title: Flapless surgery and its effect on dental implant outcomes.
abstract: OBJECTIVE
  The aim of this article was to review the current literature with regard to the efficacy and effectiveness of flapless surgery for endosseous dental implants. The available data were evaluated for short- and long-term outcomes.
  
  
  METHODS
  A MEDLINE search was conducted on studies published between 1966 and 2008. For the purpose of this review, only clinical (human) studies with five or more subjects were included, and clinical opinion papers were excluded. Clinical studies or reports were further rated in terms of the level or weight of evidence using criteria defined by the Oxford Center for Evidence-Based Medicine in 2001.
  
  
  RESULTS
  The available data on flapless technique indicate high implant survival overall. The prospective cohort studies demonstrated approximately 98.6% (95% CI: 97.6 to 99.6) survival, suggesting clinical efficacy, while the retrospective studies or case series demonstrated 95.9% (95% CI: 94.8 to 97.0) survival, suggesting effective treatment. Six studies reported mean radiographic alveolar bone loss ranging from 0.7 to 2.6 mm after 1 year of implant placement. Intraoperative complications were reported in four studies, and these included perforation of the buccal or lingual bony plate. Overall, the incidence of intraoperative complications was 3.8% of reported surgical procedures.
  
  
  CONCLUSIONS
  Flapless surgery appears to be a plausible treatment modality for implant placement, demonstrating both efficacy and clinical effectiveness. However, these data are derived from short-term studies with a mean interval of 19 months, and a successful outcome with this technique is dependent on advanced imaging, clinical training, and surgical judgment.
authors.affiliation: Department of Periodontology, CB #7450, UNC School of Dentistry, 115 Brauer Hall, Chapel Hill, NC 27599-7450, USA. nadine_brodala@dentistry.unc.edu
authors.forename: Nadine
authors.initials: N
authors.lastname: Brodala
mesh_terms: D016301:Alveolar Bone Loss / Q000209:etiology; D003758:Dental Implantation, Endosseous / Q000009:adverse effects / Q000379:methods*; D019232:Dental Restoration Failure; D006801:Humans; D007431:Intraoperative Complications; D013524:Surgical Flaps