Extraction Socket Healing in Humans After Ridge Preservation Techniques: A Comparison Between Flapless and Flapped Procedure in a Randomized Clinical Trial

Background: The preservation of hard and soft tissue volume, partially lost after tooth removal, can potentially reduce the need for the more demanding augmentation procedures used in implant-supported rehabilitation. The objective of this research study was to investigate the effect of filling with xenogeneic material the post-extractive sockets of two surgical procedures (flapless vs. flapped). Methods: In this prospective randomised clinical survey, two types of socket preservation were performed on two groups of patients: the control, treated via full thickness mucoperiosteal flap; and the test, via a flapless procedure. Anatomical measurements and related outcome variables at the 3rd month were analysed using the multi-way analysis of variance (ANOVA). Multiple comparison tests, using Tukey's honestly significant difference test (HSD), and appropriate pair-wise comparison tests for independent samples were carried out. Results: Sixty-four patients were treated: 32 for each of the two socket preservation procedures. Statistically significant differences were registered for the output variables: changes in width of keratinised gingiva (ΔWKG), changes in bucco-lingual width (ΔBW) and vertical bone changes at the buccal aspect (bΔVB); and between the two socket preservation techniques with p-values of <.001, <.001 and .0105, respectively. Conclusion: A full thickness mucoperiosteal flap gave significantly more negative results than that of the less demanding flapless procedure, with an increased width resorption of the post-extraction site. Moreover, the increased value of the keratinised gingival width attested to the positive outcome of a flapless procedure in terms of soft tissue preservation and improvement. By contrast, the flapped technique seemed to show a smaller vertical bone resorption on the buccal aspect than the flapless technique