Clinical and radiographic evaluation of soft and hard tissue changes following flap and flapless implant surgery: A randomized controlled trial.

Background: Recent advancements in implant therapy have improved the management of edentulism by reducing surgical invasiveness and enhancing clinical outcomes. Conventional flap techniques, although providing adequate access, are associated with complications such as crestal bone loss and soft-tissue recession. Flapless surgery has emerged as a minimally invasive alternative that preserves periosteal integrity, reduces trauma, and promotes faster healing and patient comfort. Aim: The aim of the study was to compare soft- and hard-tissue changes following endosseous implant placement using flap and flapless technique. Materials and Methods: This randomized controlled single-blinded study included 30 participants, with 15 implants each allocated to flap (control) and flapless (test) groups. Patients with adequate ridge dimensions and good oral health were included. Clinical parameters, including keratinized mucosa width (KMW) and peri-implant probing depth, were recorded at baseline and at 4 months. Radiographic evaluation using intraoral periapical radiographs was performed to assess crestal bone levels immediately after implant placement and at 4 months. Results: Both groups showed a significant reduction in KMW, with a greater reduction in the flapless group. Crestal bone levels were better preserved in the flapless group compared to the flap group at 4 months. No statistically significant difference in peri-implant probing depth was observed between the groups. Conclusion: Flapless implant surgery may offer advantages in preserving peri-implant hard tissues and reducing postoperative complications. However, long-term studies with larger sample sizes are required to confirm these findings.