Flapless immediate implant placement and provisionalisation (FIIPP) using a palatal implant position (≥ 2 mm): A prospective multicentre CBCT study with a 3-year follow-up.

Purpose: To radiographically assess buccal crest thickness and buccal crest height for 3 years following flapless immediate implant placement and provisionalisation while maintaining a minimum implant-buccal crest distance of 2 mm, the so-called buccal gap.

Materials and methods: In this prospective multicentre CBCT study, patients with a single failing maxillary incisor were enrolled. Across six centres, 100 consecutive patients underwent flapless immediate implant placement and provisionalisation. The buccal gap was grafted with a bovine-derived bone substitute. CBCT scans were obtained preoperatively, immediately postoperatively, and after 1 and 3 years.

Results: Complete CBCT datasets were available for 71 patients. Mean buccal crest thickness increased from 0.56 mm preoperatively to 3.30 mm postoperatively, before decreasing to 2.47 mm at 1 year and 2.29 mm at 3 years. Similarly, the mean buccal crest height increased from 0.91 mm preoperatively to 3.12 mm postoperatively, then decreased to 1.86 mm at 1 year and 1.54 mm at 3 years. Multivariable regression analysis revealed a positive correlation between pink aesthetic scores and buccal crest thickness/height at 3 years. Additionally, implant site location emerged as the strongest predictor of outcomes for buccal crest thickness and height, with central incisor sites demonstrating significantly greater buccal crest thickness/height at 3 years compared to lateral incisor sites (effect 1.43 mm, P 0.001).

Conclusion: The flapless immediate implant placement and provisionalisation approach provides long-term stability for the buccal crest, supporting peri-implant soft tissues and yielding high aesthetic outcomes, with a mean pink aesthetic score of 12.1 after 3 years. Palatal implant positioning appears to be a key determinant of successful outcomes with this approach.