Impact of Conventional vs. Vertical Tooth Extraction on Three-Dimensional Soft Tissue Remodelling and Aesthetic Parameters of Adjacent Teeth: One-Year Results of a Randomized Clinical Trial.

Objectives: Post-extraction remodelling of hard and soft tissues results in volume reduction, leading to aesthetic challenges in planning prosthetic restorations, particularly in the anterior maxilla. This study assessed whether atraumatic vertical extraction, versus conventional extraction, could reduce postoperative volume loss and aesthetic compromises at the extraction site and adjacent teeth. Methods: Following randomized tooth extraction with unassisted healing in the test (Benex® extraction, n = 10) and control group (conventional extraction, n = 10), postoperative scans were conducted at 30 days (t1), 60 days (t2), 90 days (t3) and 12 months (t4). Each scan was aligned with the baseline scan (t0), and surface comparison was performed with five regions of interest (ROIs: central, mesial, distal, papilla mesial and papilla distal). Aesthetic parameters, including recession and Pink Esthetic Score (PES) of adjacent teeth, were clinically evaluated at each follow-up appointment. Statistical analysis used a mixed linear model accounting for confounding factors such as smoking, buccal bone integrity, gingival phenotype, and provisional use. Results: Both groups showed significant volume reduction from baseline to t3 and t4. The largest volume loss occurred in the central ROI in both test (t4: -65.34 ± 36.89 mm3) and control group (t4: -70.85 ± 30.96 mm3), with no significant difference between groups. A decline in PES and recession at the adjacent teeth was noted in both groups at 12 months. Conclusions: Both groups showed significant volume reduction with aesthetic impairment at the adjacent teeth's soft tissue.