**6.3 Half punch**

• Very predictable results

• Requires good pedicel length

**6. Flap for dental implant bed preparation**

and shows better aesthetic results [16].

• Minimal postoperative pain/discomfort

• Suitable for one-stage surgery

Two-stage flap techniques are commonly used for dental implant surgery and include a flapless (e.g., Punch or Half Punch) flap and full-thickness flap, such as mid-crest, double papilla preservation flap. Full-thickness flap might be more suitable for immediate implantation; the flapless flap is superior to full-thickness flap in cases of less inflammation and less morbidity, has shallower biological width,

A small hole in the keratinized mucosa is required to be present on the crest of

the ridge at the area of interest (**Figure 14**). This punch can be created using a blade or punch drill. Precise placement of the cut can be obtained using the

surgical guide with the help of the planning software (**Figure 15**).

• Two-stage surgery

• A free graft is required

Limitations

**Figure 14.**

*Oral Diseases*

**6.1 Background**

**6.2 Punch flap**

Advantages

**210**

• Minimal surgery

• Can be used if minimal keratinized tissue is present

*Free gingival graft is applied to cover the root surface with less amount of attached gingiva.*

In the case of the presence of inadequate or deficient buccal tissues, half punch approach is used. Half punch flap is conducted with horizontal crestal incision and reflects full-thickness flap buccally. Subsequently, punch approach is used lingually or palatally to remove minimally required tissues for implant placement (**Figure 16**).

**Figure 15.** *Punch flap (flapless) at mid-crest of ridge.*

**Figure 16.** *Half punch flap used for implant bed preparation.*

Advantage

• One-stage implant surgery with possible simultaneous bone grafting
