Suture-free flap closure: less keratinised mucosa lost at 6 months

Closing the flap around a freshly placed implant is one of the most repetitive gestures in implant surgery, and one of the least questioned. Sutures hold the tissue, but they take time, and the way the flap is stabilised may influence how much keratinised mucosa survives healing. This randomised controlled trial from Yonsei University, with co-authors from the University of Zurich, asked whether a suture-free alternative — a healing abutment attachment (HAA) that stabilises the flap directly on the healing abutment — changes peri-implant soft-tissue dimensions compared with conventional suturing.

Thirty patients receiving implants in posterior maxillary and mandibular sites were randomly allocated to the HAA group (15 patients, 20 implants) or the suture group (15 patients, 15 implants). The investigators recorded keratinised tissue width (KTW), buccal supracrestal tissue height (STH) and the time needed to stabilise the flap, during surgery and over a 6-month follow-up.

Keratinised tissue shrank in both groups, but less with the attachment: at implant level, KTW decreased by 0.46 ± 0.71 mm in the HAA group versus 1.23 ± 0.95 mm with sutures, a statistically significant difference. Supracrestal tissue height increased in both groups over six months, more in the HAA group (0.95 ± 0.47 mm vs 0.59 ± 0.67 mm; p < 0.05). Flap stabilisation took about 44 seconds with the attachment versus nearly 200 seconds with sutures.

The clinical message is practical and modest in scale. In this small sample, at six months, suture-free closure saved chair time and preserved on average roughly three quarters of a millimetre more buccal keratinised mucosa. That margin matters most where the keratinised band is already borderline. The limits are equally clear: 30 patients, posterior sites only, unequal implant numbers per arm, and a follow-up that says nothing about long-term stability, marginal bone or peri-implant health. The device is a technical refinement worth watching, not yet a new standard.