# The low invasiveness design (LID) flap in immediate implant placement: a 20-patient case series on a novel flap design based on new insights into papilla vascularization

## TL;DR

This study introduces a new flap design for dental implants that reduces invasiveness while maintaining good aesthetic and clinical outcomes in 20 patients.

## Contribution

The LID flap is a novel surgical technique combining insights into papilla vascularization with low invasiveness for immediate implant placement.

## Key findings

- The LID flap showed no implant failures and satisfactory esthetic outcomes with a mean PES of 12.35.
- Patient satisfaction was high, with a mean VAS score of 9.15, indicating good clinical success.
- The flap preserved papilla height and provided soft tissue stability with minimal complications.

## Abstract

This study presents a novel Low Invasiveness Design (LID) flap for Immediate Implant Placement (IIP) and evaluates its clinical and esthetic outcomes in a 20-patient retrospective case series. The LID flap is based on recent insights into papilla vascularization and aims to balance the benefits of flapless and conventional flap techniques.

Twenty patients requiring IIP in the anterior maxilla were treated with the LID flap. The study included non-smoking, systemically healthy individuals. Esthetic outcomes and patient satisfaction were assessed one year after final prosthetic rehabilitation respectively using the Pink Esthetic Score (PES) and the Visual Analogue Scale (VAS).

No implant failures or major complications were reported. A minor case of flap distress (5%) was observed and healed spontaneously without intervention. The mean PES was 12.35 ± 0.99, indicating satisfactory esthetic outcomes, while the mean VAS score was 9.15 ± 0.75. The flap design successfully preserved papilla height and granted soft tissue stability.

The LID flap presents a promising approach for IIP, preserving soft tissue esthetics while ensuring surgical precision. The preliminary results suggest that this technique may provide an alternative to traditional flap designs. Clinical Relevance: The LID flap may serve as an alternative to traditional incision designs in IIP procedures.

The online version contains supplementary material available at 10.1007/s00784-025-06496-x.