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Tissue Healing Around Dental Implants With Marginal Bone Defects With and Without Flap Elevation: An Experimental Study in Dogs.

The technique of immediate implant placement after extraction has been conceived for preserving residual bone support and soft tissue morphology. Today, this procedure is still unpredictable and presents inconveniences for both the patient and the dentist. Therefore, the healing process around a dental implant placed into an extraction socket needs to be deeply investigated to increase the predictability of this surgical approach. The aim of the present investigation was to evaluate the healing of bone defects (fresh extraction sockets) after implant installation with flap elevation, and primary closure compared with implant installation without flap elevation. This study use histologic and histomorphometric analyses to evaluate tissue healing around dental implants with marginal bone defects with and without flap elevation 1 week, 4 weeks, and 12 weeks after implantation in the dogs. The main qualitative findings showed that after 1 week of implantation almost no bone repair was observed, and there was no significant difference between the 2 groups in terms of bone-healing performance, inflammatory infiltrates (slight to moderate grade), and bone resorption (moderate to marked grade) limited to the coronal portion of the implanted sites. The 2 groups with or without flap elevation behaved similarly at this point of implantation. Under the experimental conditions of this study, no biological differences were observed between the 2 groups with and without flap elevation in terms of crestal bone repair, inflammation, marginal bone loss, and soft tissue downgrowth. The qualitative differences observed might be imputable to fortuitous events. The histomorphometric measurements confirmed the qualitative trends observed. The limitations of this study, as with all animal studies, are its translational aspects. Investigation of the same topic in a human population by setting up a controlled, randomized, prospective trial including a sufficient amount of patients investigated according to the split-mouth method would be beneficial.