IADR Abstract Archives
Flap vs. Flapless Immediate Implant Placement- A Randomized Controlled Trial
Objectives: We carried out a randomized controlled trial of 6-month duration to compare gingival margin location (GM), buccal horizontal ridge dimensions, and interproximal crestal bone levels following two surgical approaches for immediate placement of implants in the esthetic zone: one involving flap elevation (FE) and another using a flapless protocol (FL).
Methods: Thirty-nine patients with a single non-restorable tooth in the anterior maxilla had their tooth extracted. Patients having an intact buccal plate or < 5mm fenestration post-extraction were randomized to receive a dental implant using either a FE or a FL protocol. We used clinical measurements to assess GM changes from fixed reference points, obtained standardized radiographs using bite-plates to assess bone changes, and used digitized cast overlays to assess buccal ridge dimensional changes.
Results: The mean change in GM between the groups at 6 months (follow-up minus baseline, FL vs. FE, in mm) was 0.25 vs. -0.13 at the mid-buccal site (p=0.031), 0.50 vs. -0.05 at the mesio-buccal site (p=0.003), and 0.25 vs. 0.03 at the disto-buccal site (p=0.031).
Interproximal bone level changes at 6 months were -0.31 vs. -0.37mm at the mesial surface (p=0.794), and -0.44 vs. -0.82mm at the distal surface (p=0.178), in the FL and FE groups, respectively.
Buccal horizontal ridge dimensional changes (follow-up minus pre-extraction) were -0.64 vs. -0.54mm during the first 3 months (p=0.617) followed by an additional -0.18 vs. -0.19mm during the subsequent 3 months (p=0.968) in the FL and FE groups, respectively.
Conclusions: Flap elevation resulted in <0.2mm mean recession of the gingival margin at the mid-buccal and mesio-buccal aspects of the implants at 6 months. No statistically significant differences in buccal ridge dimensions or interproximal crestal bone remodeling were detected between the groups. From a clinical standpoint, the differences between the groups were of questionable significance.
Methods: Thirty-nine patients with a single non-restorable tooth in the anterior maxilla had their tooth extracted. Patients having an intact buccal plate or < 5mm fenestration post-extraction were randomized to receive a dental implant using either a FE or a FL protocol. We used clinical measurements to assess GM changes from fixed reference points, obtained standardized radiographs using bite-plates to assess bone changes, and used digitized cast overlays to assess buccal ridge dimensional changes.
Results: The mean change in GM between the groups at 6 months (follow-up minus baseline, FL vs. FE, in mm) was 0.25 vs. -0.13 at the mid-buccal site (p=0.031), 0.50 vs. -0.05 at the mesio-buccal site (p=0.003), and 0.25 vs. 0.03 at the disto-buccal site (p=0.031).
Interproximal bone level changes at 6 months were -0.31 vs. -0.37mm at the mesial surface (p=0.794), and -0.44 vs. -0.82mm at the distal surface (p=0.178), in the FL and FE groups, respectively.
Buccal horizontal ridge dimensional changes (follow-up minus pre-extraction) were -0.64 vs. -0.54mm during the first 3 months (p=0.617) followed by an additional -0.18 vs. -0.19mm during the subsequent 3 months (p=0.968) in the FL and FE groups, respectively.
Conclusions: Flap elevation resulted in <0.2mm mean recession of the gingival margin at the mid-buccal and mesio-buccal aspects of the implants at 6 months. No statistically significant differences in buccal ridge dimensions or interproximal crestal bone remodeling were detected between the groups. From a clinical standpoint, the differences between the groups were of questionable significance.