Effect of Flapless Surgery on Single-Tooth Implants in the Esthetic Zone: A Randomized Clinical Trial.
AUTHOR
-- BY Oh TJ, Bashutski J,
Wang HL, Rudek I, Chan HL.
Background: Implant
therapy is a highly predictable treatment option; however, insufficient data
exist to show whether flapless implant surgery provides better esthetic
outcomes and less bone loss than implant surgery with a flap approach.
Methods: In this
randomized, controlled study comparing the flapless and traditional flap
protocol for implant placement, 24 patients received a single implant in the
anterior maxillary region. A cone beam computed tomography-aided surgical guide
was used for implant placement surgery for both groups. Implants were restored
using a one-piece, screw-retained ceramic crown at 3 months. Radiographic and
clinical measurements were assessed at baseline (implant placement) and at 3
(crown placement), 6, 9, and 15 months. Clinical parameters evaluated were
plaque index, gingival index, papillary index (PPI) (0 = no papilla, 1 = less
than half, 2 = more than half but not complete, 3 = complete fill, and 4 =
overfill), marginal tissue levels, biotype, width of keratinized tissue, and
soft tissue thickness.
Results: Implant
success rate was 92% in both groups. Mean PPI values for the flap control group
and flapless test group were 2.38 ± 0.51 versus 2.31 ± 0.48 at crown placement
(P = 0.68) and 2.52 ± 0.52 versus 2.64 ± 0.54 at 15 months (P = 0.42),
respectively. PPI increased over time in both groups, although the flapless
group had a significantly larger change in PPI from crown placement to 6 and 9
months (P <0.01). Crestal bone levels in the flap group were more apical in
relation to the implant platform than those in the flapless group for the
duration of the study. No differences among groups were noted for all other
measurements.
Conclusions: Both
flapless and flap implant placement protocols resulted in high success rates. A
flapless protocol may provide a better short-term esthetic result, although
there appears to be no long-term advantage.
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