Here is a nice case giving an idea about minimally invasive flapless implant placement. Phobic patients can appreciate the clean, pain-free and trauma-free dentistry done using the method. Bone height and width must be confirmed in order to proceed without raising a flap. Special conditioning of the gum tissue provides emergency profile of the future crown within its anatomical volumes. Platform-switching abutment (post) prevents bone loss around the implant.

        

Flapless implant protocol had been used widely in our practice as a tool for performing minimally invasive dentistry. It provides numerous benefits, such as decreased trauma, short recovery time, less pain, reduced rate of infection, improved patient compliance. The following article shows important additional benefits: decreased bone loss and inflammation and improved vascularity. Despite these benefits, we recommend careful consideration when and if the protocol can be applied. 3D imaging is recommended to confirm the availability of bone for insertion of implant with specific size. In case of extraction with desired immediate implant placement, measuring the amount of buccal bone is detrimental. Failure to detect deficient buccal bone leads to late esthetic failures with immediate flapless implants. In these cases, flapless protocol can still be used but not for immediate implants (Denis Tarnow's inverted cone technique for bone regeneration). Least but not last - even with confirmed bone dimensions, placement of implants without raising a flap requires a certain level of experience, skills and sensitivity of the surgeon's hand. This sensitivity, developed thru practice and analysis, relates to the density of the palatal bone compared to the  buccal bone. Same as with the open flap protocol, the surgeon needs to have understanding of implant angulation from restorative point of view. It is harder to apply this principle,and it is easier to make a mistake, when you don't actually see the bone you are working with. The harm of bone perforation and late complications may outweigh the benefit of reduced bone loss with flapless implants. Therefore, choosing an experienced dentist is extremely important when looking for minimally invasive implant surgery.

Our dental offices  ( dentist NJ , dentist London UK  and dentist in Bulgaria ) are available for consultations and treatment using flapless implant protocol with predictabe results. Patient feedback, testimonials and contacts  from all over the world can be provided at your request. Our patients can share with you their experience with flapless implants done in our office.

Dr Veselin Shumantov

ddsnewyork.com

Histological study on the implant interface following flapless implantation 

Presenter: Choi BH Wonju College of Medicine, Yonsei University, Wonju, Korea 

Co-authors: Choi BH, Jeong SM, Xuan F, Kim HR, Mo DY 

Wonju College of Medicine, Yonsei University, Wonju, Korea

 

Background and aim: While it has been shown that the exclu- 

sion of the mucoperiosteal flap can prevent postoperative bone 

resorption associated with flap elevation, there have only been a 

few studies on the peri-implant mucosa following flapless 

implant surgery. The purpose of this study was to compare the 

morphogenesis and vascularity of the peri-implant mucosa 

between flap and flapless implant surgeries by using a canine 

mandible model. 

Materials and methods: In six mongrel dogs, bilateral, edentu- 

lated, flat alveolar ridges were created in the mandible. After 3 

months of healing, two implants were placed in each side by 

either the flap or flapless procedure. After another healing period 

of 3 months, biopsies were obtained, prepared for light micro- 

scopy, and exposed to morphometric measurements. 

Results: The height of the mucosa, the length of the junctional 

epithelium, the gingival index, the bleeding on probing, the 

probing depth, and the marginal bone loss were all significantly 

greater in the dogs that had the flap procedure than those that 

had the flapless procedure (P < 0.05). The supracrestal connec- 

tive tissue lateral to the implant was found to be more richly 

vascularized in the flapless group than in the flap group. 

Conclusion: These results indicate that gingival inflammation, 

the height of junctional epithelium, and bone loss around non- 

submerged implants can be reduced when implants are placed 

without flap elevation. In addition, they suggest that the flapless 

procedure may increase the vascularity of the peri-implant mucosa.

dentist in Bulgaria

        

The following abstract shows the benefits of placing short implants vs bone graft surgery. Comment to be added soon.

Dr Veselin Shumantov
ddsnewyork.com


Vertical bone augmentation vs. 7 mm long implants
in posterior atrophic mandibles. Results up to 1 year
after loading

Presenter: Felice P
University of Bologna, Bologna, Italy
Co-authors: Felice P1, Checchi L1, Marchetti C1, Pellegrino
G1, Lizio G1, Esposito M2

University of Bologna, Bologna, Italy, 2University of Manchester,
Manchester, UK

Background and aim: To compare the outcomes obtained with
the placement of 7 mm long implants vs. the placement of
longer implants in vertically augmented bone for the treatment
of atrophic posterior mandibles.

Materials and methods: Sixty partially edentulous patients,
with a residual bone height above mandibular canal of 7–8 mm
were distributed in two treatment groups: the first group (30
patients) underwent the insertion of two/three submerged 7 mm
long implants, whereas the second one (30 patients) underwent
inlay augmentation procedure and subsequent insertion of
10 mm long implants.
After the elevation of a mucoperiosteal flap a horizontal
osteotomy and two oblique cuts were made in the coronal third of
the mandibular bone; the osteotomised segment was then raised in a
coronal direction sparing the lingual periosteum and Bio-Oss blocks
were interposed between the raised fragment and the mandibular
basal bone. The grafts were left healing for 5 months before
inserting the implants. Provisional and definitive prostheses were
placed 4 and 8 months, respectively, thereafter both in the short
implant group and in the augmented group.

Results: Three implants in three patients failed in the aug-
mented group vs. one implant in the 7 mm short implant
group up to the placement of the final prostheses. Consequently
three prostheses vs. one prosthesis could not be placed at the
planned time, though all implants were successfully replaced
and loaded. Four complications (dehiscence) occurred in
four patients of the augmented bone group vs. none in the
7 mm short implant group (no significant statistical difference).
In two cases a partial loss of the graft occurred. Only patients
subjected to vertical augmentation complained of temporary
mental nerve sensitivity disturbances. No permanent sensitiv-
ity alterations of the alveolar inferior nerve occurred in both
groups.

Conclusion: The results of this study suggest that, when the
residual bone height over the mandibular canal is between 7 and
8 mm, 7 mm short implants might a preferable choice since the
treatment is faster, cheaper and associated with less morbidity
than vertical bone augmentation.