Less Bone Loss from Flapless Implant Placement?

Which procedure causes less bone loss: flapless or convention implant placement with flap elevation? A recent study 1, compared the effect of flapless implant insertion on initial bone loss with that of conventional placement after elevation of a mucoperiosteal flap.

The study concluded:

Flapless implant insertion caused less peri-implant bone loss than implant insertion with flap preparation. Therefore, the flapless procedure represents a protective and promising method in implant surgery.
1

What has been your experience with flapless implant placement vs placement after a flap elevation?

Read the Full Abstract Here

1. Int J Oral Maxillofac Implants. 2016 Jul-Aug;31(4):876-83. Initial Crestal Bone Loss After Implant Placement with Flapped or Flapless Surgery-A Prospective Cohort Study.. Maier FM.

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8 thoughts on “Less Bone Loss from Flapless Implant Placement?

  1. Flapless is a game of luck. Even with a CBCT I get surprises when I raise a flap. If the implant is too close to the buccal or palatal wall you are gonna get remodelling and bone loss regardless. If there is a small dehiscence you may get a failure without knowing the cause whereas a flap
    would have allowed an easy GBR case. You can’t better actual visualisation of the ridge and flaps don’t have to be huge.

  2. I always flap as I agree that actuality is often different than the X-ray or clinical ‘feel” Could be thick scar tissue, or craters in the site. My flap is only of the ridge (7-8 mm) , with no releasing incisions. So I expose only the actual ridge top, and close with 2 stitches. But it gives you a chance to see what has happened with the healing of the graft and add a very minor amount of graft to any defect. Plus, how deep do you go with flapless? Is the collar of the implant at bone level??? If you see it directly , you know.
    I see no benefit to flapless.

  3. I only raise a flap when I do concurrent grafting. Definitely prefer flapless and have CBCT imaging beforehand (slices spaced 1mm apart). Works very well for me.
    However I have no objection to flap approach. Just do whatever we feel comfortable.

  4. Agree with Tony and Eric always a flap …… CBCT not the whole picture and have learnt my lesson the hard way 8 years ago…
    Peter

  5. I have been placing implants for 20 years with reflecting a flap all the time. I started to use mobile CBCT and guided flap-less approach a year ago. I have to say it is a guessing game. I opened one of my flap-less cases just because I was not sure the guide had a perfect angle. One of my implants was into lingual plate that I had to remove and repair the site. I stopped doing all cases flap-less.Now I place most of my implant cases with flap and subcrestal.

  6. It is always better to see what you are doing. Anyway flapless procedure is only for a few amount of cases…

  7. I always prefer to do a flap ,sometimes only crestal incision, as I do believe that even CBCT is not enough to give us the whole picture. Manytimes I open a flap and get a surprise.
    flapless surgery would not give you a direct vision to the field and it might end with a wrong positioning of the implant. inaddition, I don`t see that much of benefit from doing flapless surgery regarding bone resorption and incidence of infection.

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