Flap or flapless surgical procedure for quick implant placement?


One concern throughout the quick placement of dental implants is the preservation of buccal bone throughout post-extraction bone remodelling. Anatomical components such because the width of the alveolar course of and thickness of buccal bone are thought of vital as is the elevating of a mucoperiosteal flap. Research have advised a destructive impact of flap surgical procedure on buccal bone remodelling in comparison with a constructive impression for flapless surgical procedure.

The goal of this overview was to check quick implant placement utilizing flap or flapless surgical procedure.


A protocol was registered with the PROSPERO database. Searches had been carried out within the Cochrane, Embase, PubMed, Net of Science and ClinicalTrials.gov databases. This was supplemented by searches within the journals, Journal of Medical Periodontology, Journal of Periodontology, Medical Implant Dentistry and Associated Analysis, Medical Oral Implants Analysis, Medical Oral Investigations, Worldwide Journal of Oral & Maxillofacial Implants, Worldwide Journal of Oral & Maxillofacial Surgical procedure. Two reviewers independently chosen research extracted knowledge and assessed high quality of the included randomised managed trials (RCTs) utilizing the Cochrane risk-of-bias software (RoB 2). Medical research in systemically well being sufferers age a least 18 years of age evaluating quick implant placement utilizing flap or flapless surgical procedure and printed in English had been thought of. The first final result was horizontal buccal bone change with implant survival, vertical buccal bone change, ache, and scientific and aesthetic parameters as secondary outcomes. meta- evaluation was carried out for final result variables that had been reported in three or extra included papers. Steady outcomes had been expressed as imply distinction (MD|) and 95% confidence intervals (CIs) and dichotomous outcomes as danger ratios (RR) with 95% CIs.


  • 5 RCTs involving a complete of 140 sufferers (140 implants) had been included.
  • Comply with up ranged from 6 to 12 months.
  • 4 research reported on implants positioned in anterior maxilla with only one examine together with mandibular websites.
  • Two research had been thought of to be at low danger of bias and three research at excessive danger.
  • 3 RCTs (flapless: 40; flap: 41) reported on horizontal buccal bone change (measured utilizing CBCT) with a meta-analysis exhibiting a imply distinction of 0.48 mm (95% CI: 0.13mm to 0.84mm), favouring flapless surgical procedure.
  • 5 research reported on implant survival with 2 failures reported (1 flap, 1 flapless), RR= 1.0(0.93 to 1.07).
  • 2 research reported on vertical bone change with outcomes favouring flapless surgical procedure.
  • Publish-operative ache was reported in 2 research – charges had been low in each teams by decrease within the flapless group.
  • Medical and aesthetic outcomes had been solely reported in a single examine.


The authors concluded: –

Primarily based on CBCT knowledge, flapless quick implant placement resulted in additional buccal bone preservation. Nevertheless, the scientific relevance of this discovering is unclear, since scientific and aesthetic outcomes had been underreported.


The authors registered their protocol on the PROSPERO database and undertook a searched of a great vary of databases.  Solely 5 small RCTs with a comparatively brief comply with up interval (3 trials of 6 months and a couple of of 12 months) had been included. As well as, 3 of the 5 included research had been assessed as being at excessive danger of bias. Whereas a meta-analysis of the principle outcomes of horizontal bone loss advised a profit in favour of flapless surgical procedure it is probably not clinically vital.  Nicely carried out and reported RCTs of applicable measurement and length can be wanted to make clear the advantages of 1 method over the opposite because the proof is at the moment unsure. Any research also needs to embrace related affected person reported outcomes.


Major Paper  

Pitman J, Christiaens V, Callens J, Glibert M, Seyssens L, Blanco J, Cosyn J. Speedy implant placement with flap or flapless surgical procedure: A scientific overview and meta-analysis. J Clin Periodontol. 2023 Jun;50(6):755-764. doi: 10.1111/jcpe.13795. Epub 2023 Mar 5. PMID: 36843361.

Overview protocol on PROSPERO

Different references

Dental Elf – 9th Jul 2014

Overview suggests little distinction in failure charges of quick or early loaded implants positioned utilizing a flapless method




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