circle represents the frequency of occurrence, the lines connecting the circles represent the co-occurrence relationships between them, and the node color signifies the average publication year. Synonyms in the analysis were manually merged.\u003c/p\u003e \u003cp\u003eThe bibliometrix package (version 4.2) in R (version 4.2.1) was used to calculate the specific data, including journals of published articles, authors, author influence, and publication timelines, and to generate yearly occurrence data for journals, countries, institutions, authors, and author keywords.\u003c/p\u003e \u003cp\u003eCiteSpace (version 6.3.R3 Advanced) was used for burstiness analysis and cluster analysis. A burst is a symbol reflecting the importance of the literature (Kleinberg 2002), especially during a specific period. The beginning of the blue line indicates the publication of an article. The beginning of a red segment represents the start of a citation burst period, and the end of the red segment represents the end of that period. The selected duration was eight years. For clustering, the algorithm used was the G-index. The quality of clustering information was determined by the silhouette value and modularity value (Rousseeuw 1987, Newman 2006).\u003c/p\u003e \u003cp\u003eVisualization software:\u003c/p\u003e \u003cp\u003eScimago Graphica (1.0.41) was used for visualization processing. Adobe Illustrator (2003) was used for the preliminary visualization of data related to national publications and national cooperation, as well as for refining data details.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eAmount and publishing trends of global publications\u003c/h2\u003e\n \u003cp\u003eFrom 1990 to 2024, a total of 4487 articles related to ARA were published, consisting of 4092 research articles and 395 review articles. These publications involved 13,796 authors in this field, including 99 individual authors, with an average of 5.48 co-authors per article and an international co-authorship rate of 28.5%. Additionally, there were 5935 author keywords and 74,489 references, with an average of 30.37 citations per document. The number of published articles gradually increased at an annual growth rate of 3.64% (Fig.\u0026nbsp;2A). Correspondingly, the number of citations has steadily increased since 1990. A notable upward curve was observed from 2018 to 2021, indicating a significant increase in citation numbers; the trend remained stable from 2021 to 2024 and peaked in 2023 (Fig.\u0026nbsp;2B). In terms of publication count, Clinical Oral Implants Research (Impact Factor, IF\u0026thinsp;=\u0026thinsp;5.5) published the greatest number of papers. The International Journal of Oral \u0026amp; Maxillofacial Implants (IF\u0026thinsp;=\u0026thinsp;2.2) and the International Journal of Periodontics \u0026amp; Restorative Dentistry (IF\u0026thinsp;=\u0026thinsp;1.5) ranked second and third, respectively. The 4th to 7th journals were the Journal of Periodontology (IF\u0026thinsp;=\u0026thinsp;4.3), Clinical Implant Dentistry and Related Research (IF\u0026thinsp;=\u0026thinsp;4.3), Journal of Oral and Maxillofacial Surgery (IF\u0026thinsp;=\u0026thinsp;2.3), and International Journal of Oral and Maxillofacial Surgery (IF\u0026thinsp;=\u0026thinsp;2.7) (Fig.\u0026nbsp;3).\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eContinents and Countries\u003c/h3\u003e\n\u003cp\u003eEurope was the main source of publications, and more than 20 countries published more than 20 papers (Fig.\u0026nbsp;4A). The top ten contributing countries included five countries from Europe: Italy, Germany, Switzerland, Sweden, and Spain. The other five were the United States of America (USA) in North America, Brazil in South America, and China, Japan, and South Korea in Asia. The United States ranked first with 1000 publications, followed by China with 663 papers and Italy with 516 papers (Fig.\u0026nbsp;4B). Furthermore, according to the visualization map, Europe could be considered the core and has established cooperation with countries worldwild. In addition, China, Egypt, Yemen, Chile, and Croatia presented an orange node color, indicating a noteworthy increase in publication numbers in recent years (Fig.\u0026nbsp;4B).\u003c/p\u003e\n\u003ch3\u003eInstitutions\u003c/h3\u003e\n\u003cp\u003eAmong the top ten institutions with the highest number of publications, two were from Switzerland, two from the USA, and the other six were from Sweden, Italy, China, South Korea, Israel, and Brazil, respectively (Fig.\u0026nbsp;5A). The University of Bern in Switzerland and the University of Michigan in the United States ranked first and second with 151 and 150 publications, respectively, followed by the University of Gothenburg, the University of Zurich, Sichuan University, and the University of Milano. The top six universities published more than 100 papers in this area.\u003c/p\u003e\n\u003cp\u003eThe visualization map revealed that institutions from China, such as Sichuan University, Peking University, Chongqing Medical University, and Sun Yat-sen University, formed the China institutional cooperation network, represented by red circles, which indicated an active research status in the last five years (Fig.\u0026nbsp;5B). In addition, the University of Michigan and the University of Bern served as centers, while the University of Zurich, the University of Milano, the University of Gothenburg, New York University, and International University of Catalonia from served as hubs, forming an extensive collaborative network with research institutions globally (Fig.\u0026nbsp;5B).\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eAuthors\u003c/h2\u003e\n \u003cp\u003eIn terms of the top ten authors, nine were from Europe and only one was from the USA (Fig.\u0026nbsp;6A). Wang, Hom-Lay, from the University of Michigan in the USA, ranked first with 95 publications. Jung, Ronald E., and Buser, Daniel, from the University of Zurich and the University of Bern in Switzerland, ranked second and third with 46 and 45 papers, respectively. However, in terms of citations, Buser, Daniel ranked first with 4327, followed by Esposito, Marco, with 3562, while Wang, Hom-Lay ranked third with 3313. The visualization map showed that the co-author networks were consistent with the institutional networks. According to the color coding, Barbeck Mike and Jung Ole at the University Medical Center Rostock in Germany, Windisch Peter at Semmelweis University in Hungary, and Cha Jae-kook at Yonsei University College of Dentistry in Korea have been particularly productive in recent years (Fig.\u0026nbsp;6B).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eKeywords\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eA total of 66 author keywords were identified based on the statistical threshold for co-occurrences. According to total link strength (TLS), \u0026ldquo;guided bone regeneration,\u0026rdquo; \u0026ldquo;dental implants,\u0026rdquo; and \u0026ldquo;bone regeneration\u0026rdquo; were the top three keywords, with TLS values of 1489, 1486, and 959, respectively (Suppl. 2).\u003c/p\u003e\n \u003cp\u003eMoreover, 5 clusters were identified (Fig.\u0026nbsp;7B), including three large clusters and two small ones. The first cluster was marked in green and included 23 author keywords represented by \u0026ldquo;dental implants.\u0026rdquo; Author keywords with strong TLS, such as \u0026ldquo;bone augmentation\u0026rdquo; and \u0026ldquo;bone grafting,\u0026rdquo; as well as a series of keywords related to bone grafts and sinus augmentation, were grouped in this cluster. The second cluster included 21 keywords represented by \u0026ldquo;guided bone regeneration\u0026rdquo; and \u0026ldquo;bone regeneration.\u0026rdquo; In addition, the latest hotspot keywords, \u0026ldquo;3D printing,\u0026rdquo; \u0026ldquo;polycaprolactone,\u0026rdquo; and \u0026ldquo;electrospinning,\u0026rdquo; were included in this cluster. Cutting-edge technologies and biomaterials were mainly covered in this cluster. The third cluster included 16 keywords, with \u0026ldquo;alveolar ridge augmentation,\u0026rdquo; \u0026ldquo;bone substitute,\u0026rdquo; \u0026ldquo;CBCT,\u0026rdquo; and \u0026ldquo;tooth extraction\u0026rdquo; being representative terms. The fourth and fifth clusters each contained 3 keywords, including \u0026ldquo;collagen membrane,\u0026rdquo; \u0026ldquo;bone defects,\u0026rdquo; and \u0026ldquo;animal studies,\u0026rdquo; and \u0026ldquo;ridge augmentation,\u0026rdquo; \u0026ldquo;ridge preservation,\u0026rdquo; and \u0026ldquo;socket preservation,\u0026rdquo; respectively.\u003c/p\u003e\n \u003cp\u003eAccording to the timeline circular overlay visualization map, red denotes the most recent keywords, whereas green signifies the earliest keywords from 1990. Among the top 66 author keywords, two keywords were marked in red: \u0026ldquo;3D printing\u0026rdquo; and \u0026ldquo;polycaprolactone,\u0026rdquo; and the top ten keywords included \u0026ldquo;alveolar ridge preservation,\u0026rdquo; \u0026ldquo;alveolar bone grafting,\u0026rdquo; \u0026ldquo;CBCT,\u0026rdquo; \u0026ldquo;electrospinning,\u0026rdquo; \u0026ldquo;bone tissue engineering,\u0026rdquo; \u0026ldquo;xenograft,\u0026rdquo; \u0026ldquo;sinus floor augmentation,\u0026rdquo; and \u0026ldquo;vertical bone augmentation\u0026rdquo; (Fig.\u0026nbsp;7C).\u003c/p\u003e\n \u003ch2\u003eCitations\u003c/h2\u003e\n \u003cp\u003eReferences were clustered using CiteSpace, and a total of 16 clusters were obtained (Fig. 8A), including grafts (#0), dental implants (#1), titanium mesh (#2), guided bone regeneration (#3), animal study (#4), tooth extraction (#5), cross-linking (#6), distraction osteogenesis (#7), hydroxyapatite (#8), bone morphogenetic protein (#9), maxilla (#10), short implants (#11), mandibular defect (#12), human bone-derived cells (#13), polycaprolactone (#15), and clinical trials (#17). Grafts (#0) stood out as the largest cluster. Based on the timeline visualization map, we could unveil the evolution of treatments and research in a certain domain.\u0026nbsp;According to the timeline view of co-citation clustering, grafts (#0) received sustained attention over a long period, spanning from 1985 to 2005 (Fig. 8B). From 2000 to 2020, guided bone regeneration (#3), animal study (#4), cross-linking (#6), bone morphogenetic protein (#9), short implants (#11), and polycaprolactone (#15) received more attention. In recent years, dental implants (#1), titanium mesh (#2), and tooth extraction (#5) have stood out and gained substantial attention from 2015 to 2024 (Fig. 8B).\u003cbr\u003eThe CiteSpace results showed that 30 articles presented citation bursts (Fig. 8C). The list of these 30 papers is provided in Supplemental Material 3. The paper with the strongest burst was a review published in 2007, \u0026ldquo;Bone Augmentation Techniques\u0026rdquo; (McAllister and Haghighat 2007). Among the top 30 articles, 15 were clinically related (Adell et al., 1990, Becker and Becker 1990, Nyman et al., 1990, Becker et al., 1994, Simion et al., 1994, Buser et al., 1995, H\u0026auml;mmerle et al., 1996, Anitua 1999, Fiorellini et al., 2005, Chiapasco et al., 2007, Bianchi et al., 2008, Esposito et al., 2011, Jung et al., 2013, Ronda et al., 2014, Urban et al., 2014), of which 3 were randomized clinical trials (RCTs) (Fiorellini et al., 2005, Esposito et al., 2011, Ronda et al., 2014), 3 were case reports (Becker and Becker 1990, Nyman et al., 1990, Becker et al., 1994) , and 1 was a case series (Urban et al., 2014). In addition, 13 articles were animal studies (Becker et al., 1990, Dahlin et al., 1990, Seibert and Nyman 1990, Schenk et al., 1994, Berglundh and Lindhe 1997, Caplanis et al., 1997, H\u0026auml;mmerle et al., 1997, Block et al., 1998, Cochran et al., 1999, von Arx et al., 2001, Jovanovic et al., 2007, Lee et al., 2009), and 2 were reviews (Esposito et al., 1998, McAllister and Haghighat 2007).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe results showed a gradual increase in the number of publications and citations from 1995 to 2021. During these three decades, ARA techniques entered a period of rapid development. Supported by advances in biomaterials, regenerative concepts, and implant-driven treatment planning, ARA techniques have undergone rapid development in this period. Publication output remained at a high level between 2021 and 2024, which may reflect stabilization after this rapid development in the most recent years. Clinical Oral Implants Research, the International Journal of Oral \u0026amp; Maxillofacial Implants, the International Journal of Periodontics \u0026amp; Restorative Dentistry, and the Journal of Periodontology were regarded as the leading journals with the most publications and citations.\u003c/p\u003e\n\u003cp\u003eEurope showed a clear leadership position in ARA when considering\u0026nbsp;countries, institutions, and authors. In terms of national distribution, the USA\u0026nbsp;and China contributed the highest numbers of publications. This finding was consistent with the previous results of a bibliometric analysis of periodontal regeneration\u0026nbsp;(Hu et al., 2025). This result reflects the large number of universities, strong research infrastructure, and substantial academic resources in these countries. By contrast, the strength of Europe appears to lie in the broad and coordinated contributions of multiple countries. More than 20 countries in Europe\u0026nbsp;have published over 20 related studies. In addition, several leading institutions, including the University of Bern, the University of Gothenburg, the University of Zurich, and the University of Milano, formed an active and collaborative research network, which was clearly presented in the institutional visualization map. The analysis of authors further supported this finding. Nine out of the top ten authors were from Europe, which further illustrates the dominant position of Europe in GBR. These results are consistent with the previously published bibliometric analysis of the top 100 articles on bone grafting and sinus lift, in which 62% of publications originated from Europe (Dos Anjos et al., 2023). In addition, the overlay maps indicated growing activity in developing regions, particularly in Asia and Africa, suggesting that the global research landscape of ARA is continuing to expand.\u003c/p\u003e\n\u003cp\u003eFrequency and visualization analysis of keywords are considered useful not only for revealing the current research status in a specific domain, but also for understanding the historical development trajectory of a field and predicting future trends. According to our results, “guided bone regeneration,” “dental implants,” and “bone regeneration” were the top three terms, which is consistent with the results of the previous\u0026nbsp;bibliometric analysis in 2023 (Dos Anjos et al., 2023). However, that study lacked an analysis of the timeline co-occurrence overlay visualization map. Beyond simple frequency counts, our analysis also highlighted the temporal evolution of keyword clusters. In the timeline keyword circle visualization map (Fig. 7B), “xenograft” was identified as the hottest keyword among grafting materials, in agreement with previous bibliometric evidence showing that 22% of studies used only xenogeneic grafts (5130 citations), followed by alloplastic grafts (3398 citations; 14% of total), autogenous grafts (2410 citations; 12% of total), and allogeneic grafts (2397 citations; 8% of total citations) (Dos Anjos et al., 2023). Of particular interest, the latest keywords, “3D printing,” “polycaprolactone,” and “electrospinning,” in our analysis were all strongly related to the membrane technique in GBR. These terms may be viewed as representing three complementary dimensions of membrane research: design, materials, and fabrication. These results are consistent with the bibliometric analysis of biomaterials for bone regeneration published in 2026, which indicated that newer advances, especially polycaprolactone\u0026nbsp;(PCL), gained more interest, whereas traditional biomaterials and collagen membranes showed declining interest (Dadvand et al., 2026). Although resorbable collagen membranes remain the standard of care in many GBR procedures and generally provide bone regeneration outcomes comparable to those of non-resorbable membranes (Zitzmann et al., 1997, Hämmerle and Karring 1998), they also have recognized limitations, including loss of space-maintaining ability, rapid biodegradation, and limited osteogenic activity (Allan et al., 2021, Shiroud Heidari et al., 2024). To overcome these drawbacks, a synthetic resorbable membrane with desirable properties is needed as an alternative barrier membrane. PCL, a synthetic aliphatic polyester, exhibits remarkable advantages, including high biocompatibility, slow and controlled degradability, suitability as a drug and growth factor delivery system, and customizability for 3D printing (Gedik and Erdem 2025, Liu et al., 2025, Xie et al., 2025). Although most studies on these novel biomaterials remain preclinical, a controlled clinical study showed that one year after GBR, the PCL membrane achieved therapeutic effects comparable to those of the collagen membrane (Kusirisin et al., 2023).\u003c/p\u003e\n\u003cp\u003eElectrospinning technology, with its ability to create fibers spanning the micron-to-nanometer range, has emerged as a highly promising fabrication strategy in bioengineering (Tardy et al., 2021). PCL-based electrospun nanofibers have attracted significant interest because of their excellent mechanical properties and highly adjustable three-dimensional porous structures that closely resemble the extracellular matrix (ECM). These characteristics make them particularly suitable as scaffolds for tissue engineering and regenerative medicine (Dutcher 2018). In addition, combinations of multiple emerging technologies have gained attention. Multilayer membrane techniques and functionalized membranes combined with antibacterial agents or growth factors have been reported in a growing number of studies (Gedik and Erdem 2025, Liu et al., 2025, Xie et al., 2025). Together, these developments suggest that GBR is moving toward intelligent, multifunctional, and patient-specific scaffolds with optimized structure, biological performance, and controlled release properties.\u003c/p\u003e\n\u003cp\u003eCitation analysis provided a complementary perspective to the keyword analysis. According to the co-citation visualization maps, “Grafts” stood out as the largest cluster, highlighting the historical centrality of grafting materials in ARA research. However, the influence of this cluster has decreased over the past 15 years, while clusters including dental implants (#1), titanium mesh (#2), and tooth extraction (#5) have gained substantially more attention (Fig. 8B). It is worth noting that the sustained prominence of the tooth extraction cluster over the past two decades aligns with the emergence and development of ARP. In the 1990s, the concept of proactively preventing bone resorption rather than reconstructing bone defects later began to gain popularity. ARP was frequently mentioned and clearly defined in the literature of this period and has since developed into a key component of pre-implant alveolar bone management (Lekovic et al., 1997, Iasella et al., 2003). Among the top 30 references with bursts, two papers were related to ARP, and more recent randomized clinical trials and systematic reviews have further supported its effectiveness (Avila-Ortiz et al., 2019, Atieh et al., 2022). In contrast, techniques such as ADO reached their peak of attention around 1995 to 2003, and studies on ADO have declined substantially over the past 20 years. This interpretation is consistent with the keyword timeline circle map, in which ADO appeared at the end of the circle marked in light green (Fig. 7B).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides a comprehensive bibliometric overview of ARA research published from 1990 to 2024 and outlines the major trends shaping the field. Publication output and citation activity increased steadily through 2021 and stabilized from 2021 to 2024. Europe showed a leadership position in this domain, while the United States made particularly strong contributions at the country, institutional, and author levels. GBR remains the most established and widely used surgical approach for ARA. Our analysis identified “3D printing” and “polycaprolactone” as the most prominent emerging keywords, and xenogeneic grafts as the most commonly used grafting materials. Overall, membrane techniques received the most attention. The application of 3D printing combined with PCL and electrospinning in GBR appears to represent the hottest current research trend in this domain.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eARA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ealveolar ridge augmentation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGBR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eguided bone regeneration\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePCL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003epolycaprolactone\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eADO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ealveolar distraction osteogenesis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eARP༚alveolar ridge preservation༛ePTFE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003epolytetrafluoroethylene membranes\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDBBM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003edeproteinized bovine bone mineral\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBCP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ebiphasic calcium phosphate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eβ-TCP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eβ-tricalcium phosphate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSCIE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eScience Citation Index-Expanded\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWoS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWeb of Science\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003etitle search\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAK\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eauthor keyword search\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eimpact factor\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRCTs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003erandomized controlled trials. Impact Factor, IF\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUSA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUnited States of America\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eECM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eextracellular matrix\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNo funding was received for this study.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eA: conceptualization, data review, draft preparation and critical revisionB: strategy design, data collection, data acquisition, investigating and manuscript revisionC: Software, Data curation, data collection, programming, visualization, formal analysisD: conceptualization and design, data acquisition, draft preparation，investigating, writing--original manuscript\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eReferences were clustered using CiteSpace, and a total of 16 clusters were obtained (Fig. 8A), including grafts (#0), dental implants (#1), titanium mesh (#2), guided bone regeneration (#3), animal study (#4), tooth extraction (#5), cross-linking (#6), distraction osteogenesis (#7), hydroxyapatite (#8), bone morphogenetic protein (#9), maxilla (#10), short implants (#11), mandibular defect (#12), human bone-derived cells (#13), polycaprolactone (#15), and clinical trials (#17). Grafts (#0) stood out as the largest cluster. Based on the timeline visualization map, we could unveil the evolution of treatments and research in a certain domain. According to the timeline view of co-citation clustering, grafts (#0) received sustained attention over a long period, spanning from 1985 to 2005 (Fig. 8B). From 2000 to 2020, guided bone regeneration (#3), animal study (#4), cross-linking (#6), bone morphogenetic protein (#9), short implants (#11), and polycaprolactone (#15) received more attention. In recent years, dental implants (#1), titanium mesh (#2), and tooth extraction (#5) have stood out and gained substantial attention from 2015 to 2024 (Fig. 8B). The CiteSpace results showed that 30 articles presented citation bursts (Fig. 8C). The list of these 30 papers is provided in Supplemental Material 3. The paper with the strongest burst was a review published in 2007, \u0026ldquo;Bone Augmentation Techniques\u0026rdquo; (McAllister and Haghighat 2007). Among the top 30 articles, 15 were clinically related (Adell et al., 1990, Becker and Becker 1990, Nyman et al., 1990, Becker et al., 1994, Simion et al., 1994, Buser et al., 1995, H\u0026auml;mmerle et al., 1996, Anitua 1999, Fiorellini et al., 2005, Chiapasco et al., 2007, Bianchi et al., 2008, Esposito et al., 2011, Jung et al., 2013, Ronda et al., 2014, Urban et al., 2014), of which 3 were randomized clinical trials (RCTs) (Fiorellini et al., 2005, Esposito et al., 2011, Ronda et al., 2014), 3 were case reports (Becker and Becker 1990, Nyman et al., 1990, Becker et al., 1994), and 1 was a case series (Urban et al., 2014). In addition, 13 articles were animal studies (Becker et al., 1990, Dahlin et al., 1990, Seibert and Nyman 1990, Schenk et al., 1994, Berglundh and Lindhe 1997, Caplanis et al., 1997, H\u0026auml;mmerle et al., 1997, Block et al., 1998, Cochran et al., 1999, von Arx et al., 2001, Jovanovic et al., 2007, Lee et al., 2009), and 2 were reviews (Esposito et al., 1998, McAllister and Haghighat 2007).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDiscussion\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe results showed a gradual increase in the number of publications and citations from 1995 to 2021. During these three decades, ARA techniques entered a period of rapid development. Supported by advances in biomaterials, regenerative concepts, and implant-driven treatment planning, ARA techniques have undergone rapid development in this period. Publication output remained at a high level between 2021 and 2024, which may reflect stabilization after this rapid development in the most recent years. Clinical Oral Implants Research, the International Journal of Oral \u0026amp; Maxillofacial Implants, the International Journal of Periodontics \u0026amp; Restorative Dentistry, and the Journal of Periodontology were regarded as the leading journals with the most publications and citations.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEurope showed a clear leadership position in ARA when considering countries, institutions, and authors. In terms of national distribution, the USA and China contributed the highest numbers of publications. This finding was consistent with the previous results of a bibliometric analysis of periodontal regeneration (Hu et al., 2025). This result reflects the large number of universities, strong research infrastructure, and substantial academic resources in these countries. By contrast, the strength of Europe appears to lie in the broad and coordinated contributions of multiple countries. More than 20 countries in Europe have published over 20 related studies. In addition, several leading institutions, including the University of Bern, the University of Gothenburg, the University of Zurich, and the University of Milano, formed an active and collaborative research network, which was clearly presented in the institutional visualization map. The analysis of authors further supported this finding. Nine out of the top ten authors were from Europe, which further illustrates the dominant position of Europe in GBR. These results are consistent with the previously published bibliometric analysis of the top 100 articles on bone grafting and sinus lift, in which 62% of publications originated from Europe (Dos Anjos et al., 2023). In addition, the overlay maps indicated growing activity in developing regions, particularly in Asia and Africa, suggesting that the global research landscape of ARA is continuing to expand.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFrequency and visualization analysis of keywords are considered useful not only for revealing the current research status in a specific domain, but also for understanding the historical development trajectory of a field and predicting future trends. According to our results, \u0026ldquo;guided bone regeneration,\u0026rdquo; \u0026ldquo;dental implants,\u0026rdquo; and \u0026ldquo;bone regeneration\u0026rdquo; were the top three terms, which is consistent with the results of the previous bibliometric analysis in 2023 (Dos Anjos et al., 2023). However, that study lacked an analysis of the timeline co-occurrence overlay visualization map. Beyond simple frequency counts, our analysis also highlighted the temporal evolution of keyword clusters. In the timeline keyword circle visualization map (Fig. 7B), \u0026ldquo;xenograft\u0026rdquo; was identified as the hottest keyword among grafting materials, in agreement with previous bibliometric evidence showing that 22% of studies used only xenogeneic grafts (5130 citations), followed by alloplastic grafts (3398 citations; 14% of total), autogenous grafts (2410 citations; 12% of total), and allogeneic grafts (2397 citations; 8% of total citations) (Dos Anjos et al., 2023). Of particular interest, the latest keywords, \u0026ldquo;3D printing,\u0026rdquo; \u0026ldquo;polycaprolactone,\u0026rdquo; and \u0026ldquo;electrospinning,\u0026rdquo; in our analysis were all strongly related to the membrane technique in GBR. These terms may be viewed as representing three complementary dimensions of membrane research: design, materials, and fabrication. These results are consistent with the bibliometric analysis of biomaterials for bone regeneration published in 2026, which indicated that newer advances, especially polycaprolactone (PCL), gained more interest, whereas traditional biomaterials and collagen membranes showed declining interest (Dadvand et al., 2026). Although resorbable collagen membranes remain the standard of care in many GBR procedures and generally provide bone regeneration outcomes comparable to those of non-resorbable membranes (Zitzmann et al., 1997, H\u0026auml;mmerle and Karring 1998), they also have recognized limitations, including loss of space-maintaining ability, rapid biodegradation, and limited osteogenic activity (Allan et al., 2021, Shiroud Heidari et al., 2024). To overcome these drawbacks, a synthetic resorbable membrane with desirable properties is needed as an alternative barrier membrane. PCL, a synthetic aliphatic polyester, exhibits remarkable advantages, including high biocompatibility, slow and controlled degradability, suitability as a drug and growth factor delivery system, and customizability for 3D printing (Gedik and Erdem 2025, Liu et al., 2025, Xie et al., 2025). Although most studies on these novel biomaterials remain preclinical, a controlled clinical study showed that one year after GBR, the PCL membrane achieved therapeutic effects comparable to those of the collagen membrane (Kusirisin et al., 2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElectrospinning technology, with its ability to create fibers spanning the micron-to-nanometer range, has emerged as a highly promising fabrication strategy in bioengineering (Tardy et al., 2021). PCL-based electrospun nanofibers have attracted significant interest because of their excellent mechanical properties and highly adjustable three-dimensional porous structures that closely resemble the extracellular matrix (ECM). These characteristics make them particularly suitable as scaffolds for tissue engineering and regenerative medicine (Dutcher 2018). In addition, combinations of multiple emerging technologies have gained attention. Multilayer membrane techniques and functionalized membranes combined with antibacterial agents or growth factors have been reported in a growing number of studies (Gedik and Erdem 2025, Liu et al., 2025, Xie et al., 2025). Together, these developments suggest that GBR is moving toward intelligent, multifunctional, and patient-specific scaffolds with optimized structure, biological performance, and controlled release properties.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCitation analysis provided a complementary perspective to the keyword analysis. According to the co-citation visualization maps, \u0026ldquo;Grafts\u0026rdquo; stood out as the largest cluster, highlighting the historical centrality of grafting materials in ARA research. However, the influence of this cluster has decreased over the past 15 years, while clusters including dental implants (#1), titanium mesh (#2), and tooth extraction (#5) have gained substantially more attention (Fig. 8B). It is worth noting that the sustained prominence of the tooth extraction cluster over the past two decades aligns with the emergence and development of ARP. In the 1990s, the concept of proactively preventing bone resorption rather than reconstructing bone defects later began to gain popularity. ARP was frequently mentioned and clearly defined in the literature of this period and has since developed into a key component of pre-implant alveolar bone management (Lekovic et al., 1997, Iasella et al., 2003). Among the top 30 references with bursts, two papers were related to ARP, and more recent randomized clinical trials and systematic reviews have further supported its effectiveness (Avila-Ortiz et al., 2019, Atieh et al., 2022). In contrast, techniques such as ADO reached their peak of attention around 1995 to 2003, and studies on ADO have declined substantially over the past 20 years. This interpretation is consistent with the keyword timeline circle map, in which ADO appeared at the end of the circle marked in light green (Fig. 7B).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eConclusion\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThis study provides a comprehensive bibliometric overview of ARA research published from 1990 to 2024 and outlines the major trends shaping the field. Publication output and citation activity increased steadily through 2021 and stabilized from 2021 to 2024. Europe showed a leadership position in this domain, while the United States made particularly strong contributions at the country, institutional, and author levels. GBR remains the most established and widely used surgical approach for ARA. Our analysis identified \u0026ldquo;3D printing\u0026rdquo; and \u0026ldquo;polycaprolactone\u0026rdquo; as the most prominent emerging keywords, and xenogeneic grafts as the most commonly used grafting materials. Overall, membrane techniques received the most attention. The application of 3D printing combined with PCL and electrospinning in GBR appears to represent the hottest current research trend in this domain.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":false,"email":"","identity":"the-saudi-dental-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"","title":"The Saudi Dental Journal","twitterHandle":"","acdcEnabled":false,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"VoR Journals","inReviewEnabled":false,"inReviewRevisionsEnabled":false},"keywords":"Bibliometrics, alveolar ridge augmentation, mapping, guided bone regeneration","lastPublishedDoi":"10.21203/rs.3.rs-9206753/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9206753/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eThe aim of this bibliometric analysis was to illustrate research interest and trends in the field of alveolar ridge augmentation (ARA) between 1990 and 2024.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA database search was performed in the Web of Science Core Collection to retrieve relevant research published from 1990 to 2024. Bibliometric and statistical network analyses were conducted using R language, CiteSpace, and VOSviewer. Scientific maps were then constructed for journals, countries, institutions, authors, keywords, and citations, respectively.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 4487 papers were published from 1990 to 2024. Both annual publication output and citations exhibited sustained growth until 2021, followed by stabilization from 2021 to 2024. The journal with the most publications and citations was Clinical Oral Implants Research. At the country level, the United States ranked first with 1000 publications, while Europe was the most productive continent. Sixty-six high-frequency keywords were selected, among which 3D printing and polycaprolactone (PCL) emerged as the most recent high-frequency keywords. Thirty papers with the strongest citation bursts were selected. Additionally, 16 reference clusters were extracted, among which dental implants (#1), titanium mesh (#2), and tooth extraction (#5) gained prominence over the past decade.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study provides a comprehensive overview of the development and research trends of ARA. The findings indicate strong contributions from the United States and Europe. Guided bone regeneration (GBR) was the most widely used technique for ARA, and alveolar ridge preservation (ARP) has also received increasing attention. Current pivotal research themes focus on advances in GBR membrane techniques, including 3D printing, PCL, and electrospinning.\u003c/p\u003e","manuscriptTitle":"Research interest and trends in alveolar ridge augmentation and evidence-based evaluation of articles: a bibliometric analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-22 10:22:46","doi":"10.21203/rs.3.rs-9206753/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-28T05:38:49+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-27T07:18:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"299275796320252277353178893647642614819","date":"2026-04-23T08:11:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-21T12:14:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"255870570448327488586307868049000025628","date":"2026-04-20T10:07:21+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-15T08:03:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-06T01:14:33+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-06T01:14:26+00:00","index":"","fulltext":""},{"type":"submitted","content":"The Saudi Dental Journal","date":"2026-03-24T04:48:13+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":false,"email":"","identity":"the-saudi-dental-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"","title":"The Saudi Dental Journal","twitterHandle":"","acdcEnabled":false,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"VoR Journals","inReviewEnabled":false,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"022f9d56-0d25-42b4-b8c9-79b64f0974d5","owner":[],"postedDate":"April 22nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-12T13:45:21+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-22 10:22:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9206753","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9206753","identity":"rs-9206753","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}