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VOLUME 23 , ISSUE 1 ( January, 2022 ) > List of Articles


Evaluation of Crestal Bone Loss in Flap vs Flapless Implant Placement Technique: An In Vivo Comparative Study

Prashant Mishra, Amrit Tandan, Ganiga C Shivakumar, Kapil Choudhary, Sahana Shivakumar, Navdha Sharma, Anurag Saxena

Keywords : Crestal bone loss, Delayed loading, Flapless surgery, Implants

Citation Information : Mishra P, Tandan A, Shivakumar GC, Choudhary K, Shivakumar S, Sharma N, Saxena A. Evaluation of Crestal Bone Loss in Flap vs Flapless Implant Placement Technique: An In Vivo Comparative Study. J Contemp Dent Pract 2022; 23 (1):56-60.

DOI: 10.5005/jp-journals-10024-3219

License: CC BY-NC 4.0

Published Online: 21-05-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Aims: The aims of the study were to assess the technique with-flap and flapless implant placement and to compare crestal bone heights around the implant in flapless and conventional flap technique using digital radiovisiograph, in 3 and 6 months after the surgery. Materials and methods: A total of 20 implants were placed by flap and flapless implant technique; each patient received two implants, except for two patients who received four implants. A radiovisiograph was taken at implant placement, as well as 3- and 6-month intervals. Crestal bone level was compared between flapless and flap during these intervals and compared between intervals for each group. Results: On evaluating the distribution, it was found to be asymmetric and hence lacked normality (K–S = 0.382; p <0.001). On mesial side, bone loss values in group I ranged from 0.40 to 1.10 units with a mean value of 0.71 and a standard deviation of 0.26 units. The median value was 0.70. On evaluating the data for normality, it was found to be symmetric and normal (K–S = 0.166; p = 0.200). Conclusion: This study concluded that there are not any significant differences in the crestal bone with both flap and flapless techniques. Comparatively, the flapless approach showed a lesser crestal bone height reduction, which was statistically significant. Clinical significance: Implant dentistry is nonetheless behind when advances are concerned, we have seen the inclination toward minimal invasive implant techniques to yield better esthetic as well as improved results, thus taking care of patients’ discomfort.

  1. Schropp L, Wenzel A, Kostopoulos L, et al. Bone healing and soft tissue contour changes following single-tooth extraction: a clinical and radiographic 12-month prospective study. Int J Periodontics Restorative Dent 2003;23(4):313–323. PMID: 12956475.
  2. Araújo MG, Lindhe J. Dimensional ridge alterations following tooth extraction. An experimental study in the dog. J Clin Periodontol 2005;32(2):212–218. DOI: 10.1111/j.1600-051X.2005.00642.x.
  3. Wilson TG Jr, Schenk R, Buser D, et al. Implants placed in immediate extraction sites: a report of histologic and histometric analyses of human biopsies. Int J Oral Maxillofac Implants 1998;13(3):333–341. PMID: 9638003.
  4. Botticelli D, Berglundh T, Lindhe J. Hard-tissue alterations following immediate implant placement in extraction sites. J Clin Periodontol 2004;31(10):820–828. DOI: 10.1111/j.1600-051X.2004.00565.x.
  5. Grunder U, Gracis S, Capelli M. Influence of the 3-D bone-to-implant relationship on esthetics. Int J Periodontics Restorative Dent 2005;25(2):1139. PMID: 15839587.
  6. Rocci A, Martignoni M, Gottlow J. Immediate loading in the maxilla using flapless surgery, implants placed in predetermined positions, and prefabricated provisional restorations: a retrospective 3-year clinical study. Clin Implant Dent Relat Res 2003;5(Suppl. 1):29–36. DOI: 10.1111/j.1708-8208.2003.tb00013.x.
  7. Hunt BW, Sandifer JB, Assad DA, et al. Effect of flap design on healing and osseointegration of dental implants. Int J Periodontics Restorative Dent 1996;16(6):582–593. PMID: 9242096.
  8. Fortin T, Bosson JL, Isidori M, et al. Effect of flapless surgery on pain experienced in implant placement using an image-guided system. Int J Oral Maxillofac Implants 2006;21(2):298–304. PMID: 16634502.
  9. Oh TJ, Shotwell J, Billy E, et al. Flapless implant surgery in the esthetic region: advantages and precautions. Int J Periodontics Restorative Dent 2007;27(1):27–33. PMID: 17370659.
  10. al-Ansari BH, Morris HR. Placement of dental implants without flap surgery: a clinical report. Int J Oral Maxillofac Implants 1998;13(6): 861–865. PMID: 9857599.
  11. Auty C, Siddiqui A. Punch technique for preservation of interdental papillae at nonsubmerged implant placement. Implant Dent 1999;8(2):160–166. PMID: 10635158.
  12. Gibney JW. Minimally invasive implant surgery. J Oral Implants 2001;27(2):73–76. PMID: 12498430.
  13. Marchack CB. CAD/CAM-guided implant surgery and fabrication of an immediately loaded prosthesis for a partially edentulous patient. Prosthet Dent 2007;97(6):389–394. DOI: 10.1016/S0022-3913(07)60028-6.
  14. Heydenrijk K, Raghoebar GM, Batcnburg RH, et al. A comparison of labial and crestal incisions for the 1-stage placement of IMZ implants: a pilot study. J Oral Maxillofac Surg 2000;58(10):1119–1123. DOI: 10.1053/joms.2000.9570.
  15. Ozan O, Turkyilmaz I, Yilmaz B. A preliminary report of patients treated with early loaded implants using computerized tomography guided surgical stents: flapless versus conventional flapped surgery. J Oral Rehabil 2007;34(11):835–840. DOI: 10.1111/j.1365-2842.2007.01772.x.
  16. Kleinheinz J, Buchter A, Kruse Losler B, et al. Incision design in implant dentistry based on vascularization of the mucosa. Clin Oral Implants Res 2005;16(5):518–523. DOI: 10.1111/j.1600-0501.2005.01158.x.
  17. Kemppainen P, Eskola S, Ylipaavalniemi P. A comparative prospective clinical study of two single-tooth implants: a preliminary report of 102 implants. J Prosthet Dent 1997;77(4):382–387. DOI: 10.1016/s0022-3913(97)70163-x.
  18. Kingsmill VJ, Boyde A. Mineralisation density of human mandibular bone: Quantitative backscattered electron image analysis. J Anat 1998;192(21):245–256. DOI: 10.1046/j.1469-7580.1998.19220245.x.
  19. Miyamoto I, Tsuboi Y, Takahashi K, et al. Enhancement of bone volume in guided bone augmentation by cell transplants derived from periosteum: an experimental study in rabbit calvarium bone. Clin Oral Imphints Res 2004;15(3):308–314. DOI: 10.1111/j.1600-0501.2004.01011.x.
  20. Al-Juboori MJ, Bin Abdulrahaman S, Jassan A. Comparison of flapless and conventional flap and the effect on crestal bone resorption during a 12-week healing period. Dent Implantol Update 2012;23(2):9–16. PMID: 22338850.
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