Flapless implant surgery in the esthetic region: advantages and precautions

Because osseointegration is now considered highly predictable, the current trend is to develop techniques that can provide function, esthetics, and comfort with a minimally invasive surgical approach. To achieve those goals, flapless implant surgery using a tissue punch technique has been suggested. This paper presents two clinical cases of single-tooth implants placed in the esthetic region (anterior maxilla), which illustrate systematic approaches to flapless implant surgery for immediate and delayed loading protocol. For both cases, a tissue punch technique using a surgical guide fabricated with the aid of a radiographic stent was performed to provide access for implant site preparation and placement. The implants were loaded either immediately or 4 months after implant placement. With the planned flapless surgical technique, reduced operative time, accelerated postsurgical healing, and increased patient comfort and satisfaction were achieved. This paper also describes precautions of the flapless implant surgery in case selection, surgical techniques, and prosthodontic protocol. In conclusion, appropriate case selection and well-tailored surgical guides with sound surgical and prosthodontic protocols are considered to be the key elements in the success of flapless implant surgery.