Long-term clinical outcome of single implants inserted flaplessly or conventionally.

BACKGROUND: Flapless implant surgery is mostly performed using guided surgical protocols, however, long-term studies on free-handed flapless surgery for single implants are lacking.

PURPOSE: This prospective study evaluates bone level changes, peri-implant health, and complications of solitary implants placed using a conventional flap (F) or flaplessly (FL) after 6-9 years.

MATERIALS AND METHODS: Fifty-three single TiUnite Brånemark implants were originally inserted in 49 patients using an one-stage delayed loading protocol with flap (n = 27, F) or flaplessly (n = 26, FL) based on available bone volume and surgeon's decision-making. Thirty-six patients with 37 implants participated in the prospective follow-up investigation 6-9 years later whereby survival, bone level changes, peri-implant health, and complications were assessed.

RESULTS: After 88 months (range 76-107), all implants were survived. For F and FL combined, the overall average radiographic bone level was above the first implant thread, 1.26 mm apical of the implant-abutment junction (SD 1.08; 0-4.9) and statistically comparable. Bone loss from time of loading was 0.49 mm (SD 1.1; -1.3 to 2.8) for F and -0.89 mm (SD 1.0; -2.8 to 0.7) for FL (P < .01), suggesting regrowth of bone in FL due to initial countersinking. One implant (2.7%) had a probing depth above 5 mm.

CONCLUSION: Free-handed flapless implant surgery for single implants with neighboring teeth is a predictable long-term treatment provided when there is sufficient bone volume.