Discussion
tissue loss, dehiscence, volume loss
DEHISCENCE
Several techniques were suggested for alveolar ridge contour preservation including immediate implant placement, socket grafting, guided tissue regeneration concept, platelets concentrate, or other protocols like socket seal surgery and partial extraction therapy [Soft tissue augmentation techniques, such as bilaminar technique/coronally advanced flap and the pouch procedure with CTG, have emerged to address esthetic concerns in previous techniques. Such protocols showed predictability and improved soft tissue dehiscence and volume loss around dental implants [Post-extraction volumetric buccal soft tissue change is of utmost clinical interest, since the loss of root convexity may lead to unfavorable esthetic results and requires additional augmentation procedures. Accordingly, linear volumetric change of buccal soft tissue contour was considered the primary outcome in this study together with vertical tissue loss, gingival thickness, and interdental papilla height. A 6-month postoperative evaluation period was chosen based on the recommendation that final restorative measures should not be initiated until 6 months. Furthermore, qualitative and probably quantitative alterations can arise during the healing period of the augmented soft tissue [The findings presented herein showed that minimally-traumatic extraction followed by spontaneous healing without soft tissue augmentation caused a significant decrease in the buccal soft tissue contour, vertical tissue level, gingival thickness, and interdental papillae height after 6 months compared to baseline. These findings align with previous studies investigating spontaneous socket healing [On the other hand, results of this clinical trial showed that the use of SCTG buccal to extraction sockets significantly preserved buccal soft tissue contour, reduced vertical tissue loss, increased gingival thickness, and maintained interdental papillae height after 6 months. These findings were consistent with previous studies showing the benefits of SCTG in improving soft tissue profiles and correcting alveolar ridge contour defects [The current statistical analysis revealed that all the outcomes measured in the minimally-traumatic extraction with SCTG group surpassed those of the minimally-traumatic extraction followed spontaneous healing group solely with no soft tissue augmentation after 6 months. These observations suggest that the presence of the SCTG might effectively increase the soft tissue volume and mask the post-extraction contour deficiencies, especially in the esthetic zone. Furthermore, the increased gingival thickness observed after the use of SCTG might imply its ability to act as a biologic filler, improve the stability of the interdental tissues, and enhance the gingival phenotype. The current data sheds light on the effectiveness of the pouch and SCTG technique in preserving alveolar ridge contour during post-extraction modeling and remodeling. Future studies are warranted to explore the influence of intraoral scanners on volumetric analysis, in addition to examining the use of prosthetic devices and their impact on soft tissue shaping after augmentation.One of the limitations of the present clinical trial was that a third arm of bone graft placement into the socket as well as connective tissue graft should have been performed. Another limitation was that IDP measurements were not calibrated.