Clinical efficacy of dental implants placement without flap elevation: a systematic review and meta-analysis comparing immediate and early loading protocols

To systematically review and meta-analyze randomized controlled trials (RCTs) comparing the clinical outcomes of immediate loading (IL) versus early loading (EL) in flapless dental implant placement. This systematic review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and was registered with the Open Science Framework. RCTs involving partially or fully edentulous patients receiving flapless implant placement with IL or EL protocols were included. The primary outcome was implant survival. The secondary outcomes included marginal bone loss (MBL), complications, and patient satisfaction. Meta-analysis was conducted using RevMan 5.4.1. Eight RCTs comprising 360 patients and 450 implants met the inclusion criteria. The meta-analysis showed no significant differences between IL and EL groups in terms of implant survival, peri-implantitis, soft tissue ulcers, or marginal bone loss (MD: 0.02 mm; 95% CI: −0.11 to 0.15; p=0.75). On the other hand, the ISQ values favored EL slightly (MD: −0.42; 95% CI: −0.83 to −0.01; p=0.05). Patient satisfaction tended to favor IL, but the preference was not statistically significant (OR: 3.71; 95% CI: 0.73 to 18.85; p=0.11). No meaningful heterogeneity was observed for most outcomes. Flapless dental implant placement using either IL or EL protocols results in comparable clinical and radiographic outcomes. IL appears to offer greater patient satisfaction without compromising implant success, supporting its use in appropriately selected cases. Further multicenter studies with a long-term follow-up will be needed to validate these findings across diverse populations.