Modified Neumann incision for implant placement in overdentures: Case series of a less invasive alternative.

backgroundConventional envelope flap techniques for implant placement in edentulous mandibles are associated with greater postoperative morbidity, especially in elderly patients or those with anatomical limitations. Minimally invasive alternatives aim to preserve soft tissues and reduce complications, enhancing clinical predictability.

methodsA clinical study was conducted with ten fully edentulous patients, in whom 20 regular implants were placed in the interforaminal region without surgical guides. A modified Neumann incision with a mesial relaxing cut and partial-thickness "L"-shaped flap was used. Digital planning was performed using free software. Surgical time, number of anesthetic tubes, adverse events, flap healing, peri-implant inflammation (PI), gingival bleeding index (GBI), and probing depth (PD) were evaluated at 14, 30, 60, and 90 days postoperatively.

resultsNo surgical complications, such as dehiscence, infection, paresthesia, or early implant loss, were observed. All patients achieved primary wound healing. The mean surgical time was 44 min (range: 25-61 min), with an average of four anesthetic tubes per patient. GBI and PD remained low throughout follow-up, with few sites showing PD ≥ 4 mm. Healing scores and inflammatory parameters progressively improved over time.

conclusionsThe modified Neumann incision with mesial relaxing cut, guided by digital planning, proved to be a safe, predictable, and minimally invasive approach for implant placement in edentulous mandibles. This technique demonstrated favorable healing, reduced surgical time, and effective PI control, making it suitable for patients with systemic fragility or anatomical challenges. KEY POINTS: The modified Neumann incision with mesial relaxing cut allows for safe and direct visualization of the mental foramen with limited flap elevation, reducing surgical trauma and preserving soft tissue integrity. This technique demonstrated favorable healing outcomes and low postoperative morbidity, even in elderly patients and anatomically challenging mandibles, without the need for physical surgical guides. Digital preoperative planning using free software enhances precision and predictability, making the approach reproducible and applicable in daily clinical practice. PLAIN LANGUAGE SUMMARY: This study describes a new, less invasive surgical technique for placing dental implants in the lower jaw of patients who have lost all their teeth. The method, called the modified Neumann incision with a mesial relaxing cut, was tested in 10 patients who received 2 implants to support a mandibular overdenture. The technique allows the surgeon to see important anatomical structures, such as nerves, while reducing the amount of tissue that needs to be cut or lifted. Patients were followed for 3 months after surgery, and the healing process, inflammation, and peri-implant health were monitored. The results showed that all patients healed well, with no significant complications or pain, and the soft tissues around the implants remained healthy. The approach proved to be safe, efficient, and well tolerated, particularly for older adults and individuals with health conditions that increase surgical risks. This technique may help make implant treatments more comfortable and predictable for edentulous patients, although larger studies are still needed to confirm these findings.