Open Healing: A Minimally Invasive Protocol with Flapless Ridge Preservation in Implant Patients

We aimed to validate the safety and efficacy of the minimally invasive "open healing" flapless technique for post-extraction socket and alveolar ridge preservation, while assessing the alveolar bone changes. The study enrolled (n = 104) patients (0.55 sex ratio), with atraumatic extraction of (N = 135) hopeless teeth, followed by either immediate placement of tissue level implants (N₁ = 26), or later stage implant insertion (N₂ = 109). No flap was raised in either situation. Post-extraction sockets were filled with deproteinized bovine bone granules and covered by collagen resorbable membrane-left purposely exposed during healing. This yielded an uneventful healing, with sufficient bone formation, while avoiding soft-tissue problems. The need for additional augmentation was assessed clinically and by calibrated CBCT scans at six months, before either loading (N₁) or implant insertion (N₂). Implant success and survival rate were evaluated at 12-, 24-, and 60-month follow-up control sessions. The inserted implants had a survival rate of 98.5% and a success rate of 94.8% at five-year follow-up. Open healing technique with flapless approach can be favorable for preserving the 3D architecture of the post-extraction socket, as well as the alveolar ridge width and height.