Postextraction Tissue Management: A Soft Tissue Punch Technique

The aim of this prospective clinical study was to analyze graft-enhanced soft tissue healing during the initial phases after tooth extraction. Twenty patients in need of tooth extraction (incisors, canines, and premolars) and implant replacement were included. In patients with multiple extractions, one tooth was randomly selected for treatment. After administration of antibiotics, the selected tooth was gently removed. The socket was completely filled with deproteinized bovine bone mineral integrated in a 10% collagen matrix to fill out the space of the alveolus and support the soft tissue. A biopsy punch with a diameter corresponding to the socket orifice was chosen to harvest a free gingival graft of 2- to 3-mm thickness from the palate. The punched graft was carefully sutured to the deepithelialized soft tissue margins of the socket. One week after graft insertion, 64.3% of the mean graft area was fully integrated, 35.6% was fibrinoid, and 0.1% showed necrotic parts. Three and 6 weeks postsurgery, the mean integrated graft surface increased to 92.3% and 99.7%, respectively. After 6 weeks, a mean of 0.3% of the surface in four grafts showed incomplete wound closure, and no fibrin or necrosis was present. Colorimetry of the graft and adjacent tissue revealed a mean color match of ΔE = 2.91, lower than the critical threshold of 3.7 for intraoral visibility of different colors. This soft tissue punch technique led to successful biologic and esthetic integration of the transplanted graft into the local host tissues.