What Is Flapless Surgery?
Flapless surgery is a new and efficient technique for implant placement with reduced chair time and increased patient comfort. In addition, this surgery for dental implants helps maintain proper blood circulation and bone healing, allowing the patient to resume routine oral hygiene. Flapless surgery involves fewer post-operative complications such as swelling or pain compared to conventional flap surgery.
The success of dental implant surgery depends upon some of the factors, which include -
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Patient oral hygiene.
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Health condition.
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The operator-based treatment planning involves preoperative assessment before the dental implant placement.
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Surgical technique.
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The final prosthetic rehabilitation.
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Technical aspects involving the last profile of the patient.
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Stability of implant.
What Is the Method of Flapless Surgery?
Recently flapless surgery has gained a lot of popularity and is the best option for patients who meet all the requirements for successful implant placement, such as adequate bone volume and keratinized gingival tissue.
In the flapless surgical procedure, the dental implant is installed through the oral mucosal tissues without any flap reflection, as in the case of conventional flap opening and implant drilling. There are two types of flapless implant surgery which involve -
1. Direct Drill Technique - In the direct drill technique, the pilot drill is used for osteotomy (cutting of bone) preparation, followed by drilling with large diameter drills until the implant fits into the osteotomy hole.
2. Soft Tissue Punch Technique - This is the less invasive method of implant installation, and the steps involved in this procedure are given below -
- Firstly, the patient is asked to rinse their mouth with 0.2 % Chlorhexidine, and after that, the dental surgeon administers the infiltration block of Lidocaine 2 % at the implant placement site.
- After the area is anesthetized, the soft tissue punch is made by drilling the selected implant diameter. This is done after a complete preoperative assessment and analysis by the dentist by taking panoramic radiographs or CBCT (cone-beam computed tomography) of the operated area.
- The bone is cut using a round bur in the initial stage, and then a drill is used of around 2 mm to create a cavity or hole to place the implant. During this process, a copious amount of saline irrigation is needed to prevent overheating or necrosis of the bone during implant drilling.
- Parallelism of the hole is checked after every drill using intra-oral radiographs, so the implant position is placed in the correct position.
- The drilling follows a sequence of drills of different heights and diameters till the desired dimensions are achieved.
- After that implant of the specific size and depth is placed into the osteotomy site (hole site), and a healing cap is placed on the implant head.
What Are the Post-operative Instructions?
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Immediately after the implant placement, radiographs are taken to verify the ideal implant position and location, as post-operative instructions are given to the patient.
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Medicines such as antibiotics and anti-inflammatory are prescribed to the patient, and dosage is determined by the physical and systemic condition of the patient.
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The follow-up of the patient is done at the regular intervals of one week, two weeks, four weeks or one month, three months, and then six months. If there are any postoperative complications, the dentist will adopt appropriate prophylaxis.
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The final prosthesis would be delivered to the patient after four to six months when there is complete osseointegration (bone-implant contact or fusion of the dental implant into the alveolar bone).
The soft tissue punch technique is a minimally invasive surgery that inflicts less damage and trauma to the patient than conventional implant placing surgical procedures. It also involves fastened healing and less inflammation as minimal incisions are needed to perform this surgery.
What Is the Potential Drawback of the Soft Tissue Punch Technique?
The only disadvantage encountered by a few surgeons is that it is a blind technique as they cannot see critical anatomic landmarks directly when doing chair-side surgery. This causes a risk as some vital structures can get exposed when the flap is raised. However, performing a preoperative assessment using radiographs or CBCT (cone-beam computed tomography) can prevent any complications.
Conclusion:
To conclude, flapless implant surgery has various advantages as it is an atraumatic procedure that suits both the dentist and the patient. Moreover, it enhances patient compliance and reduces surgery time. And it also helps in preserving the surrounding soft and hard tissue volume.
