Microbial Air Analysis in Implant Dentistry: Open Flap vs. Flapless Approach

Abstract

Aerosol-generating procedures in dentistry pose a significant risk of airborne microbial contamination, yet evidence quantifying bioaerosol generation during implant placement—particularly comparing open flap and flapless techniques—has been lacking. In this observational study of 20 healthy patients receiving a single mandibular molar implant (10 via open flap, 10 via flapless), passive air sampling was performed with blood agar settle plates positioned centrally, near the operator, and near the assistant; CFU/dm²/hr was calculated post-incubation, and isolates were identified using API Staph and API 20 Strep biochemical tests. Statistical analysis (Wilcoxon rank-sum, Mann-Whitney U, Friedman, and Spearman’s correlation; p < 0.05) demonstrated a significant increase in airborne microbial load during procedures (operator and assistant zones) compared to baseline (p < 0.001), but no difference between those zones (p = 0.845) or between surgical techniques at any location. Both groups, however, exhibited significant intra-procedural increases in CFU counts (p < 0.01), with predominant isolates including Micrococcus sp., Staphylococcus capitis, Streptococcus sp., and Staphylococcus epidermidis. These findings indicate that dental implant placement moderately but significantly elevates airborne microbial contamination regardless of flap design, underscoring the importance of stringent infection control measures and supporting passive air sampling with the IMA standard as reliable methods for evaluating and managing operatory biosafety in implantology.