Clinical Outcome and Bone Preservation of Single TiUnite™ Implants Installed with Flapless or Flap Surgery

Background: Flapless, free-handed implant surgery offers advantages for patient comfort, but studies on long-term clinical success based on marginal bone loss are scarce. Aim: The aim of this study was to compare single implants installed with a flap (F) or flapless (FL) surgery with respect to survival and marginal bone preservation after at least 3 years. Materials and Methods: Fifty-three TiUnite (TM) Branemark implants, installed in 49 patients (27 females; 22 males; mean age 53 years) were examined. Then, 25 F and 28 FL were delayed loaded; bone level from the abutment-implant level was measured on intraoral radiographs. From 44 (21 F, 23 FL), 31 (18F, 13FL), and 36 (18 F, 18 FL) implants, radiographs were available at baseline and after 1 and 3 years of function. Results: The overall survival rate was 100% and the overall mean bone loss after an average of 38 months was 1.35 mm (SD 0.91; range 0-3.7). Both F and FL showed increasing bone loss during the first year with a higher bone loss for FL than for F sites (p < .01). Afterward, no further bone loss occurred and both groups were statistically equal (p > .7). On individual implant level, nearly 80% in both F and FL were considered a success showing bone loss between 1.5 and 1.9 mm. Conclusions: Single implants yield an excellent prognosis with stable bone levels irrespective of the surgical technique, and free-handed flapless surgery is a viable alternative to more extensively planned guided surgery. Proper case selection and clinical experience are considered prerequisites for a predictable treatment outcome.