Over the past 30 years, research has validated the success of osseointegrated implants as a viable alternative to fixed or removable prosthetic restorations. Placement of endosseous implants has become an option in comprehensive periodontal treatment plans for both fully and partially edentulous patients.' In the late 1970s, Branemark established the use of extensive surgical flaps to visualize the surgical field during implant surgery. According to this protocol, an incision in the mucosa or the mucobuccal fold was made, and then a flap was reflected to expose the underlying bone. The implants were then placed and the flaps repositioned with sutures.' Since the beginning of impIantology, the technique has been gradually modified and refined to the one or two stage procedures most frequently used today. Despite these modifications, the surgical process has remained remar~ably constant. Initial bone loss seems to be caused by interrupted blood supply that follows removal ofthe periosteum.'
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