Comparative Evaluation of Crestal Bone Loss by Conventional Flap Technique and Flapless Soft Tissue Punch Technique for Endosseous Implant Placement: An In Vivo Study

Background: Conventional dental implant placement generally involves elevation of a mucoperiosteal flap to provide direct visualization of the surgical site. Although this approach offers good access and facilitates procedures requiring augmentation or regeneration, flap elevation may disrupt the periosteal blood supply and contribute to postoperative discomfort and crestal bone remodeling. Flapless implant placement, particularly when performed using a soft tissue punch, has therefore gained interest as a minimally invasive alternative. Aim: The present study compared crestal bone changes, peri-implant soft tissue parameters, and early postoperative patient-centered outcomes following implant placement using conventional flap and flapless soft tissue punch techniques. Materials and Methods: Sixteen edentulous posterior sites in patients aged 20–60 years were included and randomly allocated to two groups of eight sites each. Group A received implant placement using a conventional flap technique, whereas Group B underwent flapless implant placement using a soft tissue punch. Crestal bone levels were assessed immediately after implant placement and at 6 months using cone-beam computed tomography (CBCT) at mesial, distal, buccal, and lingual aspects. Peri-implant probing depth was recorded at 3 and 6 months. Postoperative pain and swelling were evaluated using a 10-point Visual Analog Scale on days 0, 3, 5, and 7. Results: Both groups demonstrated significant crestal bone remodeling over 6 months. However, mean bone loss was significantly lower in the flapless group at the mesial (0.41 ± 0.14 mm vs. 0.78 ± 0.18 mm), distal (0.37 ± 0.12 mm vs. 0.70 ± 0.16 mm), buccal (0.59 ± 0.18 mm vs. 1.10 ± 0.24 mm), and lingual (0.51 ± 0.16 mm vs. 0.89 ± 0.21 mm) aspects. Peri-implant probing depths also remained more stable in the flapless group. Postoperative pain and swelling were significantly lower following flapless surgery at all evaluated time points. Conclusion: Within the limitations of this study, flapless soft tissue punch implant placement was associated with reduced crestal bone loss, more stable peri-implant probing depths, and lower early postoperative discomfort compared with conventional flap surgery.