Background: the current study investigated platelet rich fibrin and subepithelial connective tissue graft in preserving crestal bone and soft tissue around delayed implants.

Methods: Twelve participants with thin gingival biotype, were randomly assigned in two equal parallel groups. Both received delayed implant, augmented by subepithelial connective tissue graft versus platelet rich fibrin. Crestal bone level was measured at 3, 6 and 9 months. Gingival thickness and keratinized tissue width were measured at baseline, 3 and 6 months, pink esthetic score at 6 months, pain, swelling and patient satisfaction were reported after 7 days and at the end of the follow up period respectively.

Results: Both groups showed statistically significant improvement in all clinical outcomes at 3 and 6 months with no statistically significant difference at different observational periods. Subepithelial connective tissue graft showed statistically significant increase in gingival thickness and pink esthetic score compared to platelet rich fibrin after 6 months with no statistically significant difference regarding the crestal bone loss, keratinized tissue width, postoperative pain, swelling and overall patient satisfaction between both groups.

Conclusion: Inspite that PRF showed less values of crestal bone loss yet both treatment modalities could not prevent the postsurgical crestal bone loss to occur, with no statistically significant difference between them. Subepithelial connective tissue graft is effective at increasing the gingival thickness around delayed implants.

Clinical relevance: Both treatment modalities could be used safely around dental implant. Subepithelial connective tissue graft is more effective in thin phenotype for augmenting gingival thickness.