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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. [ABSTRACT FROM AUTHOR]

Chow YC, Eber RM, Tsao Y-P, Shotwell JL, Wang H-L. Factors associated with the appearance of gingival papillae. J Clin Periodontol 2010; 37: 719-727 doi: . Aim: The purpose of this study was to evaluate factors associated with the fill of inter-dental spaces by gingival papillae. Materials and Methods: Ninety-six adult subjects were evaluated. Papilla score (PS), tooth form/shape, interproximal contact length and gingival thickness were recorded for 672 maxillary anterior and first pre-molar interproximal sites. Statistical analyses included a non-parametric χ2 test,anova, the Mixed Procedure for SAS and Pearson's correlation coefficient ( r). Results: Papilla deficiency was more frequent in older subjects ( p<0.05), as papilla height decreased 0.012 mm with each year of increasing age ( p<0.05). Competent papillae (complete fill inter-dentally) were associated with: (1) crown width: length ⩾0.87; (2) proximal contact length ⩾2.8 mm; (3) bone crest-contact point ≤5 mm; and (4) interproximal gingival tissue thickness ⩾1.5 mm. Gingival thickness correlated negatively with PS ( r=−0.37 to −0.54) and positively with tissue height ( r=0.23–0.43). Tooth form (i.e. crown width to length ratio) correlated negatively with PS ( r=−0.37 to −0.61). Other parameters failed to show any significant effects. Conclusions: Gingival papilla appearance was associated significantly with subject age, tooth form/shape, proximal contact length, crestal bone height and interproximal gingival thickness. [ABSTRACT FROM AUTHOR]

Background: Flapless implant surgery has been suggested as one possible treatment option for enhancement of implant esthetics. Methods: Twenty-four patients with a missing tooth in the premaxillary region were randomly assigned to one of two groups (12 each): immediate loading (IL) or delayed loading (DL) (loading after 4 months). An endosseous implant was placed in each patient via a flapless surgery, Clinical measurements including the papillary index (PPI) (0, no papilla; 1, less than half; 2, more than half but not complete fill; 3, complete fill; and 4, overfill), marginal levels of the soft tissue (ML), probing depths (PDs), modified bleeding index (mBI), modified plague index (mPI), and the width of the keratinized mucosa (WKM) were performed at baseline (at the time of loading) and at 2, 4, and 6 months. Results: The soft tissue profile remained stable up to 6 months, without significant differences between the two groups (mean PPI and ML at 6 months, 2.16 and 0.30 mm, respectively). Mean PPI in the IL group significantly increased from 1.50 at baseline to 2.09 at 2 months, and the significance remained up to 6 months (2.30 at 6 months) (P<0.05), whereas in the DL group, no significant changes were found from baseline to 6 months in mean PPI (2.06 at both time points). Mean PPI increased over time when two treatment groups were combined; however, no statistical significance was found. In ML, the difference at baseline between the two groups (-0.28 mm for DL versus 0.17 mm for IL; P <0.05) was no longer significant at 2 months (0 versus 0.08 mm for DL and IL, respectively) and thereafter (P>0.05). No significant differences were detected between groups at each time and over time in the other clinical parameters, PD, mBI, mPI, and WKM (P>0.05). Conclusions: The results of this study indicate that creeping attachment (i.e., soft tissue recovery) might occur within 2 months after IL. The study suggests that flapless implant surgery provides esthetic soft tissue results in single tooth implants either immediately or delayed loaded. Other long term randomized controlled clinical trials with a large sample size and comparison group (i.e., implant surgery with flap) are recommended to verify the conclusions drawn in this preliminary study. [ABSTRACT FROM AUTHOR]

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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.