Other alleged advantages of the flapless implant surgery include less traumatic surgery, decreased operative time, rapid postsurgical healing, fewer postoperative complications and increased patient comfort. The alleged reasons to choose the flapless technique are to minimize the possibility of postoperative peri-implant tissue loss and to overcome the challenge of soft tissue management during or after surgery. In a flapless procedure, a dental implant is installed through the mucosal tissues without reflecting a flap. More recently, the concept of flapless implant surgery has been introduced for the patients with sufficient keratinized gingival tissue and bone volume in the implant recipient site. When a limited amount of bone is available, a flap elevation can help implant placement to reduce the risk of bone fenestrations or perforations. When placing dental implants, a flap is traditionally elevated to better visualize the implant recipient site, providing that some anatomical landmarks are clearly identified and protected. The supportive institution had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Д¬ompeting interests: The authors have declared that no competing interests exist. Not applicable.ДЇunding: This work was supported by CNPq, Conselho Nacional de Desenvolvimento CientГfico e TecnolГіgico вЂ“ Brazil. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Дata Availability: The authors confirm that all data underlying the findings are fully available without restriction. Received: MaAccepted: Published: June 20, 2014Д¬opyright: В© 2014 Chrcanovic et al. PLoS ONE 9(6):Д®ditor: Michael Glogauer, University of Toronto, Canada No apparent significant effects of flapless technique on the occurrence of postoperative infection (PвЂЉ=вЂЉ0.96 RR 0.96, 95% CI 0.23вЂ“4.03) or on the marginal bone loss ( PвЂЉ=вЂЉ0.16 MD в€’0.07 mm, 95% CI в€’0.16вЂ“0.03) were observed.Д¬itation: Chrcanovic BR, Albrektsson T, Wennerberg A (2014) Flapless versus Conventional Flapped Dental Implant Surgery: A Meta-Analysis. Thus, the results must be interpreted carefully. However, a sensitivity analysis revealed differences when studies of high and low risk of bias were pooled separately. open flap surgery) significantly affect the implant failure rates ( PвЂЉ=вЂЉ0.03), with a RR of 1.75 (95% CI 1.07вЂ“2.86). The test for overall effect showed that the difference between the procedures (flapless vs. The funnel plots indicated absence of publication bias for the three outcomes analyzed.

Sixteen studies were judged to be at high risk of bias, whereas two studies were considered of moderate risk of bias, and five studies of low risk of bias.

The estimates of relative effect were expressed in risk ratio (RR) and mean difference (MD) in millimeters. The inverse variance method was used for random-effects model or fixed-effects model, when indicated. The I 2 statistic was used to express the percentage of the total variation across studies due to heterogeneity. The search strategy resulted in 23 publications. Eligibility criteria included clinical human studies, either randomized or not. An electronic search without time or language restrictions was undertaken in March 2014. The aim of this study was to test the null hypothesis of no difference in the implant failure rates, postoperative infection, and marginal bone loss for patients being rehabilitated by dental implants being inserted by a flapless surgical procedure versus the open flap technique, against the alternative hypothesis of a difference.

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