Flapless dental implant placement

Flapless dental implant placement is possible in selected patients but limited to those sites with adequate or augmentable attached gingiva and available bone volume and density. Inadequate attached gingiva, available bone, and bone density may be augmented by pre-, intra-, or postoperative procedures. Bone ridge contour can be approximated by using a described fast set polyvinyl siloxane site evaluation technique. Assuming adequate length and height, a bone width of 5 mm is usually acceptable for standard diameter implants (3.5-4.2 mm). However, implant placement in sites with parabolic shaped ridges may need to be placed deeper to avoid vertical bone loss and implant thread exposure. Inadequate bone volume, less than 5 mm of bone width, may be developed by ridge expansion (split ridge) techniques. With ridge expansion, complications may arise such as malposition and labyrinthine concussion. Malposition may be corrected intraoperatively or grafted for a later implant placement. Labyrinthine concussion is usually of short duration but may be treated with head maneuvers. Sites with 2 mm or less width of available bone may not be treated flaplessly and may be more appropriately treated with extracortical augmentation grafting.