Bayounis AMA, Alzoman HA, Jansen JA, Babay N. Healing of peri‐implant tissues after flapless and flapped implant installation. J Clin Periodontol 2011; 38: 754–761. doi: 10.1111/j.1600‐051X.2011.01735.x. Abstract Aim: The aim of this study was to investigate the consequences of different flapless procedures for the installation of dental implants on peri‐implant bone response. Materials and methods: After bilateral extraction of the mandibular second and third premolars and a 3‐month healing period, 30 SLActive® implants were installed for 3 months in 10 Beagle dogs according to three different surgical approaches, i.e.: (1) flapped (F), (2) tissue punch flapless (P), and (3) direct flapless (DF). Results: At harvesting, 29 implants were analysed. Micro‐computed tomography and histomorphometrical evaluation (which also included the mobile implants) showed comparable results in bone volume (F=55 ± 9, P=51 ± 4, DF=54 ± 5) and crestal bone level (F=3420 ± 762, P=5358 ± 1681, DF=3843 ± 433). However, the implants inserted using the punch approach revealed a significantly lower first bone contact (F=3420 ± 762, P=5358 ± 1681, DF=3843 ± 433) and bone‐to‐implant contact percentage (F=70 ± 12, P=48 ± 23, DF=73 ± 12). Considering the gingival response, the barrier epithelium was also significantly deeper around the implants installed using the punch approach (F=1383 ± 332, P=2278 ± 1154, DF=1107 ± 300). Conclusions: The results indicate that a flapless surgical technique can be used for the installation of oral implants. In addition, using a tissue punch wider than the implant diameter should be avoided, as it can jeopardize the outcome of the implantation procedure.
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