Objective: This clinical case report aims to demonstrate a successful treatment using an alternative technique for flapless immediate implant placement by letting the xenogeneic bone graft exposed to the oral environment. Case report: A flapless immediate implant placement into the fresh mandibular first molar socket was done. The alveolar gap was filled by deproteinized bovine bone mineral (DBBM) up to the level of the gingival margin, and the biomaterial was intentionally left exposed and maintained only by the cover screw. A definitive restoration was placed six months after the implant insertion. This patient exhibited no clinical or radiologic complications throughout the six-year follow-up period. Conclusion: The DBBM exposed to the oral environment showed stability and caused no sign of infection and clinical complications. Throughout the follow-up time, the patient presented a favorable peri-implant phenotype, with a wide keratinized mucosa width, stable peri-implant buccal bone, as well as the maintenance of crestal bone. Although the exposed biomaterial may be more susceptible to displacement, this approach showed satisfactory performance regarding uneventful healing, esthetics, and function, in a six-year follow-up. However, randomized clinical trials to evaluate the clinical predictability and soft and hard tissues healing profile are needed.
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