Immediate implant placement and provisionalization in the aesthetic zone using a flapless or a flap‐involving approach: a randomized controlled trial

Aim We conducted a randomized controlled trial to compare the effect of flapless ( FLS ) or flap‐involving (F) immediate placement and provisionalization of single‐tooth implants in the aesthetic zone. Materials and Methods Thirty‐nine patients were randomized following extraction of a non‐restorable tooth to a FLS or F group. All implants were immediately placed and provisionalized. We monitored prospectively changes in the peri‐implant mucosal margin, the interproximal bone and buccal horizontal ridge at 3, 6 and 12 months. Results At 3 months post‐surgery, the mean ±  SD [median (interquartile range)] mesiobuccal peri‐implant gingival margin recession from the pre‐surgical soft tissue position amounted to 0.11 ± 0.32 mm [0 (0, 0.5)] in the FLS treatment arm versus 0.43 ± 37 mm [0.5 (0, 0.5)] in the F treatment arm ( p  = 0.02); corresponding values at the distobuccal surface were 0.11 ± 32 mm [0 (0, 0)] in the FLS arm versus 0.48 ± 0.44 mm [0.5 (0, 1)] in the F arm ( p  = 0.01). No other significant differences in soft or hard tissue remodelling between the treatment arms were observed at 3, 6 or 12 months. Conclusions Flapless and a flap‐involving immediate implant placement and provisionalization in the aesthetic zone resulted in comparable remodelling of the peri‐implant mucosa, interproximal bone and buccal ridge at 6 and 12 months.