Flapless and traditional dental implant surgery: an open, retrospective comparative study

J Oral Maxillofac Surg. 2010 Sep;68(9):2299-306. doi: 10.1016/j.joms.2010.05.031.


Purpose: Osseointegrated dental implantation is traditionally performed by a flap approach that involves soft tissue flap reflection, but this technique is associated with several drawbacks. Conversely, the flapless method requires only minimal removal of soft tissue but is not suitable for all patients. The objective of this study was to compare the flapless (FL) method of implant placement with the traditional flap (TR) method with regard to achievement of success, change in bone level, and overall safety.

Patients and methods: In this single-center, open, retrospective, investigator-driven, nonrandomized, comparative study, patients were pre- or intraoperatively assigned to the FL or TR treatment. The primary success criteria were the absence of mobility, radiolucency, pain, and infection.

Results: The FL method was applied to 174 implants (46%) in 121 patients and the TR method to 203 implants (54%) in 98 patients. At visit 1, implantation was rated successful in 171/174 (98.3%) implants with the FL method and in 200/203 (98.5%) with the TR method. Success rate remained constant until visit 2. The difference between the 2 groups in the rate of success was not significant. Similarly, no significant difference was observed for mean time to last follow-up for success.

Conclusions: Based on pre- or intraoperative decision-making, patients eligible for FL surgery can benefit from a less straining procedure without affecting the high success rate of dental implant surgery. The FL approach is a predictable procedure when patient selection and surgical technique are appropriate.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Alveolar Bone Loss / diagnostic imaging
  • Alveolar Bone Loss / etiology
  • Bone Density
  • Chi-Square Distribution
  • Dental Implantation, Endosseous / adverse effects
  • Dental Implantation, Endosseous / methods*
  • Dental Implants
  • Dental Prosthesis Design
  • Dental Prosthesis Retention
  • Dental Prosthesis, Implant-Supported
  • Dental Restoration Failure
  • Facial Pain / etiology
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Patient Selection
  • Proportional Hazards Models
  • Radiography
  • Retrospective Studies
  • Safety
  • Statistics, Nonparametric
  • Surgical Flaps*
  • Surgical Wound Infection / etiology
  • Treatment Outcome
  • Young Adult


  • Dental Implants