Preservation of marginal alveolar bone and width of the keratinized gingiva are vital for achieving prosthetic, orthodontic, aesthetic, and occlusal rehabilitation for implant placement. The aim was to evaluate the efficacy of buccal periosteal inversion technique (BUPI) in achieving primary closure in socket preservation, and minimizing soft tissue shrinkage and loss of keratinized gingiva following tooth extraction.

This was a single-center, prospective, comparative split-mouth study conducted at the Department of Oral & Maxillofacial Surgery, Mallareddy Dental College for Women, involving 42 patients. The inclusion criteria were atraumatic extraction of posterior teeth.

The key outcome variables assessed were the width of keratinized gingiva, soft tissue healing, buccolingual ridge width, pain levels, wound dehiscence, alveolar bone level, and bone density evaluated on the 1st day, 1st, 2nd, 6th weeks, and at 3 months post-extraction. Data analysis was performed using IBM SPSS version 25, with a p-value < 0.05 considered statistically significant. The BUPI technique demonstrated superior outcomes in terms of the preservation of keratinized gingiva width, soft tissue healing, buccolingual ridge width, wound dehiscence, and alveolar bone level. However, it was associated with higher pain on Day 1, while the open technique showed better bone density.

The BUPI technique was found superior to the open technique in promoting soft tissue healing, preserving keratinized gingiva, and minimizing bone changes after extraction, without the need of additional grafting materials, making it a more effective method for socket preservation.