Optimizing dimensional changes of soft tissue in alveolar ridge preservation using rotational palatal pedicle flap in posterior maxilla – A randomized controlled clinical trial

Background: After tooth extraction, it is critical to maintain alveolar bone proportions as well as soft tissue integrity for rehabilitation. The common procedure for closing the socket is a coronally advanced flap, however, it compromises the keratinized tissue dimensions. As a result, the current study’s goal is to assess and compare the soft tissue dimensional alterations caused by the new palatal rotational pedicle flap versus the conventional coronally advanced flap as an adjunct to alveolar ridge preservation. Materials and Methods: Fifty-four participants requiring extraction of single maxillary posterior teeth were randomized into two groups. While both groups used a 1:1 mixture of demineralized freeze dried bone allograft and platelet rich fibrin to preserve the ridge after atraumatic extraction, the control group used a coronally advanced flap to seal the socket, whereas the test group used a rotational palatal pedicle flap to close the socket. At baseline, 3 and 6 months after surgery, the clinical parameters, i.e., vertical ridge height (VRH), horizontal ridge width (HRW), width of keratinized gingiva (WKG), thickness of keratinized gingiva (TKG), and papillary height (PH) were measured. Results: Intergroup comparison demonstrated a significantly greater gain in WKG ( P = 0.001), TKG ( P = 0.029) and PH ( P = 0.021) in the test group. The VRH and HRW, on the other hand, were preserved in both groups. The data were analyzed using unpaired t -test for intergroup and analysis of variance for intragroup comparison. Conclusion: Both groups effectively preserved hard tissue dimensional changes, with the test group showing superior soft tissue enhancement.