title: Effect of flapless implant surgery on soft tissue profile: a randomized controlled clinical trial.
abstract: BACKGROUND
  Flapless implant surgery has been suggested as one possible treatment option for enhancement of implant esthetics.
  
  
  METHODS
  Twenty-four patients with a missing tooth in the premaxillary region were randomly assigned to one of two groups (12 each): immediate loading (IL) or delayed loading (DL) (loading after 4 months). An endosseous implant was placed in each patient via a flapless surgery. Clinical measurements including the papillary index (PPI) (0, no papilla; 1, less than half; 2, more than half but not complete fill; 3, complete fill; and 4, overfill), marginal levels of the soft tissue (ML), probing depths (PDs), modified bleeding index (mBI), modified plaque index (mPI), and the width of the keratinized mucosa (WKM) were performed at baseline (at the time of loading) and at 2, 4, and 6 months.
  
  
  RESULTS
  The soft tissue profile remained stable up to 6 months, without significant differences between the two groups (mean PPI and ML at 6 months, 2.16 and 0.30 mm, respectively). Mean PPI in the IL group significantly increased from 1.50 at baseline to 2.09 at 2 months, and the significance remained up to 6 months (2.30 at 6 months) (P <0.05), whereas in the DL group, no significant changes were found from baseline to 6 months in mean PPI (2.06 at both time points). Mean PPI increased over time when two treatment groups were combined; however, no statistical significance was found. In ML, the difference at baseline between the two groups (-0.28 mm for DL versus 0.17 mm for IL; P <0.05) was no longer significant at 2 months (0 versus 0.08 mm for DL and IL, respectively) and thereafter (P >0.05). No significant differences were detected between groups at each time and over time in the other clinical parameters, PD, mBI, mPI, and WKM (P >0.05).
  
  
  CONCLUSIONS
  The results of this study indicate that creeping attachment (i.e., soft tissue recovery) might occur within 2 months after IL. The study suggests that flapless implant surgery provides esthetic soft tissue results in single-tooth implants either immediately or delayed loaded. Other long-term randomized controlled clinical trials with a large sample size and comparison group (i.e., implant surgery with flap) are recommended to verify the conclusions drawn in this preliminary study.
authors: Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI 48109, USA.
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