The Use of Flowable Decellularized Human Placental Connective Tissue Matrix in Alveolar Ridge Preservation: A Split-Mouth Pilot Study

<b>Background/Objectives:</b> Tooth extraction is known to cause both bone loss and soft tissue collapse, changes that can complicate implant placement. While alveolar ridge preservation techniques have been proposed to limit these alterations, they often fail to maintain both hard and soft tissue dimensions at the same time. Placental-derived extracellular matrices offer a biologically active adjuvant, providing structural proteins that may support healing. The purpose of this study was to assess whether a flowable decellularized Human Placental Connective Tissue Matrix (HPCTM), combined with an allogeneic bone substitute, could improve ridge preservation by addressing changes in soft tissue as the primary outcome and underlying bone volume as the secondary outcome. <b>Methods:</b> In a split-mouth, randomized pilot trial, hopeless teeth in opposite quadrants were atraumatically extracted. Test sockets were grafted with allograft mixed with HPCTM, while control sockets received allograft alone. Healing was followed clinically and digitally using intra-oral scans; standardized photographs at 10, 21, and 30 days post-operatively; and cone-beam computed tomography at 4 months post-operatively. <b>Results:</b> Ten patients completed the study (10 test sites and 10 control sites). Sites treated with HPCTM showed faster and more stable healing. Gingival shrinkage was consistently reduced at test sites, with Hodges-Lehmann median differences of 0.50 mm at Day 10 (95% CI: 0.29-0.62; <i>p</i> = 0.0039), 0.54 mm at Day 21 (95% CI: 0.42-0.65; <i>p</i> = 0.002), and 0.54 mm at Day 30 (95% CI: 0.39-0.68; <i>p</i> = 0.002). Radiographically, test sites lost significantly less bone volume (28.24 ± 2.43%) compared with controls (38.85 ± 1.29%; <i>p</i> = 0.019). <b>Conclusions:</b> Within the limits of this study, HPCTM appears to support better preservation of both gingival architecture and alveolar bone after extraction.