Is flapless implant placement really a solid technique? What percentage of cases are amenable to flapless implant placement?

The cynic in me wondered if this is indeed a novel technique, or was it made mainstream to attract Dentists who seldom raise flaps?

I brought on straight-talking Implant genius Dr. Pav Khaira on today's Group Function to discuss flapless implant placement - 'what's the deal?!'

https://youtu.be/679HAttBQ1c

Check out this full episode on YouTube

Need to Read it? Check out the Full Episode Transcript below!

Highlights of this episode:

4:36 The Rise of Flapless Implants7:04 Indications for Flapless implants9:43 Immediate implant placement13:59 Advice to Young Dentists considering implants18:56 Implant Mentorship24:11 Dr. Pav’s Implantology Course27:46 From Course to Implementation

Check out The Dental Implant Podcast for information on dental implants and the Academy of Implant Excellence to learn how to place implants or upgrade your skills.

If you enjoyed this episode, you will also like 'Can I Probe This Implant?'

Click below for full episode transcript:

Opening Snippet: You pay to learn in one fashion or another. This is something I've said before, right? Is you either pay your mentor to show you how to do it. And when you do it that way, you'll avoid most of the pitfalls, okay? Or you don't pay your mentor you have things go wrong and then you've got to pay out of your own pocket. Of those two scenarios one leads to a happy patient and another one leads to an unhappy patient.

Jaz's Introduction:Are flapless implants a thing or are they a fad? I feel like there is a lure of some courses that want to attract the inexperienced GDP who perhaps is afraid of surgery or averse to surgery who can't raise a flap and they thought you know what, if we start teaching a guided system that doesn't involve flaps and maybe the dentist will come and learn implants and place our implants so that is the cynic in me thinking that but I got on the main man who knows everything about implants Dr. Pav Khaira on today on this group function about IS THERE A PLACE FOR FLAPLESS IMPLANTS? And of course from that we go into different directions in terms of okay, when is it suitable? When is it contraindicated? What are the problems? And how we can learn more and get into this field of implantology. If you are a novice if you are someone who's thinking about it, but you're afraid to make that next commitment. How does one get into the field of implants are huge daily topic for young dentists.

Main Episode:So let's join this group function with Dr. Pav Khaira. Dr. Pav Khaira back again for the third time from the dental implant podcast. How are you, my friend?

[Pav]I'm very good, how you doing?

[Jaz]Amazing. And last few times you came on you really busted some myths and you helped us to understand some basic things. Can we probe implants? What happens when an implant is bleeding? The soft tissues are bleeding. How can you tell if you're too worried or not? So you cover these really fundamental topics. And you guys if you haven't listened to ready, listen to those. And of course we had you on for finding your niche in dentistry. So you've done some pretty big topics. And when this topic came along about flapless implants, which what we're talking about today, and I can't wait to dig into that. But just for those people who haven't listened to that those episodes yet, and I will urge them to check out those episodes right now, those watching on YouTube, the thumbnails be flying up, you need to listen to those previous episodes to really appreciate all the wonderful things we've covered so far. But just tell them about your week to week, day to day dentistry that you're passionate about.

[Pav]Jaz, firstly, thank you for having me back again. Secondly, all I do is place implants. That's it, I don't do anything else. So what's the best way to frame it as an average implantologist and average busy implantologist that quite happy to place 200 implants per year, I'm very fortunate to be in a position where I'm placing about 1800 to 2000 implants per year. So you know, my, in the last few years, you know, my experience is going up significantly. And I say that from a point of being humbled because I thought I knew what I was doing to start with. And then you start placing that volume of implants. And it's just like, whoa, actually, this is different game. You got to relearn your skill set. So-

[Jaz]I see the crazy and amazing you know, life-changing transformation that you do on our telegram group, you know, so good at posting notes and the radiograph before and after. And so if you're a little bit of burst of blood, you probably don't look at those posts from Pav. But then he'll show you anatomy that you never knew existed. He'll show you what the pterygoid plate looks like. He will tell you all these cool stuff. But with the basic stuff as well, which you cover so well. So it's been great on the telegram group to see your cases.

[Pav]Yeah, I mean, you've seen some of my zygomatic implant cases, you've seen some other cases where, you know, patients been in dentures for 40 years, there's no bone left or have to think outside of the box a little bit. And we showed you that case where you know, the mandible had atrophied where it was only 11 millimeters in height, and we were placing 10-millimeter implants. So yeah, I get to see some crazy stuff now. And again, it's just transforming people's lives. It's just, you can't put a finger on it. It's just amazing. It's fantastic.

[Jaz]I can see that in the in the postdoc portrait photos in the eyes of the patients, the kind of work you do is very transformational. So it's great to do any part of that and to see that, and today we're covering flapless implant courses and just technique of flapless and the position I come from Pav is as a position of being a cynic, in the sense that a few years ago, I started noticing all these like pop up courses, now I don't place implants, right? But I'm very keen restorative dentist. So I refer out to colleagues who do place implants, but I did see a surge in courses saying, 'Hey, you don't even need to be able to raise flaps to base implants, flapless implants.' And I'm thinking, my worry Pav was, are these courses being set up because they recognize that dentists who don't raise flaps who can't raise flaps, this will be an easy lure to get them in to implants. Is that what it was? Or is flapless a valid technique? And that's a big level question. You're probably going to break it down which you're very good at doing, but that's the position I'm coming from. Is it a fad or is it a thing?

[Pav]So let me spin this question around for you. So if something sounds too good to be true, is normally too good to be true, right? So there is a position for flapless implants, here's the key in the correct circumstance, they're fantastic. Okay? There are a number of courses available now where it's very much, as you said, you don't have to be able to raise a flap, we will do it guided, we will plan it for you, all you have to do is a tissue punch, and then you use the guidance system. And then you place the implant, that's it. Jaz it' really not as simple as that, right? You need, you need a certain amount of bone volume around implants, you need a certain amount of soft tissue around implants, not only do you need a certain volume of soft tissue, you need a certain quality of soft tissue as well. And if you're doing flapless, you may end up having just enough soft tissue, and then you do a tissue punch, and all of a sudden, it's gone. So what do you do, then, because you're immediately on the backfoot, with this case, this case is likely to start sliding backwards really quite quickly. And here's the other thing, as well as what do you do if the guide doesn't fit? You know? There's a say, when you get into that implant ecosystem, when you get into that implantology world, once you start doing a number of cases, everybody says the same thing. Guided surgery is great. Okay, it's really, really good. It's got a great position in implantology. But you should not be using guides unless you can place freehand. Because your guide doesn't fit, you're then relying on this, what's in between your ears, and you're relying on your hands.

[Jaz]I see as a non-placing dentist, I didn't even occur to me that you know, you can put in there just like obviously, it's acrylic and whatnot. So there's a good chance it might not fit or chance that the measurements are skewed or whatnot. And so it makes sense to me now thinking as a restorative dentist, but you're right, if that doesn't fit, then your whole plan is gone. And therefore we need to be able to pivot onto a Plan B or Plan C, which is where I guess you need to have the knowledge and skills beyond just as one way of doing it. So I guess my next question is, what percentage of implants do you place that are flapless? And maybe because you're different, I don't know, what percentage of implants do you think are amenable to flapless technique?

[Pav]I'd say about 10%, which is quite low. And the reason for that is quite simple. There's really good data nowadays, that you need a good band of keratinized tissue around implants. But in addition to the good band of keratinized tissue, it needs to be about two to two and a half millimeters thick. And in a lot of areas, particularly in the mandible, that isn't enough soft tissue height. In order to achieve that two to two and a half millimeters, okay, then it goes back to what we were saying a few minutes ago, if you do a tissue punch, whatever was there all of a sudden you've gotten rid of. So when you don't have enough tissue, there are a number of tricks that you can use to increase the thickness of the tissue. But you can't do that with guided surgery. Now,