Flapless surgery (i.e, without the elevation of a mucoperiosteal flap) has been advocated as a method for implant placement that is quicker and less traumatic than the conventional approach, in which a soft tissue flap is raised. As a result, it has been proposed that this technique can often replace other conventional methods for implant surgery.

Flapless surgery has been recommended to reduce patient discomfort and postoperative sequelae, and to improve soft tissue response. A number of authors have demonstrated favorable results using this approach; frequently, they have specified that the precision of the surgery is dependent on the skills of the clinician and on comprehensive pre-surgical planning involving the use of computer-generated three dimensional imaging.

After discussion of the systematic review by Brodala, it was felt by the group that the data on implant survival suggest that flapless implant surgery is efficacious and clinically effective in patients; however, this information was derived from relatively short-term studies (mean interval of 19 months), and based on the systematic review no comparative evidence was identified regarding soft tissue response. The measured incidence of intraoperative complications (3.2%) may be clinically relevant.

It is unclear from the systematic review by Brodala whether there is a higher rate of bony perforations using a flapless surgical technique, as the majority of articles did not report the presence or absence of this complication. It is also unclear whether such bony perforations will have long-term adverse effects on implants.

The systematic review by Brodala indicated that for the immediate postoperative period, available data demonstrated a statistically significant improvement in patient comfort with flapless versus conventional implant surgery. This was based on evidence from two high-level studies, but the same systematic review identified no comparative evidence regarding the soft tissue response.

The group also felt it was important that conclusions derived for flapless surgery not be extrapolated from other long-term studies utilizing the traditional surgical approach.

The group felt that the flapless surgery technique should normally be reserved for skilled and experienced implant surgeons who utilize comprehensive three-dimensional planning. From the review, it was apparent that implant survival using this technique appeared to be efficacious and clinically effective; however, this information was derived from relatively short-term studies.