Flapless implant protocol had been used widely in our practice as a tool for performing minimally invasive dentistry. It provides numerous benefits, such as decreased trauma, short recovery time, less pain, reduced rate of infection, improved patient compliance. The following article shows important additional benefits: decreased bone loss and inflammation and improved vascularity. Despite these benefits, we recommend careful consideration when and if the protocol can be applied. 3D imaging is recommended to confirm the availability of bone for insertion of implant with specific size. In case of extraction with desired immediate implant placement, measuring the amount of buccal bone is detrimental. Failure to detect deficient buccal bone leads to late esthetic failures with immediate flapless implants. In these cases, flapless protocol can still be used but not for immediate implants (Dennis Tarnow's inverted cone technique for bone regeneration). Least but not last - even with confirmed bone dimensions, placement of implants without raising a flap requires a certain level of experience, skills and sensitivity of the surgeon's hand. This sensitivity, developed thru practice and analysis, relates to the density of the palatal bone compared to the buccal bone. Same as with the open flap protocol, the surgeon needs to have understanding of implant angulation from restorative point of view. It is harder to apply this principle, and it is easier to make a mistake, when you don't actually see the bone you are working with. The harm of bone perforation and late complications may outweigh the benefit of reduced bone loss with flapless implants. Therefore, choosing an experienced dentist is extremely important when looking for minimally invasive implant surgery.
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Histological study on the implant interface following flapless implantation
Presenter: Choi BH Wonju College of Medicine, Yonsei University, Wonju, Korea
Co-authors: Choi BH, Jeong SM, Xuan F, Kim HR, Mo DY
Wonju College of Medicine, Yonsei University, Wonju, Korea
Background and aim: While it has been shown that the exclu-
sion of the mucoperiosteal flap can prevent postoperative bone
resorption associated with flap elevation, there have only been a
few studies on the peri-implant mucosa following flapless
implant surgery. The purpose of this study was to compare the
morphogenesis and vascularity of the peri-implant mucosa
between flap and flapless implant surgeries by using a canine
mandible model.
Materials and methods: In six mongrel dogs, bilateral, edentu-
lated, flat alveolar ridges were created in the mandible. After 3
months of healing, two implants were placed in each side by
either the flap or flapless procedure. After another healing period
of 3 months, biopsies were obtained, prepared for light micro-
scopy, and exposed to morphometric measurements.
Results: The height of the mucosa, the length of the junctional
epithelium, the gingival index, the bleeding on probing, the
probing depth, and the marginal bone loss were all significantly
greater in the dogs that had the flap procedure than those that
had the flapless procedure (P < 0.05). The supracrestal connec-
tive tissue lateral to the implant was found to be more richly
vascularized in the flapless group than in the flap group.
Conclusion: These results indicate that gingival inflammation,
the height of junctional epithelium, and bone loss around non-
submerged implants can be reduced when implants are placed
without flap elevation. In addition, they suggest that the flapless
procedure may increase the vascularity of the peri-implant mucosa.
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