Comparative Assessment of Clinical Outcomes in Flapless and Flapped Implant Surgical Techniques: A Randomized Controlled Trial

Abstract

Background: Dental implant placement is a predictable treatment for edentulism. Conventional surgery involves flap elevation for direct visualization, while flapless techniques aim to minimize surgical trauma. The comparative long-term efficacy of these two approaches remains a subject of clinical investigation.

Methods: A single-center, parallel-group randomized controlled trial was conducted with 60 patients requiring a single implant in the posterior maxilla or mandible. Patients were randomly allocated to either the Flapless Group (n=30), where implants were placed using a surgical guide and tissue punch, or the Flapped Group (n=30), where a full-thickness mucoperiosteal flap was elevated. Outcomes assessed included surgical duration, postoperative pain (Visual Analog Scale - VAS), crestal bone loss (CBL) at 12 months, implant stability quotient (ISQ), and Pink Esthetic Score (PES). Follow-up was conducted at 1 week, 3 months, and 12 months post-loading.

Results: The mean surgical duration was significantly shorter in the Flapless Group (24.6 ± 5.1 min) compared to the Flapped Group (45.2 ± 8.3 min; p < 0.001). Postoperative pain at 24 hours was significantly lower for flapless surgery (VAS: 2.1 ± 0.8 vs. 4.9 ± 1.2; p < 0.001). At 12 months, the Flapless Group exhibited slightly less mean CBL (0.58 ± 0.21 mm) than the Flapped Group (0.79 ± 0.25 mm), a statistically significant difference (p = 0.012). Both groups achieved excellent implant stability with no significant difference in final ISQ values (p = 0.45). The mean PES was significantly higher in the Flapless Group (12.1 ± 1.5) compared to the Flapped Group (10.5 ± 1.9; p = 0.003). All implants survived, yielding a 100% survival rate in both groups.

Conclusion: Flapless implant surgery offers significant advantages regarding reduced surgical time, less postoperative pain, better crestal bone preservation, and superior aesthetic outcomes in selected cases. With comparable implant stability and survival rates, it represents a highly effective and less invasive alternative to the conventional flapped technique.