Comparison of General and Aesthetic Effects Between Flapless and Flap Techniques in Dental Implantation: a Meta-analysis of Randomized Controlled Trials

Overview

Journal Int J Implant Dent

Publisher Springer

Specialty Dentistry

Date 2021 Oct 1

PMID 34595691

Citations 5

Authors

Xiaomeng Gao

Siyu Qin

He Cai

Qianbing Wan

Affiliations

Soon will be listed here.

Abstract

Background: Information 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 Methods: Following 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.

Results: Fourteen 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.

Conclusions: The 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.

Citing Articles

A Comprehensive Analysis of Flapless and Conventional Flap Technique in Dental Implant Surgery - A Comparative Study.

Chandrshekhar V, Shetty A, Hemavathi U, Iyengar A, Rodrigues N, Suryavanshi S Ann Maxillofac Surg. 2025; 14(2):147-153.

PMID: 39957865 PMC: 11828072. DOI: 10.4103/ams.ams_74_24.

A narrative review of papilla preservation techniques in clinical dentistry.

Fu Y, Zhang Z, Tang X, Su J Medicine (Baltimore). 2025; 104(3):e41033.

PMID: 39833085 PMC: 11749603. DOI: 10.1097/MD.0000000000041033.

Advantages of using touch-controlled, minimally invasive implantation technique on soft tissue in the aesthetic zone of maxillary anterior teeth.

Li W, Ruan N, Tian Y, Li S, Boldbaatar D, Badral B Medicine (Baltimore). 2024; 103(50):e40051.

PMID: 39686453 PMC: 11651473. DOI: 10.1097/MD.0000000000040051.

Comparative Evaluation of Hard- and Soft-tissue Changes in Immediate Implant Placement Using Flapless Approach with and without Demineralized Freeze-dried Bone Allograft Clinically and Radiographically Using Cone-beam Computed Tomography.

Purohit M, Kolte A, Kolte R, Trivedi D Contemp Clin Dent. 2024; 15(3):158-166.

PMID: 39512299 PMC: 11540209. DOI: 10.4103/ccd.ccd_246_23.

Effects of flapless and flapped implantations on soft tissue: a systematic review and Meta-analysis.

Chen Y, Sun C, Li H Hua Xi Kou Qiang Yi Xue Za Zhi. 2024; 42(3):382-393.

PMID: 39049660 PMC: 11190870. DOI: 10.7518/hxkq.2024.2023341.

References

Bashutski J, Wang H, Rudek I, Moreno I, Koticha T, Oh T . Effect of flapless surgery on single-tooth implants in the esthetic zone: a randomized clinical trial. J Periodontol. 2013; 84(12):1747-54. DOI: 10.1902/jop.2013.120575. View

Papi P, Penna D, Di Murro B, Pompa G . Clinical and volumetric analysis of peri-implant soft tissue augmentation using an acellular dermal matrix: A prospective cohort study. J Periodontol. 2020; 92(6):803-813. DOI: 10.1002/JPER.20-0219. View

Wadhwa B, Jain V, Bhutia O, Bhalla A, Pruthi G . Flapless versus open flap techniques of implant placement: A 15-month follow-up study. Indian J Dent Res. 2015; 26(4):372-7. DOI: 10.4103/0970-9290.167629. View

Lemos C, Verri F, Cruz R, Gomes J, Dos Santos D, Goiato M . Comparison between flapless and open-flap implant placement: a systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2018; 49(9):1220-1231. DOI: 10.1016/j.ijom.2018.04.002. View

Sunitha R, Sapthagiri E . Flapless implant surgery: a 2-year follow-up study of 40 implants. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012; 116(4):e237-43. DOI: 10.1016/j.oooo.2011.12.027. View

Zardawi F, Gul S, Fatih M, Hama B . Surgical Procedures Reducing Excessive Gingival Display in Gummy Smile Patients With Various Etiologic Backgrounds. Clin Adv Periodontics. 2020; 10(3):130-134. DOI: 10.1002/cap.10089. View

Yang L, Lu W . [The effect and safety of two techniques of immediate implants on alveolar bone length, soft and hard tissue in the anterior maxillary zone]. Shanghai Kou Qiang Yi Xue. 2017; 26(3):317-320. View

Sclar A . Guidelines for flapless surgery. J Oral Maxillofac Surg. 2007; 65(7 Suppl 1):20-32. DOI: 10.1016/j.joms.2007.03.017. View

Pjetursson B, Thoma D, Jung R, Zwahlen M, Zembic A . A systematic review of the survival and complication rates of implant-supported fixed dental prostheses (FDPs) after a mean observation period of at least 5 years. Clin Oral Implants Res. 2012; 23 Suppl 6:22-38. DOI: 10.1111/j.1600-0501.2012.02546.x. View

10.

Zhuang J, Zhao D, Wu Y, Xu C . Evaluation of Outcomes of Dental Implants Inserted by Flapless or Flapped Procedure: A Meta-Analysis. Implant Dent. 2018; 27(5):588-598. DOI: 10.1097/ID.0000000000000820. View

11.

Jemt T . Regeneration of gingival papillae after single-implant treatment. Int J Periodontics Restorative Dent. 1997; 17(4):326-33. View

12.

Bassir S, El Kholy K, Chen C, Lee K, Intini G . Outcome of early dental implant placement versus other dental implant placement protocols: A systematic review and meta-analysis. J Periodontol. 2018; 90(5):493-506. PMC: 6500770. DOI: 10.1002/JPER.18-0338. View

13.

Roccuzzo M, Roccuzzo A, Ramanuskaite A . Papilla height in relation to the distance between bone crest and interproximal contact point at single-tooth implants: A systematic review. Clin Oral Implants Res. 2018; 29 Suppl 15:50-61. DOI: 10.1111/clr.13116. View

14.

Berglundh T, Abrahamsson I, Welander M, Lang N, Lindhe J . Morphogenesis of the peri-implant mucosa: an experimental study in dogs. Clin Oral Implants Res. 2007; 18(1):1-8. DOI: 10.1111/j.1600-0501.2006.01380.x. View

15.

Blanco J, Carral C, Argibay O, Linares A . Implant placement in fresh extraction sockets. Periodontol 2000. 2019; 79(1):151-167. DOI: 10.1111/prd.12253. View

16.

Hutchens L, Beauchamp S, McLeod S, Stern J . Considerations for Incision and Flap Design With Implant Therapy in the Esthetic Zone. Implant Dent. 2018; 27(3):381-387. DOI: 10.1097/ID.0000000000000769. View

17.

Stoupel J, Lee C, Glick J, Sanz-Miralles E, Chiuzan C, Papapanou P . Immediate implant placement and provisionalization in the aesthetic zone using a flapless or a flap-involving approach: a randomized controlled trial. J Clin Periodontol. 2016; 43(12):1171-1179. DOI: 10.1111/jcpe.12610. View

18.

Lin G, Chan H, Bashutski J, Oh T, Wang H . The effect of flapless surgery on implant survival and marginal bone level: a systematic review and meta-analysis. J Periodontol. 2013; 85(5):e91-103. DOI: 10.1902/jop.2013.130481. View

19.

Buser D, Janner S, Wittneben J, Bragger U, Ramseier C, Salvi G . 10-year survival and success rates of 511 titanium implants with a sandblasted and acid-etched surface: a retrospective study in 303 partially edentulous patients. Clin Implant Dent Relat Res. 2012; 14(6):839-51. DOI: 10.1111/j.1708-8208.2012.00456.x. View

20.

Pisoni L, Ordesi P, Siervo P, Bianchi A, Persia M, Siervo S . Flapless Versus Traditional Dental Implant Surgery: Long-Term Evaluation of Crestal Bone Resorption. J Oral Maxillofac Surg. 2016; 74(7):1354-9. DOI: 10.1016/j.joms.2016.01.053. View