Patient Centered, Clinical, Radiographic, and Biochemical Comparative Evaluation of Transgingival and Conventional Flapped Implant Surgical Technique: A Randomized Controlled Trial

A multifaceted study compared transgingival (flapless) implant placement with conventional flapped placement, which employed clinical, radiographic, biochemical, and patient-centered parameters. The study was approved by the institutional ethics committee and was conducted according to the ethical standards in the 1964 Declaration of Helsinki and its amendments. Seventy-five implants were placed, 37 by flapless method (Group 1) and 38 by flapped method (Group 2). The Group 1 subjects underwent flapless implant placement, while Group 2 underwent flapped implant placement. The Modified Plaque Index was significantly higher in Group 2 at 6 weeks (Mann-Whitney U test, z = -3.08, P = .002). Modified Sulcus Bleeding Index was also significantly higher in Group 2, up to the 12-week follow-up (Mann-Whitney U test, z = -4.63, P < .001). Crestal bone loss revealed no significant intergroup difference. Under biochemical evaluation, matrix metalloproteinase-8 was significantly higher in flapped implants up to the 6-week follow-up. The patient-reported questionnaire-based acceptability assessment showed that the flapless technique is better regarding the perceived duration of the surgery and postoperative comfort.