Abstract
BackgroundInformation about the aesthetic effects of flapless in implant surgeries is scant. Differences of the survival rate (SR) and crestal bone loss (CBL) between the two techniques were also controversial. Thus, this review was aimed to compare the general and aesthetic effects of flapless and flap approaches in implant surgeries.Materials and methodsFollowing the principals of PRISMA, literature databases were searched for the eligible randomized controlled trials (RCTs) comparing the clinical performances of flap and flapless techniques. After that, relevant data of selected studies were pooled and analyzed to compare SR, bleeding on probing (BOP), probing depth (PD), visual analogue scale (VAS), papillae presentation index (PPI), keratinized mucosa (KM) width and CBL between the two techniques.ResultsFourteen RCTs were included. No significant difference was found in SR (RR = − 0.01, 95% confidence interval (CI) (− 0.05, 0.04)), BOP (OR = 0.40, 95% CI (0.15, 1.02)), KM width (WMD = − 0.42, 95% CI (− 1.02, 0.17)) between two groups. Subgroup analysis revealed that the difference of CBL was insignificant in two groups (WMD = − 0.13, 95% CI (− 0.63, 0.38)). However, flap techniques would lead more peri-implant PD (WMD = − 0.37, 95% CI (− 0.51, − 0.23)). Subgroup analysis also indicated lower VAS scores in flapless group after 1 day (WMD = − 1.66, 95% CI (− 2.16, − 1.16)) but comparable pain experience after 3 days (WMD = − 0.59, 95% CI (− 1.33, 0.16)). Mean difference of PPI (WMD = 0.32, 95% CI (0.28, 0.35)) between the two groups was significant.ConclusionsThe flapless procedure showed a superiority in preserving gingival papillae, reducing postoperative pain and peri-implant PD compared to the flap procedure, while exhibiting comparable effects on SR, BOP, KW width changes and CBL. Flapless technique is more recommended at the ideal soft and hard tissue implanting sites.
Highlights
Implant-supported restorations have become the primary treatments for missing teeth with great prognosis [1–3]
No significant difference was found in survival rate (SR) (RR = − 0.01, 95% confidence interval (CI) (− 0.05, 0.04)), bleeding on probing (BOP) (OR = 0.40, 95% Confidence interval (CI) (0.15, 1.02)), keratinized mucosa (KM) width (WMD = − 0.42, 95% CI (− 1.02, 0.17)) between two groups
Subgroup analysis revealed that the difference of crestal bone loss (CBL) was insignificant in two groups (WMD = − 0.13, 95% CI (− 0.63, 0.38))
Summary
Implant-supported restorations have become the primary treatments for missing teeth with great prognosis [1–3]. The traditional way to expose the bone was the flap technique with mucosa incision and flap elevation, which makes the surgery field more visible and allows guided bone regeneration. Flapless technique is a modified way to conduct implant procedures and it did not involve horizontal or vertical incisors for immediate and delayed implant placement. [5] Usually, the flap elevation step was omitted or the entrance to bone was created by a tissue punch device, drill preparation or immediate implant placement (IIP) [6]. Flapless procedure is considered as a more noninvasive approach to alveolar bone as there is no incision to cut the blood supply from bone membranes or soft tissues. This review was aimed to compare the general and aesthetic effects of flapless and flap approaches in implant surgeries
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