# Comparative Assessment of Clinical Outcomes in Flapless and Flapped Implant Surgical Techniques: A Prospective Cohort Study

## TL;DR

This study compares flapless and flapped dental implant techniques, finding that flapless surgery causes less pain and better short-term soft tissue healing without affecting long-term bone stability.

## Contribution

The study provides new clinical evidence comparing flapless and flapped implant techniques, focusing on pain and tissue outcomes over 12 months.

## Key findings

- Flapless surgery resulted in significantly lower postoperative pain at days 3 and 7.
- Flapless implants showed reduced peri-implant probing depth at six months.
- Both techniques showed similar crestal bone height changes over 12 months.

## Abstract

Introduction: Dental implants have become the standard treatment for restoring missing teeth, offering both functional and esthetic benefits. The surgical approach (flap versus flapless) may influence peri-implant tissue healing, postoperative discomfort, and long-term implant success. This study aimed to compare postoperative pain, peri-implant probing depth (PD), and crestal bone height (CBH) changes between the flapless and flapped implant placement over a 12-month period post functional loading of implants.

Materials and methods: A prospective cohort study was conducted with 20 patients who required single posterior dental implants. Patients were allocated into two groups: flapless (n = 10) and flap (n = 10). The allocation was based on clinical evaluation and patient preferences. Soft tissue assessment included PD measurements at six and 12 months at the four peri-implant sites using a periodontal probe. Hard tissue assessment included CBH measurements at baseline, six months, and 12 months post functional loading using standardized intraoral radiographs. Pain intensity was evaluated on postoperative days 3 and 7 using the visual analog scale (VAS). All data were analyzed using appropriate parametric and non-parametric tests, with significance set at p < 0.05.

Results: Postoperative pain was significantly lower in the flapless group compared to the flap group at both day 3 (3.1 ± 0.74 vs. 5.7 ± 0.95, p = 0.001) and day 7 (0.5 ± 0.71 vs. 2.4 ± 1.17, p = 0.001). PD was significantly lower in the flapless group at six months (p < 0.05), although by 12 months, the differences between the groups were not statistically significant. Both groups showed significant intragroup reductions in PD over time (p = 0.001). The CBH decreased slightly in both groups over 12 months, but no significant intergroup differences were observed at any time point (p > 0.05).

Conclusion: Flapless implant placement was associated with significantly lower postoperative pain and more favorable soft tissue healing with reduced PD at six months than the flap technique. However, both approaches demonstrated comparable changes in CBH at 12 months. These findings suggest that flapless surgery may offer early postoperative benefits without compromising long-term hard tissue stability.