Advantage of two stage surgery are all the great things listed by other clinicians here and if you are less experienced ,then please do two stage with cover screw until you are more comfortable. However, another very important factor is to always look at your soft tissue health in terms of how much keratinized tissue you have, especially on the facial/ buccal side of your fixture. We know , for better successes , several years after, we need more keratinzed tissue on facial / bucal side of your fixture , so when you place a healing cap/cuff/ abutment/collar, you eliminate the chance of creating a thicker facial keratinized profile for you fixture
Two stage allows you to expose the fixture more palatally or lingually and then you can move your flap more facial to the new taller healing cap during stage 2 recovery. Therefore you have just found a method of creating more keratinized attached tissue around your fixture on the buccal aspect. So please don't tissue punch everything! That tissue punch saves you two minutess but feeds your suction tip, vital soft tissue that will prevent the threads of your implant from showing in 5-10 years or sooner.
Only tissue punch on sites where you have abundant pink keratinized zone.
I usually do one stage on slam dunk predictable sites , healthy patients ,lots of bone, and and when I have enough attached tissue w/ good primary stability .......but for onlay / veneer grafts around fixtures , vertical/ crestal or lateral sinus lifts and cases where I need primary closure ,like immediate placements w/ grafts , or to bulk gingival tissue on facial later on , or D4 and some D3 patients where if you over-prep your osteotomy and get less then optimum primary stability ,medically compromised cases, smokers ,diabetics ,I do stage two recovery with a cover screw.
Great site , first time responder!!
Matt Helm DDS
5/27/2018
Great comment Gangji. I agree on just about everything, as I am also generally against the tissue punch. Experience has shown that generally, besides allowing the manipulation of tissue (as you said with a bit more lingually-placed incision), the uncovering incision generates tighter, more predictable and more keratinized tissue around the collar of the healing abutment. And of course the tighter the tissue is around the abutment, the better in the long term.