title: Healing of peri-implant tissues after flapless and flapped implant installation.
abstract: OBJECTIVE
  The aim of this study was to investigate the consequences of different flapless procedures for the installation of dental implants on peri-implant bone response.
  
  
  METHODS
  After bilateral extraction of the mandibular second and third premolars and a 3-month healing period, 30 SLActive(®) implants were installed for 3 months in 10 Beagle dogs according to three different surgical approaches, i.e.: (1) flapped (F), (2) tissue punch flapless (P), and (3) direct flapless (DF).
  
  
  RESULTS
  At harvesting, 29 implants were analysed. Micro-computed tomography and histomorphometrical evaluation (which also included the mobile implants) showed comparable results in bone volume (F=55 ± 9, P=51 ± 4, DF=54 ± 5) and crestal bone level (F=3420 ± 762, P=5358 ± 1681, DF=3843 ± 433). However, the implants inserted using the punch approach revealed a significantly lower first bone contact (F=3420 ± 762, P=5358 ± 1681, DF=3843 ± 433) and bone-to-implant contact percentage (F=70 ± 12, P=48 ± 23, DF=73 ± 12). Considering the gingival response, the barrier epithelium was also significantly deeper around the implants installed using the punch approach (F=1383 ± 332, P=2278 ± 1154, DF=1107 ± 300).
  
  
  CONCLUSIONS
  The results indicate that a flapless surgical technique can be used for the installation of oral implants. In addition, using a tissue punch wider than the implant diameter should be avoided, as it can jeopardize the outcome of the implantation procedure.
authors.affiliation: Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Abeer M A
authors.initials: AM
authors.lastname: Bayounis
authors.forename: Hamad A
authors.initials: HA
authors.lastname: Alzoman
authors.forename: John A
authors.initials: JA
authors.lastname: Jansen
authors.forename: Nadir
authors.initials: N
authors.lastname: Babay
mesh_terms: D000539:Alveolar Process / Q000503:physiopathology; D000818:Animals; D001641:Bicuspid / Q000601:surgery; D003238:Connective Tissue / Q000473:pathology / Q000503:physiopathology; D003758:Dental Implantation, Endosseous / Q000295:instrumentation / Q000379:methods*; D015921:Dental Implants; D004285:Dogs; D004846:Epithelial Attachment / Q000473:pathology / Q000503:physiopathology; D005881:Gingiva / Q000473:pathology / Q000503:physiopathology; D008334:Mandible / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016348:Osseointegration / Q000502:physiology; D010519:Periodontium / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D011677:Punctures / Q000379:methods; D013524:Surgical Flaps; D014081:Tooth Extraction; D020390:Tooth Socket / Q000601:surgery; D014945:Wound Healing / Q000502:physiology; D055114:X-Ray Microtomography
chemical_list: D015921:Dental Implants