Journal of Oral Implantology June 2014 - (Page 321)

CASE REPORT Flapless Implant Placement: A Case Report Deshraj Jain, MDS1* Ghanshyam Gaur, MDS2 Full-thickness periosteal flap elevation for implant placement is often accompanied by potential marginal bone loss and/or soft tissue recession around the implant due to compromised blood supply to underlying bone. To preserve the blood supply to underlying bone, implants can be placed with a flapless surgical procedure. This procedure also provides numerous other benefits, such as decreased trauma, short recovery time, less pain, reduced rate of infection, and improved patient compliance. This report presents a case of flapless implant placement in the mandibular posterior region that achieved optimum results and caused minimal discomfort to the patient. The advantages and limitations of this procedure are also discussed. Key Words: dental Implants, flapless surgery, crestal bone loss INTRODUCTION O ver the past 30 years, flap designs for implant surgery have been modified, and more recently, the concept of implant placement without flap elevation and exposure of the bony tissues was introduced. Flapless procedures have already been used for some time with tooth extractions and site preservation, and such procedures have shown less morbidity.1 The flapless approach is considered for immediate implants in order to preserve the vascular supply and existing soft tissue contours.2 Surgeons use rotary instruments or a tissue punch to perforate the gingival tissues to gain access to bone. The method of flapless implant placement has multiple advantages for the patient and the surgeon. For instance, leaving the periosteum intact on the buccal and lingual aspects of the ridge maintains a better blood supply to the site, reducing the likelihood of bone resorption.3 In addition it results in fewer complications at the patient level, such as swelling and pain, and it reduces intraoperative bleeding, surgical time, and the need for suturing.4 However, despite these advantages, the flapless 1 Department of Prosthodontics, Government College of Dentistry, Indore, India. 2 Department of Prosthodontics, College of Dental Science and Hospital, Rau, Indore, India. * Corresponding author, e-mail: drdeshrajjain@rediff.com DOI: 10.1563/AAID-JOI-D-12-00026 technique also has some shortcomings: the surgeon cannot visualize anatomic landmarks and vital structures or manipulate the circumferential soft tissues to ensure the ideal dimensions of keratinized mucosa around the implant; there is also decreased access to the bony contours for alveoloplasty.4 Despite being a seemingly simple operation, it nevertheless requires a highly experienced dental surgeon as the implant has to be inserted into the bone without direct visual checking of its position in the bone. As this is a blind procedure the success is very much depends on preoperative planning and proper case selection. This case report presents an implant placement with a flapless surgical technique that caused minimal discomfort to the patient. CASE REPORT A 28-year-old man reported to our department with the complaint of missing tooth 29 (right lower second premolar). The tooth had been extracted 3 years earlier due to caries, and since then he had been wearing an acrylic removable partial denture; however, he had difficulty chewing with this removable partial denture, so he wanted to replace it with a fixed prosthesis. After an initial intraoral examination, treatment options of a fixed partial denture and an implant-supported prosthesis were discussed with patient; he agreed to the implantJournal of Oral Implantology 321

Table of Contents for the Digital Edition of Journal of Oral Implantology June 2014

Controlled Early Inflammation and Bone Healing—Potential New Treatments
Zygomatic Implants: The Impact of Zygoma Bone Support on Biomechanics
A Comparative Study on Microgap of Premade Abutments and Abutments Cast in Base Metal Alloys
Topical Simvastatin Improves the Pro-Angiogenic and Pro-Osteogenic Properties of Bioglass Putty in the Rat Calvaria Critical-Size Model
Assessment of the Correlation Between Insertion Torque and Resonance Frequency Analysis of Implants Placed in Bone Tissue of Different Densities
Benefits of Rehabilitation With Implants in Masticatory Function: Is Patient Perception of Change in Accordance With the Real Improvement?
A Method for Fabrication of Implant-Supported Fixed Partial Dentures
Safe Sinus Lift: Use of Acrylic Stone Trimmer to Avoid Sinus Lining Perforation
The Effects of Sinus Membrane Pathology on Bone Augmentation and Procedural Outcome Using Minimal Invasive Antral Membrane Balloon Elevation
Cellular Responses to Metal Ions Released From Implants
A Two-Stage Surgical Approach to the Treatment of Severe Peri-Implant Defect: A 30-Month Clinical Follow-Up Report
Eight-Year Follow-Up of a Fixed-Detachable Maxillary Prosthesis Utilizing an Attachment System: Clinical Protocol for Individuals With Skeletal Class III Malocclusions
Active Implant Peri-Apical Lesion: A Case Report Treated Via Guided Bone Regeneration With a 5-year Clinical and Radiographic Follow-up
Flapless Implant Placement: A Case Report
Active Implant Periapical Lesions Leading to Implant Failure: Two Case Reports
A Review of Platelet Derived Growth Factor Playing Pivotal Role in Bone Regeneration
LETTER TO THE EDITOR
REVIEW OF CURRENT LITERATURE

Journal of Oral Implantology June 2014