Marginal bone preservation is an important determinant of long-term implant success. Conventional flap implant placement provides direct visualization of the surgical site but may disturb the periosteal blood supply and contribute to early crestal bone remodeling.

Flapless guided implant placement is a minimally invasive approach that aims to preserve soft tissue architecture and vascular integrity. CBCT allows three-dimensional evaluation of peri implant bone levels, including mesial, distal, buccal, and lingual aspects.

Aim: The aim of this study was to compare flapless guided implant placement with conventional flap implant placement in terms of marginal bone loss, implant stability, postoperative pain, and soft-tissue healing.

Inclusion Criteria:

• Patients aged 20 years or older.
• Patients requiring at least two dental implants within the same arch.
• Patients with good general health and able to undergo oral surgery.
• Patients willing to participate in the study and provide informed consent.
• Patients with adequate bone volume for implant placement as determined by preoperative radiographic assessment (e.g., cone beam computed tomography).

Exclusion criteria:

• Patients with systemic diseases that could compromise healing or implant success (e.g., uncontrolled diabetes, immunocompromised conditions).
• Patients with a history of radiation therapy to the head and neck region.
• Patients with active periodontal disease or untreated oral infections.
• Patients who are pregnant or breastfeeding.
• Patients with a history of bisphosphonate therapy or other medications that may affect bone metabolism.
• Smoker Patients with a history of smoking or heavy alcohol consumption.
• Patients with unrealistic expectations or inability to comply with postoperative care instructions.
• Patients with significant facial trauma or anatomical deformities affecting the implant site.
• Patient who requires Immediate implant placement
• Thin gingival biotype