Randomized controlled trial of immediate alveolar ridge preservation for bone and soft tissue aesthetics after tooth extraction

Objective This study aimed to evaluate the long-term outcomes of alveolar ridge preservation (ARP) on soft tissue morphology, correlate them with underlying bone changes, and assess its clinical value. It directly compared alveolar bone preservation and soft tissue aesthetics between ARP and conventional tooth extraction. Methods In this prospective randomized controlled trial, sixty patients were randomly assigned (1:1) via sealed envelopes to a control group (conventional extraction) or an ARP group (immediate grafting with β -TCP and a collagen membrane). Over a 12-month follow-up, alveolar bone height and width changes were measured using CBCT. Soft tissue morphology was examined via plaster models, and aesthetics were evaluated using a 10-point scoring system for color and morphology. Results Baseline characteristics were comparable between groups. After 12 months, the control group showed significantly greater bone resorption in height (1.3 mm) and width (1.7 mm) compared to the ARP group (0.7 mm and 1.1 mm, respectively; P < 0.001). Soft tissue contours were significantly better in the ARP group (50.0% smooth, 50.0% mild abnormalities) than in the control group (33.3% margin disruption, 60.0% moderate irregularities; P < 0.001). A strong negative correlation was found between aesthetic scores and bone resorption ( P < 0.001). The ARP group also achieved significantly higher soft tissue color (7.8 ± 0.5) and morphological scores (7.7 ± 0.6) than the control group (6.1 ± 0.6 and 5.9 ± 0.7; P < 0.001). Conclusions Immediate ARP using β -TCP and a collagen membrane significantly reduces alveolar bone resorption, better maintains soft tissue morphology and aesthetics, and provides a superior foundation for future implant rehabilitation, demonstrating substantial clinical value.