title: Biological width following immediate implant placement in the dog: flap vs. flapless surgery.
abstract: OBJECTIVE
  To assess the marginal soft tissue healing process after flap or flapless surgery in immediate implant placement in a dog model.
  
  
  METHODS
  This study was carried out on five Beagle dogs. Four implants were placed in the lower jaw in each dog immediately after tooth extraction. Flap surgery was performed before the extraction on one side (control) and flapless on the other (test). After 3 months of healing, the dogs were sacrificed and prepared for histological analysis.
  
  
  RESULTS
  Ten implants were placed in each group. Two failed (one of each group). The length of the junctional epithelium in the flapless group was 2.54 mm (buccal) and 2.11 mm (lingual). In the flap group, the results were very similar: 2.59 mm (buccal) and 2.07 mm (lingual), with no significant differences observed between the groups. The length of the connective tissue in the flapless group was 0.68 mm (buccal) and 0.54 mm (lingual), and 1.09 mm at the buccal and 0.91 mm at the lingual aspect in the flap group, with no significant differences between groups. The difference between the mean distance from the peri-implant mucosa margin to the first bone-implant contact at the buccal aspect was significant between both groups (3.02 mm-flapless and 3.69 mm flap group). However, this difference was mostly due to the Pm3 group (flapless: 2.95/flap: 3.76) because no difference could be detected in the Pm4 group. Both groups showed minimal recession, with no significant differences between groups (flapless group - 0.6 mm buccal and 0.42 mm lingual; flap group - 0.67 and 0.13 mm).
  
  
  CONCLUSIONS
  The clinical evaluation of immediate implant placement after 3 months of healing indicated that buccal soft tissue retraction was lower in the flapless group than in the flap group, without significant differences. The mean values of the biological width longitudinal dimension at the buccal aspect were higher in the flap group than in the flapless group, this difference being mostly due to the Pm3, probably because of a thinner biotype in this region.
authors.affiliation: Department of Estomatology, University of Santiago de Compostela, Santiago, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Blanco
authors.forename: Célia Coutinho
authors.initials: CC
authors.lastname: Alves
authors.forename: Vanesa
authors.initials: V
authors.lastname: Nuñez
authors.forename: Luis
authors.initials: L
authors.lastname: Aracil
authors.forename: Fernando
authors.initials: F
authors.lastname: Muñoz
authors.forename: Isabel
authors.initials: I
authors.lastname: Ramos
mesh_terms: D000818:Animals; D003238:Connective Tissue / Q000033:anatomy & histology; D000044:Dental Abutments; D003758:Dental Implantation, Endosseous / Q000009:adverse effects / Q000379:methods*; D015921:Dental Implants / Q000009:adverse effects; D004285:Dogs; D004846:Epithelial Attachment / Q000033:anatomy & histology; D005260:Female; D005881:Gingiva / Q000033:anatomy & histology*; D005889:Gingival Recession / Q000209:etiology*; D013524:Surgical Flaps; D013997:Time Factors; D020390:Tooth Socket / Q000601:surgery*
chemical_list: D015921:Dental Implants