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24 Volume 2 | Issue 1/2016 Journal of Oral Science & Rehabilitation Fla ples s s oc ket pres ervati o n pro ce du re brane were evaluated over the observation period. Bone cores were also harvested at the time of implant placement for histological analysis. Materials&methods S tud y popula tion and de si gn Patients were recruited from the consultation clinicattheIstitutoStomatologicoToscano,Ver- silia general hospital, University of Pisa, Lido di Camaiore, Italy, from January 2013 to January 2014. The study was approved by the ethics committee of the Versilia general hospital ac- cording to the principles outlined in the Declara- tion of Helsinki on clinical research involving hu- man subjects.All ofthe patients received athor- ough explanation of the study and completed a writteninformedconsentformpriortobeingen- rolledinthetrial. Fortypatients requiring extraction ofat least one premolarorone molarand a subsequent im- plant-supported restoration who were 18 years old orolderand ableto sign an informed consent form were eligible for inclusion in this trial. One patientshowedcompletelossofthebuccalbone plate immediately after the extraction and two patients did not return for the follow-up exami- nations. Consequently, these patients were ex- cluded, and 37 patients were included in the study. The patients enrolled in the study had a mean age of 40.5 ± 13.5 and an age range of be- tween20and61. Theexclusioncriteriawere: –historyofsystemicdiseasethatwould contraindicateoralsurgicaltreatment –long-termnonsteroidalanti-inflammatory drugtherapy –intravenousandoralbisphosphonatetherapy –lackoftheoccludingteeth –absenceofadjacentteeth –completelossofabonewall –surgicalsitesintheestheticarea –uncontrolledperiodontaldisease –unwillingnesstoreturnforthefollow-up examination –smokingofmorethantencigarettesperday— subjectswhosmokedfewerthantenciga- rettesperdaywererequestedtostopsmoking beforeandaftersurgery;however,theircom- pliancecouldnotbemonitored. Patientswhowereincludedinthestudywereac- curately evaluated by examining clinical aspects and periapical and panoramic radiographs. Moreover, data were collected for each patient, including age, sex, smoking habits, and indica- tions for tooth extraction based on both clinical and radiographic examinations, tooth location andthepresenceorabsenceofadjacentteeth. Aftertheconsentformhadbeensigned,allof the patients underwent at least one session of scaling and root planing prior to the extraction procedures in order to provide a more favorable oral environment for wound healing. All of the patients underwentthetooth extraction andthe ridge preservation procedure at baseline. Four months after tooth extraction, all of the sites were re-entered, bone biopsies were taken and implantswereplaced. Su rgi cal tre atme nt Allofthepatientsreceivedantibiotictherapy(2 g amoxicillin or 600 mg clindamycin, if allergic to penicillin)1 hbeforethesurgeryandcontinuedto take the antibiotic postoperatively (1 g amoxi- cillin or 300 mg clindamycin) b.i.d. forfour days. All of the patients rinsed for 1 min with a 0.2% chlorhexidine mouthwash prior to the surgery (as well as b.i.d. for the following three weeks) andweretreated underlocalanesthesia using li- docaine with 1:50,000 epinephrine. All of the surgicalprocedureswere performed bytwo sur- geons (AB, FA), who received training during a one-week session before beginning the study. The training included calibration for the surgical and follow-up procedures, as well as the han- dling of any complications. All of the patients were treated with the same surgical technique and periotomes were used around every tooth treated. Moreover, ultrasound bone surgery (PIEZOSURGERY,mectron,Italy)wasperformed where necessary in order to avoid buccolingual movements of the tooth, thus preventing dam- agetoorafullfractureofthebuccalbonewall. The extraction sockets were thoroughly curetted and irrigated with a sterile saline solu- tion. Cortico-cancellous porcine bone (mp3, Os- teoBiol, Tecnoss Dental, Pianezza, Italy) was lightly condensed inside the socket and a re- sorbable collagen membrane (Evolution, Osteo- Biol, Tecnoss Dental) was placed over it in order to cover the socket completely. The membrane, which was left exposed to the oral cavity, was stabilized with 4-0 silk sutures, and soft-tissue