A novel atraumatic extraction technique using vestibular socket therapy for immediate implant placement: a randomized controlled clinical trial

Purpose This randomized controlled clinical trial compared soft tissue changes following a novel vestibular atraumatic extraction technique (test group) versus the conventional incisal atraumatic extraction approach (control group) while implementing the vestibular socket therapy for immediate implant placement. Methods Thirty patients with hopeless maxillary anterior teeth requiring atraumatic extraction were randomly assigned into two equal groups to receive either test or control. Vertical soft tissue alterations in mm were measured at baseline and 12 months post-restoration using intraoral digital scans at three reference points, distal papilla, mid-facial gingival margin, and mesial papilla, as well as pink esthetic scores (PESs) after 12 months. Results Vestibular extraction technique showed significant soft tissue improvement and creeping when compared to incisal extraction (P < 0.05). The test group showed soft tissue measurements with a mean (+/- SD) of 0.26 (+/- 0.58), 0.39 (+/- 0.64), and 0.05 (+/- 0.37) mm for the mesial papilla, mid-facial gingival margin, and distal papilla respectively. While the incisal extraction technique demonstrated gingival recession at the distal papilla, mid-facial gingival margin, and mesial papilla of - 0.37 (+/- 0.54) mm, - 0.32 (+/- 0.68) mm, and - 0.39 (+/- 0.59) mm respectively. The overall PESs after 12 months were 12.67 (+/- 1.59) in vestibular extraction group, while incisal extraction group was 11.40 (+/- 1.40), with significant difference between them (P = 0.03). Conclusion This investigation suggests that both studied techniques were successful in the atraumatic extraction of hopeless severely damaged teeth. The novel vestibular extraction technique might be considered an alternative reliable atraumatic extraction approach compared to the conventional incisal extraction when performing the vestibular socket protocol for immediate implant placement with soft tissue enhancement.