Soft Tissue Alterations Research Articles

Sickle Cell Disease: An Overview of Oral Health Considerations for Pediatric Patients

Aim: This literature review aims to update the evidence for orofacial manifestations and current treatment recommendations for children and adolescents with sickle cell disease.
 Background: Sickle cell disease is a frequent hemoglobinopathy and a life-threatening genetic disorder. The lifelong condition is characterized by chronic hemolytic anemia and vaso-occlusive crisis that may occur in a variable range of clinical presentations in different regions of the body, including the oral cavity.
 Review results: This review explored the most common orofacial alterations of pediatric patients with SCD. Dental caries is a common finding in SCD pediatric patients, especially in those who are socio-economically vulnerable. Moreover, malocclusions occur in high prevalence in SCD pediatric patients. Other oral health complications seen in SCD patients include periodontal inflammation, bone changes, infections, mental nerve neuropathy, facial overgrowth, delayed tooth eruption, dental anomalies, pulp necrosis, soft tissue alterations and salivary changes. Dental infections may trigger a vaso-occlusive crisis leading the patient to a higher probability on arriving in hospital emergency departments and in need for further hospital admission to deal with the correlated complications. Thus, preventive dental care and non-invasive dental procedures are the principal focus in SCD patients in order to avoid possible subsequent complications.
 Conclusion: The review showed that in pediatric patients with SCD the risk for orofacial manifestations and complications depends not only on the presence of SCD but also on other confounding factors such as oral hygiene, diet habits and social conditions. Moreover, more well-designed epidemiological studies are necessary to assess the real link between SCD disease and its impact on stomatognathic health.

Botulinum Toxin Treatment for Thoracic Outlet Syndrome Induced by Subclavius Muscle Hypertrophy

Thoracic outlet syndrome (TOS) is frequently caused by bone abnormalities and congenital or acquired soft-tissue alterations. Among these, isolated Subclavius Muscle (SM) hypertrophy represents a rare condition that could lead to a reduction in costoclavicular space and brachial plexus compression. A 47-year-old forest ranger with a history of gun shooting during animal hunting and training sessions of skeet shooting for 20 years developed TOS due to ultrasonography-detected isolated SM hypertrophy, successfully treated with an ultrasound-guided Botulinum Toxin (BTX)-A injection. In our patient, ultrasonography of the brachial plexus has allowed SM hypertrophy to be recognized and to perform BTX-A injection just in the muscle, with a complete resolution of the symptoms.

Volumetric changes at implant sites: A systematic appraisal of traditional methods and optical scanning-based digital technologies.

To evaluate techniques for assessing soft tissue alterations at implant sites and compare the traditionally utilized methods to the newer three-dimensional technologies emerging in the literature. A comprehensive search was performed to identify interventional studies reporting on volumetric changes at implant sites following different treatments. Seventy-five articles were included the following: 30 used transgingival piercing alone, one utilized calliper, six with ultrasonography, six on cone-beam computed tomography, and 32 utilized optical scanning and digital technologies. Optical scanning-based digital technologies were the only approach that provided 'volumetric changes,' reported as volumetric variation in mm3 , or the mean distance between the surfaces/mean thickness of the reconstructed volume. High variability in the digital analysis and definition of the region of interest was observed. All the other methods reported volume variation as linear dimensional changes at different apico-coronal levels. No studies compared volumetric changes with different approaches. Despite the emergence of optical scanning-based digital technologies for evaluating volumetric changes, a high degree of variation exists in the executed workflow, which renders the comparison of study results not feasible. Establishment of universal guidelines could allow for volumetric comparisons among different studies and treatments.

Five-years outcome of medial patellofemoral ligament reconstruction in isolated post-traumatic tear: A retrospective study

IntroductionMedial patellofemoral ligament (MPFL) reconstruction is the procedure of choice for lateral patellar dislocation. However, studies depicting the long terms results of this procedure is lacking. The present study was conducted to evaluate the functional outcomes after MPFL reconstruction at a minimum of five years follow-up. MethodsThis study was retrospective evaluations of patients who underwent MPFL reconstruction by basket weave method. A total of 35 patients (37 knees) with isolated MPFL tear who met the inclusion criteria were included in this study. These patients were assessed for functional outcome scores including Kujala score, International Knee Documentation Committee (IKDC) score, Lysholm score and Tegner activity score at a minimum follow-up of 5 years. ResultsThe mean follow-up was 81.57 ± 16.07 months and mean age of patients was 19.56 ± 8.02 years. There was no re-dislocation in any of the patients but 4 patients had apprehension test positive (10.81%). The mean Kujala score, IKDC score and Lysholm score preoperatively and postoperatively after MPFL reconstruction were 62.20 ± 16.86 and 90.32 ± 16.42 respectively (p < 0.0001); 58.62 ± 14.34 and 85.15 ± 7.65 respectively (p < 0.0001); 68.21 ± 10.72 and 95.30 ± 8.02 respectively (p < 0.0001) at the five-year follow-up. Mean Tegner score pre-injury and post-surgery was 6.23 ± 2.10 and 5.82 ± 1.90 respectively (p = 0.38) at a mean follow-up of five years. ConclusionsMPFL reconstruction surgery for isolated MPFL tears without any associated bony deformity, or soft tissue alterations has a good long-term functional outcome.

Marginal bone and soft tissue alterations after use of OsseoSpeed Profile EV implants

Marginal bone and soft tissue alterations after use of OsseoSpeed Profile EV implants

Evaluation of the anterior meniscal displacement with reduction by High-Resolution Ultrasonography pulsed-wave Doppler mode (PWD). A pilot study

Introduction : The temporomandibular joint disorder (TMD) refers to mandibular dysfunction caused by reduced function of the primary structures that compose the temporomandibular joint (TMJ) or other structures related to the TMJ or by the interaction of these structures with each other. Ultrasound imaging (USI) can not only demonstrate soft tissue alterations but also visualize hard tissue alterations. Pulsed-wave Doppler mode is a widely used technique in the study of movable structures, particularly the vascular system. Material and Methods: 16 patients (32 TMJ) were included in this study, grouped in 10 women’s and 6 men’s) . Extraoral and intraoral examination of the TMJ was realized to detect anterior disc displacement with reduction. Ultrasonography high resolution examination was carried out by LOGIQ e Healthcare ® with a 16 MHz high frequency transducer. A musculoskeletal L8-18i wideband linear array was used for pulsed wave doppler mode examination. Results : Fourteen patients presented anterior disc displacement with reduction, and 2 patients presented normal disc position. When meniscal displacement is detected, PWD mode presents a distinct waveform on the timeline of the exploration. Conclusion : Pulsed-wave Doppler mode provides an advantage in USI, helping to confirm the existence of anterior disc displacement or crepitation. USI is a noninvasive technique with no radiation exposure and permits static and dynamic exploration of the TMJ with a short examination time, low cost, and no contraindications or special patient preparation.

Hard and soft tissue alterations during the healing stage of immediate implant placement and provisionalization with or without connective tissue graft: A randomized clinical trial.

To evaluate the hard and soft tissue alterations of immediately placed and provisionalized implants with or without connective tissue graft (CTG). Single unsalvageable maxillary incisors were replaced with immediately placed and provisionalized implants in 42 participants. The patients were randomly assigned to receive simultaneous CTG (test group) and not receive CTG (control group). Digital impression and cone-beam computed tomography images were obtained before extraction and after 6months. Mid-facial gingival margin migrations, soft tissue contour changes and hard tissue remodelling were analysed and compared between the two groups using three-dimensional superimposition method. Forty participants completed the study. The test group showed significantly less buccal tissue collapse in the area 2-5mm apical to the gingival margin. In both groups, the mid-facial gingival margin migrated in an apico-palatal direction and the socket void, except for a triangular space in the bucco-coronal region, demonstrated radiographic new bone formation without statistically significant differences. The CTG used with immediate implant placement and provisionalization could compensate for the facial tissue collapse, but it did not benefit maintenance of the mid-facial gingival margin position during the 6-month follow-up. New bone formation observed radiographically can be expected in most areas of the socket void, regardless of CTG use (ChiCTR-1900028494).

Discovering a new anatomy: exploration of oral mucosa with ultra-high frequency ultrasound.

Ultra-high frequency ultrasound (UHFUS) is a recently developed diagnostic technique involving the use of ultrasound frequencies up to 70 MHz, allowing to obtain 30 µm resolution of targets located within 1 cm from the surface. Oral mucosa can be affected by diverse pathological conditions, which are currently investigated by means of clinical examination. In this scenario, intraoral UHFUS can provide additional information and support clinical assessment of oral mucosa. In this preliminary study, typical features of normal oral mucosa are described, in order to set a benchmark for the future identification of oral soft tissue alterations. Twenty healthy subjects (10 males and 10 females, mean age 30 years) were enrolled and underwent intraoral UHFUS examination. In all the subjects, tongue, buccal mucosa, gingiva, lip mucosa, and palate were scanned, and images acquired. Intraoral UHFUS scan included Brightness-mode and Doppler mode acquisitions performed with a standardized protocol. UHFUS images were postprocessed and analyzed using a dedicated software. UHFUS-based biomarkers (epithelial thickness, echogenicity, and vascularization) were employed for image description. Normal oral anatomy of the different sites analyzed was described. For all the sites, UHFUS biomarkers were characterized, and information on typical aspect of oral mucosa was retrieved. In this explorative study, we suggest a potential role for intraoral UHFUS in the study of oral mucosa, giving insights into the possibility to improve the assessment, diagnosis, and management of the conditions involving oral mucosa. UHFUS seems a promising tool, which could potentially support clinical examination in daily oral medicine practice.

Soft-Tissue Changes After Using Collagen Matrix Seal or Collagen Sponge With Allograft in Ridge Preservation: A Randomized Controlled Volumetric Study.

The objective of this study is to assess alterations in buccal soft-tissue contour after alveolar ridge preservation (ARP) using either a collagen matrix seal (CMS) or a collagen sponge (CS) as barriers with freeze-dried bone allograft (FDBA). Participants (28 total) were randomly assigned to the CMS group or CS group (14 participants each). The same clinical steps were used in both barriers. Cast models were taken at baseline and 4 months, and both models were then optically scanned and digitally superimposed. Volumetric, surface, and distance-adjusted measurements were calculated to assess buccal soft-tissue alterations. Surface area and volume loss in the CMS group were observed to be 71.44 ± 1189.09 mm2 and 239.58 ± 231.89 mm3, respectively. The CS group showed measurements of 139.56 ± 557.92 mm2 and 337.23 ± 310.18 mm3. Mean buccal soft-tissue loss and minimum-maximum distance loss were less in the CMS group (0.88 ± 0.52 mm and 0.2-2.15 mm, respectively) as compared with the CS group (1.63 ± 1.03 mm and 0.3-3.68 mm, respectively), with no statistically significant difference between the groups (P = .2742). Both alveolar ridge preservation barriers were unable to entirely prevent soft-tissue contour changes after extraction. However, collagen matrix seal application was slightly better in minimizing the amount of soft-tissue reduction compared with the CS.

Epidemiologic characterization of endodontic diagnosis and treatment

Objetive: To characterize the endodontic diagnosis and treatments performed during 2008-2011 at School of Dentistry, University of Andres Bello, Chile. Methos: Case series study comprising 632 endodontics clinical records, corresponding to 506 patients. Variables included were clinical and radiographic features of the tooth anatomy, and variables related to treatment. Statistics analysis was performed through Stata 11 software. For multivariate analysis, logistic regression model was used, including adjusted Odd ratio; p<0.05 was considered significative. Results: The most frequent diagnosis were pulp necrosis and asymptomatic irreversible pulpitis. Endodontic treatments were more common in women, in upper maxilla, in molars and premolars; in general, the main biomechanical preparation technique is manual and hybrid, except in molars, where mechanized technique is more common; the most used master apical file was file #40, and in upper incisors, #60; lateral condensation obturation technique was the most frequently used. A good prognosis was related with lateral and vertical obturation technique, and absence of soft tissue alterations. Conclusions: This study brought relevant information about working lengths for each root canal for each tooth type. It related tooth type with the technique used for the coronal two-thirds preparation and its instruments, obturation technique and informed about the master file used for each root canal, by means of cross tables. Also, it builds an estimation model for the postoperative prognosis

Predicting bone and soft tissue alterations of immediate implant sites in the esthetic zone using clinical parameters.

Immediate implantation is generally a predictable treatment, but sometimes there are significant tissue alterations at the surgical site which compromise clinical outcomes. This study aimed to investigate the association between tissue alterations and different clinical parameters in esthetic areas following immediate implant placement and provisionalization. Clinical parameters were measured at 36 non-grafted immediate implant sites enrolled in a randomized controlled trial. Alterations of bone and soft tissue were measured at 12 months after the treatment. Stepwise linear regression analysis was performed to analyze the association between different clinical parameters and outcomes of interest. Gingival thickness 3 mm apical to the gingival margin (GT3) was positively associated with recession of mid-buccal gingival margin, while vertical distance between the buccal gingival margin and the crest (GM-bone) was negatively associated (P = .03, .01). Flap elevation and older age were positively associated with recession of the interproximal gingival margin (P = .04, .01). Horizontal defect dimension was positively associated with buccal ridge dimensional reduction while gingival thickness at free gingival margin (GT1) was negatively associated (P = .01, .04). Regarding interproximal bone level change, none of the clinical parameters was significantly associated. Gingival phenotype was the only parameter significantly associated with both buccal gingival recession and buccal ridge dimensional reduction. It is important to assess clinical parameters before and during immediate implant procedure.

Ultrasonographic alterations of bovine claws sole soft tissues associated with claw horn disruption lesions, body condition score and locomotion score in Holstein dairy cows

Claw Horn Disruption Lesions (CHDL) negatively affect the sole soft tissue structures located beneath the sole horn. The aim of the present study was to investigate the effect of CHDL on sole soft tissues by ultrasound means, correlating Body condition score (BCS), locomotion score and CHDL with ultrasonography evaluations of sole soft tissues in Holstein dairy cows. 100 Holstein dairy cows were enrolled in the study. BCS and locomotion score were assessed and functional trimming was performed on all animals. 84 healthy claws and 174 claws with solely one CHDL per claw were evaluated both clinically and with ultrasound, and CHDL were identified and recorded. Sole soft tissues thickness (mm) and echogenicity was determined, and ultrasonographic alterations, related to CHDL presence, where measured long their vertical (L1) and horizontal (L2) axis. Statistically significant (P < .001) differences were found in echogenicity between healthy claws and all the affected ones, with the healthy ones being mainly anechoic. Statistically significant (P < .001) differences were found for vertical (L1) and horizontal (L2) axis measures between the diverse CHDL, confirming ultrasonography as a useful tool to distinguish lesions and their extension by measuring L1 and L2. BCS had an influence both on sole soft tissues ultrasonographic appearance and on CHDL insurgency.These results confirm ultrasonography as a reliable tool for detecting an increase in sole soft tissues echogenicity, that was seen to occur with CHDL insurgency, and in determining lesion extension.

Peri-implant Soft Tissue Management: Cairo Opinion Consensus Conference.

Peri-implant soft tissues play a role of paramount importance, not only on the esthetic appearance, but also on the maintenance and long-term stability of implants. The present report presents the conclusions from the Consensus Conference of the South European North African Middle Eastern Implantology & Modern Dentistry Association (SENAME) (4–6 November 2016, Cairo, Egypt). The conference focused on the topic of the soft tissue around dental implants, and in particular, on the influence of implant configurations on the marginal soft tissues, soft tissue alterations after immediate, early or delayed implant placement and immediate loading, the long-term outcomes of soft tissue stability around dental implants, and soft tissue augmentation around dental implants. Thirty world experts in this field were invited to take part in this two-day event; however, only 29 experts were in the final consensus voting process.

Postoperative Complications of Box-Shift Osteotomy for Orbital Hypertelorism.

To summarize and analyze the postoperative complications of box-shift osteotomy performed at our center for Chinese orbital hypertelorism patients from 2008 to 2017. This retrospective study reviews the records of 78 patients with complete medical records and at least 2 years of postoperative follow-up data. Both radiologic and anthropometric assessments were conducted before, 1 month after and 2 years after surgery to evaluate the bony and soft-tissue alterations. Postoperative complications were recorded during hospitalization and at each follow-up visit and divided into 3 groups: acute complications that occurred within 1 month after surgery; early complications that occurred within 6 months after surgery; and long-term complications that occurred within 2 years after surgery. Both bony and soft-tissue alterations were significant at 1 month after surgery. The acute complications that occurred in our center included infection (12.8%), cerebrospinal fluid leakage (29.5%), epilepsy (2.6%), and nasal tip skin necrosis (1.3%). The early complications included strabismus (11.5%) and nasolacrimal duct obstruction (3.8%). The long-term complications included insufficient correction (55.1%), palpable metal implants (92.3%) and a drooping nasal tip (33.9%). Due to the insufficient correction and the continued growth of rib graft, the difference in the hypertelorism index and nasal length, between one month and 2 years postoperatively were statistically significant (P < 0.01). Other radiographic and anthropometric measurements changed with growth without a significance difference between 1 month and 2 years after surgery. In this study, we recorded all postoperative complications of box-shift osteotomy. The challenge of our future work is to identify methods for decreasing the incidence of these complications.

EXPERIMENTAL MATURATION OF FEATHERS: IMPLICATIONS FOR INTERPRETATIONS OF FOSSIL FEATHERS

ABSTRACT Exceptionally preserved fossil feathers and feather-like integumentary structures provide valuable insights into the early evolution of feathers and flight, but taphonomic biases often make interpretations at the microstructural and ultrastructural levels ambiguous. Maturation experiments have been demonstrated to be useful for investigating the taphonomic alterations of soft tissues, including feathers, during diagenesis. However, experimentally matured feathers resembling fossil feathers preserving keratinous matrix have not yet been obtained. Here we employ experimental maturation to obtain feathers corresponding to different degradation stages, and compare these matured feathers with untreated feathers and fossil feathers at the macroscopic, microstructural, and ultrastructural levels. Results show that several features of thermally matured feathers are similar to those found in fossil feathers. The fusion of barbules that occurred in thermally matured feathers suggests that such a process could occur during diagenesis, making barbules difficult to identify in fossil feathers. Under the most extreme experimental condition, the keratinous matrix can partially survive when the whole feather is turned into ash-like remains and many melanosomes are exposed. Moreover, our results show that the keratinous matrix immediately surrounding melanosomes appears to be more resistant to degradation than the unpigmented keratinous matrix, supporting the hypothesis that melanin can act as a fixative agent to prevent the degradation of keratin.

Marginal Bone and Soft Tissue Alterations After Use of OsseoSpeed EV Profile Implants

Marginal Bone and Soft Tissue Alterations After Use of OsseoSpeed EV Profile Implants

Two Different Missense C1S Mutations, Associated to Periodontal Ehlers-Danlos Syndrome, Lead to Identical Molecular Outcomes.

Ehlers-Danlos syndromes (EDS) are clinically and genetically heterogeneous disorders characterized by soft connective tissue alteration like joint hypermobility and skin hyper-extensibility. We previously identified heterozygous missense mutations in the C1R and C1S genes, coding for the complement C1 proteases, in patients affected by periodontal EDS, a specific EDS subtype hallmarked by early severe periodontitis leading to premature loss of teeth and connective tissue alterations. Up to now, there is no clear molecular link relating the nominal role of the C1r and C1s proteases, which is to activate the classical complement pathway, to these heterogeneous symptoms of periodontal EDS syndrome. We aim therefore to elucidate the functional effect of these mutations, at the molecular and enzymatic levels. To explore the molecular consequences, a set of cell transfection experiments, recombinant protein purification, mass spectroscopy and N-terminal analyses have been performed. Focusing on the results obtained on two different C1S variants, namely p.Val316del and p.Cys294Arg, we show that HEK293-F cells stably transfected with the corresponding C1s variant plasmids, unexpectedly, do not secrete the full-length mutated C1s, but only a truncated Fg40 fragment of 40 kDa, produced at very low levels. Detailed analyses of the Fg40 fragments purified for the two C1s variants show that they are identical, which was also unexpected. This suggests that local misfolding of the CCP1 module containing the patient mutation exposes a novel cleavage site, between Lys353 and Cys354, which is not normally accessible. The mutation-induced Fg40 fragment contains the intact C-terminal serine protease domain but not the N-terminal domain mediating C1s interaction with the other C1 subunits, C1r, and C1q. Thus, Fg40 enzymatic activity escapes the normal physiological control of C1s activity within C1, potentially providing a loss-of-control. Comparative enzymatic analyses show that Fg40 retains the native esterolytic activity of C1s, as well as its cleavage efficiency toward the ancillary alarmin HMGB1 substrate, for example, whereas the nominal complement C4 activation cleavage is impaired. These new results open the way to further molecular explorations possibly involving subsidiary C1s targets.

A prospective cohort study of immediate implant placement into posterior compromised sockets with or without primary wound closure of reactive soft tissue.

Conventional wisdom states that reactive soft tissue consisting of granulation tissue and long junctional epithelium in compromised sites should be curetted completely, while others approve of its preservation in implant surgeries. To evaluate the presence of reactive soft tissue as wound closure for immediate implantation in posterior compromised sockets. Thirty-three implants were included in this study: (a) experimental group (EG), the reactive soft tissue was raised as the primary wound closure for the implant; (b) control group (CG), the reactive soft tissue was also elevated but failed to cover the site. Implants were inserted immediately after the tooth extraction. The bone dimensional changes were observed instantly after surgery (T1) and 6 months later (T2) by cone beam computed tomography. Soft tissue alterations were evaluated before tooth extraction (T0), at prosthesis delivery and at 1-year follow-up (T3). Measurements of marginal bone level (MBL) was obtained at the time of prosthesis placement and at T3. In all, 100% implant survival was reported during the study period. The buccal bone height and width of keratinized mucosa decreased less in the EG compared to the CG. At the 1-year follow-up, MBL and soft tissue changes were not significantly different between the two groups. Within the limitations of this study, the presence of reactive soft tissue as primary closure may contribute to hard-soft tissue augmentation during immediate implants into posterior compromised sockets.

Evidence of prenatal toxicity of herbal based indigenous formulations for sex selection in rat models

Indigenous preparations(IPs) for a male child is reported from some parts of India. The present study aims to explore the effects of IPs for sex selection or sex selection drugs (SSDs) on pregnancy outcomes in rat models. SSDs contain Bryonia laciniosa, Quercus infectoria and Putranjiva roxburghii along with other ingredients. MethodsAn experimental design with successfully mated female rats were randomized into control and treatment groups. Phase 1 had 2 interventional arms while phase 2 had 3 interventional arms (12 rats/arm) besides control arm. In phase-1, pregnant females were dosed two SSDs(1000 mg/kg) on gestation days 1–5 whereas, in phase-2, on gestation days 6–19 to correlate the effect of the SSDs (500/1000/1500 mg/kg) consumption during different stages of pregnancy. Pregnant females were observed for clinical signs following treatment. The rats were sacrificed one day before expected day of delivery for evaluation. Pregnancy rate, gestation index, number of corpora lutea, and litter size were assessed. Foetuses were examined for sex, skeletal and soft tissue alterations. Discussion and conclusionIn phase 1, no appreciable findings were there with SSD exposure. In phase 2, intrauterine growth and survival of foetuses were affected when SSDs were administered during organogenesis period. Decreased number of live foetuses and increased incidence of early and late resorption, reduced fetal growth with significant alteration in skeleton and viscera were found in treatment groups in a dose-dependent manner. This correlates well with findings from observational studies in pregnant women. However, such treatment at any dose did not effect sex differentiation.

Two procedures for ridge preservation of molar extraction sites affected by severe bone defect due to advanced periodontitis

To evaluate and to compare dimensional alterations of hard and soft tissues in molar extraction sites with irregular deficiency of bone plates due to advanced periodontitis receiving two different procedures, namely the flapped and flapless techniques with Bio-Gide membrane covering the Bio-Oss material for ridge preservation. Twenty-three patients with 24 infected-molar extraction sites received ridge preservation procedure, the first consecutive 12 sites belonged to the flap group (a full thickness mucoperiosteal flap and primary soft tissue closure) and the following 12 sites belonged to the flapless group (minimal flap with a collagen sponge and a secondary soft tissue closure). Width of keratinized tissue was evaluated before tooth extraction and after 6-month healing. Parallel periapical radiographs were taken immediately and 6 months after extraction to evaluate vertical bone changes. The width of the ridge was measured in the center of the ridge at the time of tooth extraction and after 6 months at implant placement. After 6 months, width of keratinized tissue decreased (1.6±1.5) mm in the flap group (P=0.004) when compared with (0.3±1.6) mm in the flapless group (P>0.05). Both groups showed increases in ridge height from the central aspect, (5.53±4.20) mm for flap group and (7.70±4.35) mm for flapless group. These differences between the groups were not statistically significant (P=0.226). The ridge widths were (9.5±2.2) mm for flap group and (9.3±1.0) mm for flapless group at the time of implant insertion, and no statistical significance was observed between the flap and flapless groups. The study points out that both ridge preservation techniques were effective in increasing ridge height and minimizing ridge resorption after tooth extraction, and the ridge width allowed the placement of implants 6 months after ridge preservation. The flapless technique gave positive outcome in terms of the keratinized gingival width than that of the flap technique.