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I n t e n t i o n a l l y e x p o s e d m e m b r a n e study. The medical history of the enrolled patients was collected and study models were produced. Preoperative radiographs, including periapical and panoramic radiographs, and com- puted tomography or cone beam computed tomography scans, were obtained for initial screening and evaluation. All procedures were conducted in accordance with the Declaration of Helsinki of 1975, as revised in 2013, for biomedical research involv- ing human subjects. One clinician (RL) per- formed all of the surgical and prosthetic proce- dures, and one dental laboratory manufactured all of the restorations. S u r g i c a l a n d p r o s t h e t i c p r o t o c o l s The teeth were atraumatically extracted with the aid of a periotome and atraumatic elevators (PT1 and EPTSMS, Hu-Friedy Italy, Milan, Italy) to reduce trauma to the bony walls (Fig. 1). After accurate debridement of the socket with a curette (CL866, Hu-Friedy), the distance from the gingival margin to the residual buccal or pal- atal bone plate was measured with the aid of a periodontal probe (PCPUNC15, Hu-Friedy, Chicago, Ill., U.S.) in order to verify the degree of bone crest resorption. If the distance was more than 5 mm, a nonresorbable d-PTFE mem- brane (Cytoplast TXT-200, De Ore, Negrar, Italy), adequately cut into an ice-cream cone shape,16 was introduced into the socket corresponding to the area of the missing buccal plate, in order to prevent soft-tissue proliferation. Subse- quently, the d-PTFE membrane was inserted into the socket with the narrower part facing the buccal soft tissue and stabilized with a cortico- cancellous particulate allograft biomaterial (Puros, Zimmer Dental, Carlsbad, Calif., U.S.), placed inside the socket using a curved stain- less-steel graft delivery syringe with a 4.5 mm funnel opening (ACE Surgical Supply, Brockton, Mass., U.S.; Fig. 2a). Then the wider part of the membrane was overturned above the bone graft and sutured with a 5-0 PTFE mattress suture (Cytoplast, De Ore) to the palatal and buccal mucosa, leaving it intentionally exposed (Fig. 2b). The patient was placed on an antibiotic reg- imen of 1 g of amoxicillin and clavulanic acid (Augmentin, GlaxoSmithKline, Verona, Italy) twice a day, starting the day before the surgery and continuing 7 days after, and an analgesic (ibuprofen, 600 mg) was prescribed if needed. All of the patients were instructed to rinse with 0.12% chlorhexidine 3 times a day for 1 min after brushing their teeth. No special indications were recommended for the area of the graft. After 5 weeks, the membrane was removed without the need for anesthetic, leaving the exposed site to heal by secondary intention (Fig. 3). After 6 months, a crestal incision was performed, then a full-thickness flap was ele- vated, and an implant of 4.0 mm in width and 11.5 mm in length was placed according to the manufacturer’s instruction (Full OSSEOTITE Tapered Natural, Implant Innovations, Palm Beach Gardens, Fla., U.S.; Fig. 4). The implant was submerged and the flap was sutured using a resorbable suture (4-0; Vicryl, Ethicon, Ohio, U.S.), obtaining a primary closure healing. After 4 months of healing, the implant was uncovered and the provisional prosthesis was immediately delivered. Four months later, the definitive metal- free crown was delivered and the occlu- sion was adjusted (Fig. 5). The patients were enrolled in a strict hygiene program and were followed up to 3 years after initial loading. The primary outcome measures were the success rates of the implants and prostheses and any surgical and prosthetic complications that occurred during the entire follow-up. An independent blinded assessor recorded all of the measurements and collected the related data according to the following criteria: – An implant was considered a failure if it pre- sented with any mobility, tested by tapping or rocking the implant head with a hand instru- ment and/or any signs of radiolucency and/or fracture on an intraoral radiograph taken with the paralleling technique strictly perpendicu- lar to the implant–bone interface. The implant stability was assessed at initial loading and at each follow-up. – A prosthesis was considered a failure if it needed to be replaced with a different type of prosthesis. – Complications: Any biological (pain, swelling, suppuration, etc.) and/or mechanical (fracture of the framework and/or the veneering mate- rial, screw loosening, etc.) complication was considered. The secondary outcome measures were dimen- sional changes in the alveolar ridge width, mar- ginal bone level changes and gingival recession. – The alveolar ridge width was measured to the nearest millimeter using a periodontal probe (PCPUNC156, Hu-Friedy) at the time of tooth extraction (T0), at implant placement (6 months later; T1), and at the time of implant 10 Volume 3 | Issue 4/2017 Journal of Oral Science & Rehabilitation