Flapless Surgery Research Articles

Flap versus flapless surgery

Flap versus flapless surgery

Survival rate of dental implant placement by conventional or flapless surgery in controlled type 2 diabetes mellitus patients: A systematic review.

Dental implant may serve as a choice of treatment for replacement of missing tooth in diabetic patients with their well-controlled glycemic index. To minimize postoperative complications, dental surgical procedures comprises mainly two types, namely conventional and flapless surgery. The aim of this review is to find the survival rate of the dental implant when placed with either of the technique, that is, conventional or flapless in patients with controlled Type 2 diabetes mellitus from published studies. A total of 14 studies were included from PubMed database related to the survival rate of dental implant placement by conventional or flapless surgery among patients with controlled diabetes mellitus. The cumulative mean of dental implant survival rate by conventional and flapless techniques calculated from included studies is 94.2% and 92.3%, respectively. The survival rate of dental implant placement by conventional and flapless techniques is similar. As few studies on flapless technique are available, therefore researchers in future should explore its advantages and disadvantages.

Short dental spiral implants placed by a progressive steps technique in the atrophic posterior maxilla – a personal 10 years follow‐up on 80 implants

Background A recent analysis of the literature shows a growing evidence on the utility of short dental implants (<10 mm) in clinical situations of limited vertical bone height. The most challenge situation is the atrophic posterior maxilla with a residual bone height radiographically ranging from 4.5 to 6 mm. Several surgical techniques and implant morphologies have been suggested in the past to avoid sinus floor elevation, with its postoperative morbidity, higher costs and higher risks of complications. Aim/Hypothesis This report describes a new surgical procedure used for the placement of 80 short spiral implants <10 mm (SPI and ICE implants, Alpha-bio, Israel) by a progressive steps drilling in the posterior maxilla for single tooth restoration, with a follow-up of 10 years. Material and Methods Inclusion criteria was a residual vertical bone height, measured on CT or CBCT, minimum of 4.5 mm (ranging from 4.5 to 6 mm). No data regarding osteoporosis in females where collected as retained unnecessary. Surgery was flapless in 50 cases with low speed bone drilling and irrigation+ no adjunctive bio-material has ever been used+ progressive steps surgical technique (step one-first 2 mm drill of 2 till to the sinus floor with its slow and atraumatic drilling, minimal perforation probed with gauge always with Valsalva test negativity – step two – 2.8 mm drill used only for 2–4 mm – step three – 3.2 mm drill used only for 2 mm in depth) was performed in all cases, without any adjunctive technique, with high insertion torque (up to 50 Ncm). Prostheses were placed 3 months later and were cemented metal-ceramics crowns in 40 cases and screwed hybrid ceramics crowns (Vita Enamic) in the remaining cases+ 35 implants were 6.25 mm in length and the remaining 8 mm all with a diameter of 4.1 mm. Results In all cases a spiral implant longer (from 2 up to 4 mm) than the length pre-operative measured was inserted. One implant was lost 30 days after placement for lack of osseointegration and another implant for parodontal infection of the adjacent tooth, both placed by flapless surgery with healing cap positioning+ one implant showed perimplantitis related to poor hygiene with bone loss around fixture but without mobility, and is still in follow-up. In the remaining cases a good perimplant bone level was always preserved during the follow-up till to date. Spiral implants, even though reduced in length (6.25 mm up to 8 mm), if placed by the surgical technique proposed in this report, promote an excellent bone dislocation in apical direction during implant insertion. The latter provides an increase of exploitable vertical dimension compared to the one measured on radiograms, leading contextually to the insertion of a longer implant and to a high primary stability of the fixtures. Conclusions and Clinical Implications With this report a protocol including spiral morphology of the implant, progressive steps fixture placement, in addition single screwed hybrid ceramics crowns, is suggestable for the single tooth restoration of the posterior maxilla. The suggested protocol shows good results in term of simplicity, predictability, durability and above all acceptability by the patients of such kind of implant treatments for the posterior atrophic maxilla.

Risks for flapless surgery

Flapless implant surgery has been suggested as a possible treatment option. The goal of a flapless implant approach is to provide function, esthetics, and comfort with a minimally invasive surgical technique in a reduced operative time, resulting in accelerated postsurgical healing, and increased patient comfort and satisfaction. In an attempt to provide accurate and predictable clinical outcomes, various surgical protocols have been introduced to the market. Scientific information regarding accuracy of implant placement and surgical and prosthetic complications is highly relevant as it provides evidence to implement this surgical technique predictably in a clinical scenario. The aim of this presentation is to cover the potential benefits and risks of such surgical technique.

Do Implant Surgical Guides Allow an Adequate Zone of Keratinized Tissue for Flapless Surgery?

A major advantage of guided implant surgery using 3-dimensionally printed guides is the ability to perform accurate flapless surgery.A drawback of a flapless technique is the inability to manipulate soft tissue to ensure sufficient gingiva around the implant. The purpose of this study was to determine how often flapless surgery using surgical guides results in less than 2mm of keratinized tissue surrounding the implant. This retrospective analysis included 27 maxillary and 27 mandibular implant sites that underwent treatment planning for implant-guided surgery using 3Shape Implant Studio (3Shape, Copenhagen, Denmark).Intraoral scan images were used to measure the width of the keratinized tissue on the buccal aspect of each implant site in both arches and the lingual aspect in the mandibular arch. Three examiners measured the amount of buccal and lingual keratinized tissue in millimeters at each implant site. Analysis of variance (P<.05) and correlation coefficients were used to determine statistically significant differences in keratinized tissue among sites. No statistically significant difference was found either between the widths of buccal keratinized tissue in the maxillary anterior (4.06±1.42mm) and posterior (4.93±2.54mm) areas (P=.293) or between the amounts of buccal and lingual keratinized tissue in the mandible (P=.995). The keratinized tissue width in the maxillary buccal area was significantly different (4.48±2.04mm) from that in the mandibular posterior buccal (1.98±1.41mm) and lingual (1.98±1.23mm) areas (P<.001). Over 77% of maxillary implant sites had greater than 3mm of gingiva, and just over 20% had sufficient gingiva in the mandible. Adequate keratinized tissue was found in most of the planned maxillary implant sites, whereas most of the mandibular posterior implant sites had inadequate keratinized tissue. Therefore, elevation of a flap to preserve and reposition existing keratinized tissue around implants should be considered when planning to use tooth-borne surgical guides in the posterior mandible.

Flapless boning to increase space by piezosurgery: A novel mini-invasive strategy for teeth extraction. A retrospective study.

This study aimed to investigate the application of piezosurgery-associated flapless surgery for increasing bone space during teeth extraction and evaluate its success rate, postoperative outcomes, and incidence of major complications.From January 2014 to December 2016, patients who experienced teeth extraction via piezosurgery-associated flapless surgery were enrolled in this study. The positions, diagnosis, dental medical history, and radiographic examination of teeth were recorded before the treatment. During the surgery, the fracture or displacement of root, injuries of soft tissue, and fractures of the alveolar process were noted.A total of 140 patients fulfilled the eligibility criteria in the present study. All these teeth were classified into 4 groups based on diagnosis: residual roots that underwent root canal therapy (28 cases), teeth with root fracture (37 cases), teeth extraction because of orthodontics needed (31 cases), and the vertically impacted lower third molar (44 cases). The radiographic presentation revealed about 50% ankylosed teeth. No root fracture and root displacement emerged, and all roots were removed intact. Moreover, fracture of the alveolar process did not occur. Two cases with buccal mucosal injury were noted, which were because of heat injuries caused by the basement of the tip while cool water was used out.This study introduced a novel mini-invasive strategy for increasing space during teeth extraction. The advantage of this piezosurgery-associated flapless surgery included maximal preservation of the alveolar bone, minimal injury to soft tissues, and prevention of root fracture during the surgery. Furthermore, the cool water used during the surgery must be carefully checked before the procedure.

Comparing Masticatory Efficiency of Mandibular Bar-Supported Overdentures with Different Loading Protocols

Purpose: The study aimed to compare progression of masticatory efficiency associated with mandibular bar-supported overdentures either retained by immediately or delayed loaded two implants.Material and Methods: A total 12 completely edentulous patients with persistent complaints from their complete mandibular dentures were chosen. Each participant received two dental implants of (3.8 mm x 12 mm) bilaterally using computer-guided flapless surgery. The participants were grouped according to the bar attachment design into two equal groups. Group SB: six participants received mandibular overdenture supported by immediately loaded two implants connected with prefabricated SFI-Bar system. Group CB: six participants received mandibular overdentures supported by delayed loaded two implants splinted with conventional cast Co-Cr bar attachment. Glucose extraction method was performed to objectively measure the masticatory efficiency for each patient at different time points including; including; one week after implant-bar connections connections (T0), six months after implant-bar connections (T6), and 12 months after implant-bar connections (T12). Results: There were statistically significant difference of masticatory efficiency between the (SB) and, (CB) (P=.004 and P=.001 respectively). Starting from T0, the findings showed highly statistical significance (P=0.000) in improving the masticatory efficiency at (T6) and (T12) respectively. Conclusion Regardless the limitations of this clinical study, it can be conclude that restoring edentulous patient with mandibular overdenture assisted with bar improves the masticatory efficiency with a noticeable statistical improvement of masticatory efficiency for immediate versus delayed loading protocol.

Specificities of Molars Replacement by Implants Supported Crowns

This article describes a case report of rehabilitation of missing two mandibular molars using implants supported crowns and a flapless surgery A year old female patient with defective mandibular bridge was referred to the department of fixed prosthodontics at Dental Clinic of Monastir The edentulous ridge was measured and it was suitable for adequate dimensions two molars The adjacent tooth was vital and prepared the third molars wax extracted Radiographic evaluation showed the feasibility of implant placement in the edentulous site A flapless surgery technique was performed for implant placement The implant supported crown was cemented using Zinc phosphate cement A metal ceramic crown was realized for the second premolar

Crestal Bone Changes around immediately loaded Single-piece Implants using Flap and Flapless Technique: A Radiographic Study

With the trend shifting toward the minimally invasive surgeries in implant surgery, the flapless technique of implant placement is gaining popularity among the implantologists. This study was done to assess the crestal bone loss level in flap and flapless surgery at follow-up periods of 0, 1, and 3 months. Patients presenting with missing teeth requiring dental implants for rehabilitation were included in the study. Implant placement was done in 10 patients with traditional flap technique, while in other 10 patients, flapless technique was performed after determining the availability of sufficient bone width with ridge mapping. Radiographical follow-up was done for 3 months at 0-, 1-, and 3-month intervals. It was observed that for most of the flapless cases, the bone loss settled at 1st thread or just below the implant collar after 3 months. It was seen that crestal bone height was reduced in both flap and flapless techniques. On comparing the bone loss, the flapless approach showed statistically significant lesser reduction as determined by radiovisiography. The study has been done to evaluate crestal bone level using flap and flapless technique. It was seen that reduction of crestal bone height was seen in both flapless and with flap techniques. However, on comparison, less bone resorption was observed in flapless technique.

Double Guided Surgery in All-on-4® Concept: When Ostectomy Is Needed.

Background The rehabilitation of edentulous jaws with guided and flapless surgery applied to the All-on-4 concepts is a predictable treatment with a high implant and prosthetic survival rates, but there are several contraindications for this technique like when bone reduction is needed due to a high smile line in the maxilla or when there is an irregular or thin bone crest. Purpose To report a technique with double guided surgery for bone reduction and implant placement with the All-on-4 concept. Materials and Methods 7 patients were included in the study. Guided implant planning was performed using CBCT, and the virtual templates were created with three dedicated software. Custom surgical templates were made for the ostectomy and for implants positioning. Results 28 implants were placed using a double bone-supported surgical guide. The mean angular errors between the preoperative-planned implant and the postoperative-placed implant were 2.155° ± 2.03°; the mean distance errors between the planned and the placed implants were 0.763 mm ± 0.55 mm on the shoulder implant and 0.570 mm ± 0.40 mm on the apex implant. Conclusions The results of our study indicate that this treatment is predictable with an excellent survival rate allowing excellent results even when bone reduction is mandatory.

Effect of 2 Different Drilling Speeds on the Osseointegration of Implants Placed With Flapless Guided Surgery: A Study in Rabbits.

The aim of this study was to evaluate the influence of the drilling speed on bone healing and the osseointegration of implants placed with a guided flapless surgical technique in rabbit tibias. For the evaluation of bone healing, a total of 30 perforations (defects) were made in both tibias of 15 rabbits using 2 different drilling speeds (1500 rpm-control group; 50 rpm-test group). The regeneration of bone tissue in the surgical sites was evaluated at 0, 7, and 14 days. For the evaluation of implant osseointegration, another 15 rabbits underwent drilling in both tibias for implant placement. Thirty implants (3.75 × 10 mm) were placed to evaluate osseointegration at 4, 8, and 12 weeks after surgery. Both groups showed a progressive healing of the defect, which involved the complete closure of the perforation. The osseointegration occurred in all groups with no statistically significant differences in the assessment of the osseointegration between the groups. In the experimental models used, the drilling speed does not prejudice the pattern of bone healing and osseointegration of implants placed with guided flapless surgery.

The effect of stereolithographic‐guided flapless surgery on implant success

The effect of stereolithographic‐guided flapless surgery on implant success

In-Office Guided Implant Placement for Prosthetically Driven Implant Surgery.

Application of surgical stents for implant placement via guided flapless surgery is increasing. However, high cost, need for some professional machines, and not taking into account the soft-tissue parameters have limited their application. We sought to design and introduce a technique named in-office guided implant placement (iGIP) to decrease the cost by using available devices in office and enhance the applicability of surgical stents. A customized surgical stent was fabricated based on prosthetic, soft- and hard-tissue parameters by taking into account the amount of available bone (using the computed tomographic [CT] data), soft-tissue thickness and contour (using a composite-covered radiographic stent), and position of the final crown (by diagnostic cast wax up and marking the final crown position with composite). The efficacy of iGIP, in terms of the accuracy of the three-dimensional position of the implant placed in the study cast and in patient's mouth, was confirmed by direct observation and postoperative CT. The iGIP can enhance implant placement in the prosthetically desired position in various types of edentulism. Using this technique minimizes the risk of unwanted consequences, as the soft-tissue thickness and contour are taken into account when fabricating a surgical stent.

Pre-surgical Provisional Prosthesis for Immediate Non-occlusal-loaded Flapless Implant.

A 49-year-old patient reported for immediate replacement of missing maxillary anterior teeth with implant-retained prosthesis. Elevation of flap alters the mucosal level, causes discomfort, and delays the restorative procedure. To maintain the esthetics, flapless surgery was planned. Since placement of an implant is pre-planned in a predetermined site, fabrication of the prostheses before commencement of the surgery, especially when replacing the teeth in the anterior region, could be a viable option. This case report explains the method of fabrication of the provisional restoration for flapless surgery in the presurgical phase. The technique would avoid any micromotion and implant instability caused due to abutment preparation and impression procedure postsurgically.

Morse Taper Implants Immediately Loaded in Fresh Extraction Sockets: A Prospective Cohort Study.

To evaluate survival rate and bone response around immediate loaded Morse taper implants installed in fresh sockets on the anterior area of the maxilla. The sample comprised 16 patients in whom 16 single implants were installed. All the teeth were extracted in a flapless surgery. Radiographic and tomographic evaluations were performed immediately after surgery (T1) and after 12 months (T2). The variables studied were height of the buccal wall (HBW), buccal wall width (BW) at 3 levels, and proximal bone height at 2 different areas: the alveolar crest level (CLH) and at the point where bone tissue meets the implant surface (BIS). Statistically significant differences were observed. The buccal plate showed bone loss in height (HBW = -0.50 ± 0.42 mm) and in width (BW-1 = -0.71 ± 0.48 mm; BW-2 = -0.48 ± 0.34 mm; BW-3 = -0.48 ± 0.34 mm). In the proximal areas, there was also bone loss in height (CLH-M = -0.85 ± 0.89 mm; BIS-M = -0.91 ± 0.70 mm; CLH-D = -0.64 ± 0.57 mm; and BIS-D = -0.68 ± 0.62 mm). There was 100% survival rate after a 12-month period, but bone loss was observed in all evaluated areas.

Immediate implant placement and restoration in the anterior maxilla: Tissue dimensional changes after 2-5 year follow up.

Immediate implant placement followed by an immediate restoration has proven to be a viable technique in the anterior maxillary region. This prospective study evaluated the mid-long term (2-5 years) tissue changes around immediately placed and restored implants in the anterior maxilla using flapless surgery and simultaneous hard tissue augmentation. Thirty AstraTech implants were immediately placed in 30 patients, followed by the delivery of an immediate provisional restoration on the same day. All participating 30 patients underwent the same treatment strategy that involved flapless removal of a failing maxillary anterior tooth, immediate implant placement, simultaneous augmentation with a deproteinized particulate xenograft, followed by the connection of a screw-retained provisional restoration. Radiographs and photographs were used to measure hard and soft tissue changes. Aesthetic evaluation was performed using the Pink Esthetic Score (PES). All implants remained osseointegrated during the follow up period of 2-5 years (mean 47 ± 15 months). Twelve of the thirty patients completed the 5 year follow up. Radiographic evaluation revealed average gains in bone levels of 0.18 and 0.34 mm mesially and distally, respectively. Soft tissue evaluation showed a mean tissue loss of 0.05 ± 0.64 mm and 0.16 ± 0.63 mm at the mesial and distal papillae, respectively, while mid-facial mucosal recession was 0.29 ± 0.74 mm. A significant improvement in the Pink Esthetic Scores was seen at the final follow-up (mean PES 11.50), as compared to the baseline (mean PES 10.27) (P = .001). In addition to a favorable implant success rate and peri-implant bony response, the soft tissue levels and overall aesthetics around single immediately placed and restored implants can also be maintained in the mid-long term.

Correction of Buccal Dehiscence During Immediate Implant Placement Using the Flapless Technique: A Tomographic Evaluation.

The aim of this study was to evaluate a new technique for treating dehiscence buccal bone sites (Class II) with immediate implant and collagen-enriched bovine-derived xenograft blocks without a surgical flap or membrane. Individuals with at least 5 mm of buccal bone dehiscence were selected for a flapless surgical approach to insert xenograft blocks into buccal dehiscence defects as well as the gap between implant and residual bone wall. No membrane was used. Buccal bone wall height was measured by computed tomography in the preoperative period (T0) and 6 to 12 months after procedure (T1). Likewise, buccal-lingual width of alveolar ridge as well as thickness of buccal wall was compared with the contralateral tooth. Fourteen patients were selected. Buccal wall height at T1 was not significantly different after 6 to 12 months between the treated and contralateral teeth, although both were greater than T0 (P <0.01). The heights ranged from 6.4 to 16.30 mm at T0, 12.8 to 25.6 mm at T1, and 14.8 to 25.29 mm in the contralateral teeth. Significant differences were observed between treated teeth (T1) and their contralateral, both buccal-lingually in the alveolar ridge (P = 0.007) and in buccal wall thickness (P = 0.003). Wall thickness ranged from 0.9 mm to 3.81 mm at T1 and 0.25 mm to 1.60 mm in the contralateral teeth. Immediate implant placement at dehiscence buccal bone sites using flapless surgery combined with xenograft blocks provided complete formation of the buccal bone wall up to the implant shoulder.

A pilot clinical study of immediate provisionalization with a chairside computer aided design and computer aided manufacture monolithic crown for single tooth immediate implant placement

Objective: To evaluate the primary clinical outcomes of immediate provisionalization with a monolithic crown utilizing a novel chairside computer aided design and computer aided manufacture (CAD/CAM) workflow for single tooth immediate implant placement. Methods: This pilot study was a prospective within-subjects design. Thirteen consecutive patients were included and diagnosed with untreatable single incisor or premolar with fine general and local anatomical conditions. The trial was conducted at Department of Implantology, Peking University School and Hospital of Stomatology, Beijing, between January 2016 and June 2016. The teeth were extracted atraumatically and implants were immediately placed in the fresh sockets. Two screw-retained interim crowns were fabricated for the same site utilizing different workflows, a monolithic lithium disilicate (LS2) crown produced by CEREC (Sirona, Germany) chairside CAD/CAM system (CER group) and a manually fabricated resin crown utilizing conventional workflow (CONV group) respectively. The patients were blinded to the group allocation of the two interim crowns. After the clinical try-in for both crowns in a randomized sequence, the patients' level of satisfaction was assessed with a virtual analogue scale (VAS) questionnaire. The restorations chosen by patients themselves were seated in the implants by one experienced prosthodontist. The accuracy, aesthetic effect and clinical time consumption of both groups were compared. Statistical analyses were performed with the Wilcoxon signed rank test. Results: All patients were treated with atraumatic tooth extraction, immediate implant placement using flapless surgery and immediate provisionalization in a single visit. The interim crowns of both groups could be fitted with or without slight adjustments. For each patient, the interim crown of CER group was chosen to be seated with a relatively higher VAS result. The white esthetic score (WES) results demonstrated no statistically significant difference between CER group (7.5±1.1) and CONV group (7.9±0.9) (P>0.05). The mean total work time was significantly different resulting in (131.9±5.0) min for CER group and (205.2±6.3) min(P<0.05). The major difference lied in the laboratory work time, resulting in (113.5±6.3) min for CER group which was significantly shorter than (185.6±6.6) min for CONV group. As for impression taking time, the CER group (7.5±0.8) min was significantly shorter than CONV group (11.7± 1.1) min (P<0.05). However, analysis for clinical adjustment time showed a significantly longer time for CER group [(11.0±2.1) min vs (8.0±2.8) min, P<0.05]. After 3-6 months of observation, the overall survival rate was 100%. Screw loosening occurred in 4 patients and was tightened again. No other major complication soccurred. Conclusions: The full digital workflow utilizing CEREC chairside CAD/CAM system to fabricate interim crowns after immediate implant placement in one single visit was feasible. It was more time-efficient and could effectively shorten the laboratory work time compared to the conventional workflow. Patients demonstrated high satisfaction and there was no statistical difference in WES results compared to the conventional workflow. Favorable clinical outcomes were gained in this short-term follow-up study.

Clinical parameters of implants placed in healed sites using flapped and flapless techniques: A systematic review.

BackgroundDental implant placement using flapless surgery is a minimally invasive technique that improves blood supply compared with flapped surgery. However, the flapless technique does not provide access to allow bone regeneration.ObjectivesThe aim of this systematic review was to evaluate the clinical parameters following implant surgery in healed sites, using two procedures: flapped vs. flapless surgery.Material and MethodsA detailed electronic search was carried out in the PubMed/Medline, Embase and Cochrane Library databases. The focused question was, “How do flapped and flapless surgical techniques affect the clinical parameters of dental implants placed in healed sites?”. All the studies included with a prospective controlled design were considered separately, depending on whether they had been conducted on animals or humans. The following data were recorded in all the included studies: number of implants, failures, location (maxilla, mandible), type of rehabilitation (partial or single), follow-up and flap design. The variables selected for comparison in the animal studies were the following: flap design, gingival index, mucosal height, recession and probing pocket depth. In humans studies the variables were as follows: flap design, plaque index, gingival index, recession, probing pocket depth, papilla index and keratinized gingiva.ResultsTen studies were included, six were experimental studies and four were clinical studies. Studies in animals showed better results using the flapless technique in the parameters analyzed. There is no consensus in the clinical parameters analyzed in human studies, but there is a trend to better results using flapless approach.ConclusionsThe animal studies included in the present review show that implants placed in healed sites with a flapless approach have better clinical parameters than the flapped procedure in a short-term follow-up. In human studies, there is no consensus about which technique offer better results in terms of clinical parameters. Therefore, more research in humans is required in order to overcome the limitations and contrast these results. Key words: Clinical parameters, gingival recession, probing depth, dental implants, flap, flapless.

Increasing volume of vestibular soft tissues in flapless implant surgery through a modified connective punch technique: a controlled clinical trial.

The aim of this article is to make a comparative assessment between the modification of the soft-tissue profile, around the healing cap screws (HCSs), following both the traditional flapless surgery (TFS) and a new modified flapless surgery, named Modified Connective Tissue Punch (MCTP) technique. 8 patients (3M and 5F) (mean age 54.25±11.247 years) were enrolled in this study. Sixteen two-piece implants were placed on upper jaws, 2 for each patient, 8 with TFS and 8 with MCTP technique. In each patient the implants were placed in edentulous areas, of 2 or 3 adjacent teeth long. MCTP technique was performed on the front implant site (FIS) while the TFS was performed on the rear implant site (RIS). All implants were inserted and covered with healing cap screws (HCSs). Alginate impressions were carried out at the moment of the surgery, at 1 month and 4 months post-operative. Plaster models were poured and subsequently digitally scanned, in order to measure the distance between the gingival outline and the free margin of the HCS. The recorded values were analyzed with the ANOVA test. The use of MTCP technique, in comparison to TFS, showed a significative better outcome, in terms of vertical increments, of gingiva, on the VS toward the HCSs, during the entire observation period (p = 0.000 for all). The Authors recommend the use of MCTP technique for a better vestibular soft tissue outcome in flapless implant surgery.