ABSTRACT
Today, one of the most challenging aspects of esthetic implant modalities is to obtain a predictable pen-implant papilla in the esthetic zone starting with the facts about the morphology of periimplant tissues, to various parameters influencing papilla reconstruction around implants. This prospective study investigates the interproximal alveolar crestal bone loss occurring after placement of mandibular single posterior implant using two different flap designs. Ten patients were included in this study [6 females and 4 males] with missing posterior mandibular teeth, their age ranged between twenty to forty years. The designed flap was performed with a conventional wide type flap on the distal side of the implant and records obtained from this side were referred to as group I, while the mesial side of the same implant was performed with a limited or a papillary preserved flap and records obtained from this side were referred to as group II. Each patient was evaluated clinically and radiographically at immediate, 1.5, 3 and 6 months post-operatively. There was high rate of crestal bone loss in group one with widely mobilized flap compared with that in group two of limited flap design through out the follow up periods. The use of a limited flap design [papillary preserved flap] for single-tooth implants is indicated to avoid possible loss of interdental papillae and to minimize interproximal crestal bone loss with subsequent implant exposure. During application of the conventional flap, it is better to insert the implant 1mm beneath the cortex by about to compensate the amount of bone loss during healing stage