Influence of flap type on early outcomes of dental implants

Aim: Alternative approaches compared to the traditional flap surgery have been suggested to enhance the postoperative morbidity and outcome of dental implants. The aim of this study is to compare the early outcomes of dental implant insertion using three different approaches; Full Flap (FF), Crestal Flap (CF), and Flapless (FL). Subjects and methods: A total of 214 patients (671 implants) took part in this study. The FF method was used in 376 implants (122 patients), the CF was used in 137 implants (49 patients), and the FL was used in 158 implants (43 patients). Cases were performed by single operator, non-randomly allocated to the three groups according to pre-operative and operative findings. The main outcomes were postoperative pain and early implant failure. Chi-square test and ANOVA test were used to examine the differences between the target groups.Results: Implant failure rate was highest when the FL method was used (7.2%) compared to the CF group (3.6%), and the FF group (3.2%) (p = 0.042, X2 test). Significant differences were also found in the degree of postoperative pain; the average pain scale was 1.4 ± 2.5 in the FL, 0.6 ± 0.98 in the CF, and 1.9 ± 2.2 in the FF group (p= 0.012, ANOVA test). Conclusions: More implant failure was encountered using the free handed FL implant surgery. FL implant surgery needs more careful case selection and advanced treatment planning in order to gain the advantages of the procedure without compromising the results.