Clinical and Radiological Evaluation of Flap and Flapless Procedures with Biomaterials in Alveolar Ridge Preservation

Although ridge preservation procedures have been shown to prevent post-extraction bone loss, the effectiveness of using a flap or flapless surgical approach remains unclear. The aim of the study was to compare the mentioned above alveolar ridge preservation procedures in the esthetic region of maxilla. Twenty-nine patients were randomly assigned to receive flap (n = 14) or flapless (n = 15) alveolar ridge preservation procedure. Sockets were grafted with alloplastic biomaterial, then covered with a collagen membrane in both groups. Clinical examinations were performed over a 6-month observation period and radiological (CBCT) examination was conducted before and 6 months after treatment. For both after flap and flapless procedures, there was a reduction in interdental papillae height and keratinized tissue width, increase in buccal soft tissues thickness with a decrease in radiological buccal bone plate width, decrease in radiological buccal and lingual plate height (significantly for the flapless group) and radiological alveolar process width reduction (significantly in flapless group at the height of 5 mm and 7 mm from the bottom of the socket). A decrease in the radiological buccal bone plate width was observed, where the further measuring point was from the bottom of the alveolus. In the mucoperiosteal flap preparation, group buccal bone plate width reduction at the height 3 mm, 5 mm and 7 mm was significant and in the flapless group a significant decrease was observed from 5 to 9 mm from the bottom of the socket. Despite ridge preservation, there is soft tissue thickening and a decrease in bone height and width regardless of the flap/flapless method used.