Comparison of crestal bone loss around dental implants placed in healed sites using flapped and flapless techniques: a systematic review.

BACKGROUND The aim of the present systematic review is to compare the crestal bone loss (CBL) around dental implants placed in healed sites using flapped and flapless surgical techniques. METHODS The focused question was, "Does flapped and flapless surgical technique influence CBL around dental implants placed in healed sites?" Databases were searched from 1975 up to and including May 2014 using different combinations of the following keywords: "crestal bone loss"; "dental implant"; "surgery"; "flap"; and "flapless." Unpublished data, experimental studies, letters to the editor, review articles, case reports, commentaries, and articles published in languages other than English were excluded. In all studies, the test group comprised implants placed using flapless surgery, and the control group, implants placed after reflection of a full-thickness mucoperiosteal flap. RESULTS Ten clinical studies were included. In five studies, CBL around implants was comparable between the test and control groups. In four studies, implants in the test group showed significantly less CBL compared with the control group. In one study, CBL was significantly higher in the test group than the control group. CONCLUSION CBL around dental implants placed in healed sites using flapped and flapless techniques is comparable.