Comparative evaluation of crestal bone level by flapless and flap techniques for implant placement: Systematic review and meta-analysis

Aim: To compare the crestal bone level of flapless technique of dental implant placement with the flap technique. Setting and Design: This Systematic review and Meta-analysis was conducted according to the Preferred Reporting Items For Systematic Review and Meta-Analyses (PRISMA) Guidelines and registered with PROSPERO. Materials and Methods: Electronic search of Medline and Google scholar databases for articles from 2010 till March 2020 was performed. Studies comparing the crestal bone level with both the techniques were included. After the collection of data, the risk of bias was assessed for each study. Statistical Analysis Used: Meta-analysis was executed using RevMan 5 software version 5.3. Results: 23 studies were included. Statistically significant difference in crestal bone level was found between flapless and flap surgery with mean difference of −0.14 (flapless placement versus flap surgery; 95% CI: −0.24 to −0.03; P = 0.01FNx01). The difference in crestal bone level between the 2 groups was not statistically significant with a mean difference of -0.05(Guided flapless placement versus flap surgery; 95% CI: −0.10 to 0.00; P=0.06). Meta-analysis of the freehand flapless surgery with flap surgery generated a mean difference of −0.20 which was found to be statistically significant (Freehand flapless placement versus flap surgery; 95% CI: −0.37 to −0.03; P=0.02FNx01). Conclusions: Flapless placement of implant can positively influence crestal bone loss in comparison with conventional flap technique.