The FACE Difficulty Scale Applied to a Retrospective Case Series of Vertical Bone Augmentation

OBJECTIVE: Vertical bone augmentation (VBA) presents variable levels of difficulty depending on the defect morphology and soft-tissue conditions. We propose the FACE scale as a preoperative tool to guide clinicians in evaluating the anticipated surgical complexity of VBA procedures. CLINICAL CONSIDERATIONS: The FACE scale evaluates the following four dimensions, each scored from 1 to 3: flap configuration (F1-3), apical mucosa position (A1-3), crestal bone peak alignment (C1-3), and defect extent (E1-3). The total score ranges from 4 to 12 points (maximum difficulty). The scale was retrospectively applied to 43 VBA procedures, performing bilateral analyses to assess the association between FACE scores and complications. Complications were recorded in 23.3% of cases and overall success in 76.7%. A tendency toward higher complication rates was observed in cases with extensive defects (E3) and apical dehiscence (A3), although statistical significance was not reached. CONCLUSIONS: The FACE scale provides a structured framework for anticipating surgical complexity in VBA by integrating defect-related and soft-tissue factors. Preliminary results suggest a trend toward increased complication rates with higher FACE scores. These findings should be interpreted as exploratory, offering a preliminary framework to guide future validation of the FACE scale in larger prospective studies. CLINICAL SIGNIFICANCE: The FACE scale offers clinicians a practical tool to anticipate the complexity of VBA procedures by incorporating both defect-related and soft-tissue factors. Its application may be useful for surgical planning, risk assessment, and patient counseling.