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

SIMPLE SUMMARY: We describe a minimally invasive technique for optimal preservation of post-extraction tooth socket, prior to implant insertion in over 100 patients (n = 104, with 0.55 sex ratio), with a follow-up period of up to five years. This “open healing” concept is a flapless protocol, using a collagen membrane and a bovine bone substitute that yielded an uneventful healing, with sufficient bone formation, checked periodically after one, two, and five years by calibrated computer tomography. Open-healing protocol led to alveolar ridge and height preservation that contributed to a 98.5% implant survival and 94.8% success rate at five-year follow-up. ABSTRACT: 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 (N(1) = 26), or later stage implant insertion (N(2) = 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 (N(1)) or implant insertion (N(2)). 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.