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? Brånemark 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.