Flapless Immediate Implant Placement in the Esthetic Zone
Video highlights
- Three-year implant survival: 100% in a consecutively enrolled cohort of 100 patients.
- Broader patient inclusion: The study included cases with recession, trauma, and buccal bone defects of up to 13 mm.
- Streamlined clinical workflow: A one-drill protocol, bovine bone substitute, base abutment, and provisional crown were used.
- Key anatomical consideration: Buccal cortical plates thinner than 0.7 mm were associated with a higher risk of incomplete reconstruction at implant shoulder level.
- Radiographic outcome: CBCT evaluation demonstrated an approximately 2 mm hard-tissue crest around the implant.
Overview
Tooth loss in the esthetic zone presents significant clinical challenges, particularly when patients have soft-tissue recession, trauma, or buccal bone defects.
In this video, Edith Groenendijk examines whether flapless immediate implant placement can provide predictable outcomes beyond the ideal clinical situations traditionally described in the literature.
What you will learn
- How flapless immediate implant placement performed in a consecutively enrolled cohort of 100 patients
- Whether the initial buccal bone defect influenced esthetic outcomes
- Which anatomical factors were associated with incomplete bone reconstruction
- How a streamlined one-drill and immediate provisionalization workflow was applied
- What three-year clinical and radiographic follow-up demonstrated
Study overview and findings
The study included 100 consecutive patients without excluding more complex presentations, including soft-tissue recession, trauma, and buccal bone defects. In some cases, the defect measured up to 13 mm after extraction.
White and pink esthetic scores improved at one year and remained stable at the three-year follow-up. The reported implant survival rate was 100% within the study cohort.
The size of the initial buccal bone defect was not found to significantly affect the final esthetic outcome. Buccal bone reconstruction was achieved in the majority of cases.
Clinical considerations
A thin buccal cortical plate, particularly below 0.7 mm, was identified as an important factor associated with incomplete reconstruction at implant shoulder level.
The clinical protocol included a one-drill system, placement of bovine bone substitute, connection of a base abutment, and delivery of a provisional crown. The definitive crown was placed after eight weeks.
CBCT assessment demonstrated the formation of an approximately 2 mm hard-tissue crest around the implant.
Conclusion
The presented findings support flapless immediate implant placement as a predictable treatment option for appropriately selected patients requiring single-tooth replacement in the esthetic zone.
The video also highlights the importance of anatomical assessment, careful case selection, and adherence to the clinical protocol when treating more complex presentations.
References
References
- Groenendijk, E., Staas, T. A., Bronkhorst, E., Raghoebar, G. M., & Meijer, G. J. (2020). Immediate implant placement and provisionalization: Aesthetic outcome 1 year after implant placement. A prospective clinical multicenter study. Clinical Implant Dentistry and Related Research, 22(2), 193-200.
- Staas, T. A., Groenendijk, E., Bronkhorst, E., Verhamme, L., Raghoebar, G. M., & Meijer, G. J. (2022). Does initial buccal crest thickness affect final buccal crest thickness after flapless immediate implant placement and provisionalization: A prospective cone beam computed tomogram cohort study. Clinical Implant Dentistry and Related Research, 24(1), 24-33.
- Groenendijk, E., Staas, T. A., Bronkhorst, E. M., Raghoebar, G. M., & Meijer, G. J. (2023). Factors Associated with Esthetic Outcomes of Flapless Immediate Placed and Loaded Implants in the Maxillary Incisor Region—Three-Year Results of a Prospective Case Series. Journal of Clinical Medicine, 12(7), 2625.
- Groenendijk, E., Bronkhorst, E. M., & Meijer, G. J. (2021). Does the pre-operative buccal soft tissue level at teeth or gingival phenotype dictate the aesthetic outcome after flapless immediate implant placement and provisionalization? Analysis of a prospective clinical case series. International Journal of Implant Dentistry, 7(1), 84.
