title: Submerged flapless technique vs. conventional flap approach for implant placement: experimental domestic pig study with 12-month follow-up.
abstract: OBJECTIVE
  The aim of our study was to compare osseointegration and peri-implant crestal bone resorption in submerged flapless and conventional flap surgery over a 12-month follow-up.
  
  
  METHODS
  The study used five domestic pigs. Implants were inserted 9 weeks after tooth extraction. Each animal received six implants in the mandible, following a split-mouth design: one side was treated using a flapless technique using mini-incisions, while a flap was raised on the other. The animals were sacrificed at 2 weeks, 1, 3, 6 and 12 months after implant placement. Radiographic images were taken to analyze crestal bone loss, and samples were extracted for histopathological and bone-to-implant contact (BIC) analyses.
  
  
  RESULTS
  Significantly, greater crestal bone loss (P = 0.005) was obtained in the flap group compared with the flapless group. The flapless group presented significantly higher percentages of BIC (P < 0.05) at 3, 6 and 12 months compared with the conventional flap group.
  
  
  CONCLUSIONS
  Within the limitations of this experimental animal study, it may be concluded that the type of surgery (flap or flapless) affects peri-implant bone preservation and osseointegration of regular platform implants. Flapless surgery is associated with peri-implant crestal bone preservation. Flapless surgery in combination with submerged implants allows higher osseointegration values.
authors.affiliation: Faculty of Medicine and Dentistry, University of Murcia, Murcia, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Pérez-Albacete Martínez
authors.affiliation: Department of Dental Medicine, Faculty of Medical Science, University of Pristina, Kosovska Mitrovica, Serbia.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Vlahović
authors.affiliation: School of Dentistry, University of Belgrade, Belgrade, Serbia.
authors.forename: Miodrag
authors.initials: M
authors.lastname: Šćepanović
authors.affiliation: Department of Dental Medicine, Faculty of Medical Science, University of Pristina, Kosovska Mitrovica, Serbia.
authors.forename: Goran
authors.initials: G
authors.lastname: Videnović
authors.affiliation: Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy.|Tuscan Stomatologic Institute, Versilia General Hospital, Lido di Camaiore (LU), Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Barone
authors.affiliation: Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Calvo-Guirado
mesh_terms: D000818:Animals; D001862:Bone Resorption / Q000000981:diagnostic imaging; D003758:Dental Implantation, Endosseous / Q000379:methods*; D015921:Dental Implants; D005500:Follow-Up Studies; D008334:Mandible / Q000000981:diagnostic imaging / Q000601:surgery*; D023421:Models, Animal; D016348:Osseointegration; D013552:Swine
chemical_list: D015921:Dental Implants
keywords: bone-to-implant contact; crestal bone loss; flapless; mini-incision