Abstract
The purpose of this study was to compare changes at the marginal bone level adjacent to implants placed with flapless surgery and flap surgery during a stress-free healing period. Seven hundred and eighty-five implants were placed in 417 patients with a flapless approach and 459 implants were placed in 227 patients using flap techniques. The marginal bone level was determined radiographically, using digitized panoramic radiographs, at two time points: at implant placement (baseline) and after the healing period. The median follow-up time was 0.5 years (SD, 1.2; range: 0.3-0.7). Implants placed with flapless surgery had a mean crestal bone loss of 0.5 mm (SD, 0.5; range: -0.7-2.4) and implants placed with flap surgery had a mean bone loss of 0.5 mm (SD, 0.7; range: -2.0-3.0) after healing. Differences in bone level changes between smokers and non-smokers were statistically significant for the flapless group (P<0.01). A radiographic evaluation of marginal bone levels adjacent to implants showed comparable results for implants placed with flapless surgery and flap surgery. Appropriate case selection after virtual planning of the implant position and a sound surgical protocol is necessary for flapless surgery. Smoking habits may compromise the efficacy of flapless implant procedures.
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