Comparison of flap and flapless procedures for the stability of chemically modified SLA titanium implants: an experimental study in a canine model.

BACKGROUND: Flapless implant surgery has been shown to accelerate recovery and increase the vascularity of the peri-implant mucosa after implant placement. OBJECTIVE: The aim of this study was to compare dental implant stabilization patterns between flap and flapless implant surgeries over the first 8 weeks after implant placement. STUDY DESIGN: In 6 mongrel dogs, bilateral, edentulated, and flat alveolar ridges were created in the mandible. After 3 months of healing, 2 implants (Straumann SLA-active) were placed in each side of the mandible using either a flap or flapless procedure. The implant stability quotient (ISQ) that was obtained from Osstell Mentor was measured at the time of implantation and weekly over the first 8 weeks after implant placement. RESULTS: Implants stabilized more quickly without flap elevation than with flap elevation. For flapless implants, an increase in stability occurred after 2 weeks without a period of decreasing stability. However, for flap implants, a shift in implant stability from decreasing stability to increasing stability occurred after 2 weeks. CONCLUSION: In the canine model, flapless surgical placement of implants may increase the initial stability of implants compared with implants placed after the reflection of the mucoperiosteal flap.

A comparative study on the extractions of partially impacted mandibular third molars with or without a buccal flap: a prospective study.

PURPOSE: The present report describes a flapless extraction method for partially impacted mandibular third molars and compares the effects of flap and flapless extractions of the teeth in terms of postoperative pain, swelling, and pocket depth of the second molar. PATIENTS AND METHODS: A prospective study was performed of 27 patients who underwent bilateral extraction of partially impacted mandibular third molars. Two molars in the same patient were extracted on each side, either with or without a buccal flap. RESULTS: The postoperative pain, swelling, and pocket depth of the second molar were all significantly greater on the side that underwent flap extraction than on the side that underwent flapless extraction (P < .05). CONCLUSIONS: Our results support the clinical use of flapless extractions when the distal surface of the crown is completely anterior to the anterior border of the mandibular ramus and the occlusal surface of the impacted tooth is level or nearly level with the occlusal plane of the second molar.

A 1-year prospective clinical study of soft tissue conditions and marginal bone changes around dental implants after flapless implant surgery.

BACKGROUND: Despite several reports on the clinical outcomes of flapless implant surgery, limited information exists regarding the clinical conditions after flapless implant surgery. OBJECTIVE: The objective of this study was to evaluate the soft tissue conditions and marginal bone changes around dental implants 1 year after flapless implant surgery. STUDY DESIGN: For the study, 432 implants were placed in 241 patients by using a flapless 1-stage procedure. In these patients, peri-implant soft tissue conditions and radiographic marginal bone changes were evaluated 1 year after surgery. RESULTS: None of the implants were lost during follow-up, giving a success rate of 100%. The mean probing depth was 2.1 mm (SD 0.7), and the average bleeding on probing index was 0.1 (SD 0.3). The average gingival index score was 0.1 (SD 0.3), and the mean marginal bone loss was 0.3 mm (SD 0.4 mm; range 0.0-1.1 mm). Ten implants exhibited bone loss of >1.0 mm, whereas 125 implants experienced no bone loss at all. CONCLUSION: The results of this study demonstrate that flapless implant surgery is a predictable procedure. In addition, it is advantageous for preserving crestal bone and mucosal health surrounding dental implants.

Effects of soft tissue punch size on the healing of peri-implant tissue in flapless implant surgery.

OBJECTIVE: In an attempt to help produce guidelines for the use of soft tissue punches, this animal study was undertaken to examine the effects of soft tissue punch size on the healing of peri-implant tissue in a canine mandible model. STUDY DESIGN: Bilateral, edentulous, flat alveolar ridges were created in the mandibles of 6 mongrel dogs. After a 3-month healing period, 3 fixtures (diameter 4.0 mm) were placed on each side of the mandible using 3-mm, 4-mm, or 5-mm soft tissue punches. After subsequent healing periods of 3 weeks and 3 months, the peri-implant mucosa was evaluated using clinical, radiologic, and histometric parameters, which included gingival index, bleeding on probing, probing pocket depth, marginal bone loss, and vertical dimension measurements of the peri-implant tissues. RESULTS: The results obtained showed significant differences (P < .05) between the 3-mm, 4-mm, and 5-mm tissue punch groups for the length of the junctional epithelium, probing depth, and marginal bone loss at both 3 weeks and 3 months after implant placement. When the mucosa was punched with a 3-mm tissue punch, the length of the junctional epithelium was shorter, the probing depth was shallower, and less crestal bone loss occurred than when using a tissue punch with a diameter >or=4 mm. CONCLUSIONS: The results show that the size of the soft tissue punch plays an important role in achieving optimal healing. The findings support the use of a tissue punch slightly narrower than the implant itself to obtain better peri-implant tissue healing around flapless implants.