Minimally Invasive Implant Treatment Using Small Incisions

Flapless implant surgery has gained increasing popularity due to its advantages, including preservation of the periosteal blood supply, minimization of soft and hard tissue trauma, and reduction of patient discomfort. However, conventional flapless techniques are regarded as limited in cases involving narrow alveolar crests or inadequate keratinized tissue, due to restricted visibility and limited access. This case report presents a modified flapless approach that overcomes these challenges through minimally invasive techniques. A 1 mm guide pin was inserted into the alveolar bone to serve as a radiographic and intraoral reference, facilitating accurate angulation and depth control without requiring a surgical stent. At a site with insufficient keratinized gingiva, a small semilunar incision was made slightly lingual to the crest to reposition the soft tissue without flap elevation. Additionally, an implant fixture with variable machined surface lengths was selected to accommodate crestal bone morphology and soft tissue thickness, eliminating the need for bone grafting. At the 4-year and 4-month follow-up, the site exhibited stable crestal bone and firm keratinized gingiva, with no evidence of inflammation. This technique offers a simple and reproducible strategy for extending the indications for flapless implant surgery, even in anatomically compromised patients.