PurposeThe level of the implant above the marginal bone and flap design have an effect on the bone resorption during the healing period. The aim of this study is to detect the relationship between the level of the implant at the implant placement and the bone level at the healing period in the mesial and distal side of implants placed with flapless (FL) and full-thickness flap (FT) methods.MethodsTwenty-two nonsubmerged implants were placed with the FL and FT technique. Periapical radiographs were taken of the patient at implant placement, and at 6 and 12 weeks. By using computer software, bone level measurements were taken from the shoulder of the healing cap to the first bone implant contact in the mesial and distal side of the implant surface.ResultsAt 6 weeks, the correlation between the crestal bone level at the implant placement and crestal bone level of the FT mesially was significant (Pearson correlation coefficient=0.675, P<0.023). At 12 weeks, in the FT mesially, the correlation was nonsignificant (Spearman correlation coefficient=0.297, P<0.346). At 6 weeks in the FT distally, the correlation was nonsignificant (Pearson correlation coefficient=0.512, P<0.107). At 12 weeks in the FT distally, the correlation was significant (Spearman correlation coefficient=0.730, P<0.011). At 6 weeks in the FL mesially, the correlation was nonsignificant (Spearman correlation coefficient=0.083, P<0.809). At 12 weeks in the FL mesially, the correlation was nonsignificant (Spearman correlation coefficient=0.062, P<0.856). At 6 weeks in the FL distally, the correlation was nonsignificant (Spearman correlation coefficient=0.197, P<0.562). At 12 weeks in the FL distally, the correlation was significant (Pearson correlation coefficient=0.692, P<0.018).ConclusionsA larger sample size is recommended to verify the conclusions in this preliminary study. The bone level during the healing period in the FT was more positively correlated with the implant level at implant placement than in the FL.

An oroantral fistula is a complication of the maxillary posterior teeth that can occur after a tooth extraction that affects the maxillary sinus. Improper management may lead to a persistent fistula, which may become chronic. In this case report, platelet-rich fibrin (PRF) was used with a collagen membrane to close a chronic fistula in a single patient. A flap was raised, the oroantral fistula tract was eliminated, and the opening was closed with a resorbable membrane as a first layer and covered with a PRF clot as a second layer. The flap was closed, and the patient was followed up for suture removal and confirmation of complete soft tissue closure. The postsurgical sign and symptoms of the patient disappeared in the first week; complete tissue healing was detected within 2 weeks, and tissue hypertrophy was observed in the fourth week. The use of PRF may have advantages for soft-tissue healing and for accelerating soft tissue formation by subsequent hypertrophy.

There was a significant negative correlation between the crestal bone resorption and implant stability at 6 weeks, whereas the negative correlations between the crestal bone resorption and implant stability at 12 weeks were nonsignificant.

Purpose : When soft tissue flaps are reflected for implant placement, the blood supply from the periosteum to the bone is disrupted. The aim of this study was to compare the effects of the flapless (FL) and full-thickness flap (FT) techniques on implant stability. Methods : Nine patients received 22 implants. The implants were placed using the FL technique on the contralateral side of the jaw; the FT technique was used as the control technique. Resonance frequency analysis (RFA) was performed at the time of implant placement and at 6 and 12 weeks after implant placement. RFA values were compared between the FL and FT groups and between time intervals in the same group. Results : The median (interquartile range [IQR]) RFA values at the time of implant placement were 75.00 (15.00) for the FL technique and 75.00 (9.00) for the FT technique. At 6 weeks, the median (IQR) values were 79 (3.30) for the FL technique and 80 (12.70) for the FT technique. At 12 weeks, the median (IQR) values were 82.3 (3.30) for the FL technique and 82.6 (8.00) for the FT technique. There were no significant differences between the 2 techniques at the time of implant placement, after 6 weeks or after 12 weeks, with p values of 0.994, 0.789, and 0.959, respectively. There were significant differences between the RFA values at the time of implant placement and after 6 weeks for the FL technique (p=0.028) but not for the FT technique (p=0.091). There were also significant differences between the RFA values at 6 weeks and the RFA values at 12 weeks for the FL technique (p=0.007) and for the FT technique (p=0.003). Conclusion : Periosteum preservation during the FL procedure will speed up bone remodeling and result in early secondary implant stability as well as early loading.

This review revealed that the FL technique might be more appropriate in immediate implant loading cases. This specific technique results in shallower biological width, reduced inflammation, less morbidity with guided implant placement, and better esthetics in comparison with the FT technique. The implant survival rates are not significantly different between the 2 flap techniques. With respect to crestal bone resorption in FL and FT, it is inconclusive, depending on the study type (human or animal).